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Physician reimbursement

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https://www.readbyqxmd.com/read/28730640/2016-updated-thai-rheumatism-association-recommendations-for-the-use-of-biologic-and-targeted-synthetic-disease-modifying-anti-rheumatic-drugs-in-patients-with-rheumatoid-arthritis
#1
Worawit Louthrenoo, Nuntana Kasitanon, Wanruchada Katchamart, Duangkamol Aiewruengsurat, Parawee Chevaisrakul, Praveena Chiowchanwisawakit, Pornchai Dechanuwong, Punchong Hanvivadhanakul, Ajanee Mahakkanukrauh, Siriporn Manavathongchai, Chayawee Muangchan, Pongthorn Narongroeknawin, Veerapong Phumethum, Boonjing Siripaitoon, Anawat Suesuwan, Siraphop Suwannaroj, Parichat Uea-Areewongsa, Sittichai Ukritchon, Paijit Asavatanabodee, Ajchara Koolvisoot, Ratanavadee Nanagara, Kitti Totemchokchyakarn, Kanokrut Nuntirooj, Tasanee Kitumnuaypong
AIM: In June 2015, the Thai Rheumatism Association (TRA) approved an update of its recommendation for the use of biologic disease-modifying anti-rheumatic drugs (bDMARDs) and targeted synthetic (tsDMARD) in the treatment of rheumatoid arthritis (RA) to cover those currently available in Thailand (etanercept, infliximab, golimumab, rituximab, tocilizumab, abatacept and tofacitinib). METHOD: A search of the literature was performed between January 2000 and June 2015...
July 21, 2017: International Journal of Rheumatic Diseases
https://www.readbyqxmd.com/read/28716650/the-use-of-prostate-specific-antigen-screening-in-purchased-versus-direct-care-settings-data-from-the-tricare-military-database
#2
Alexander P Cole, Wei Jiang, Stuart R Lipsitz, Peter A Learn, Maxine Sun, Toni K Choueiri, Paul L Nguyen, Adam S Kibel, Mani Menon, Jesse D Sammon, Tracey Koehlmoos, Adil Haider, Quoc-Dien Trinh
PURPOSE: Fee for service (FFS) reimbursement incentives may affect care. We sought to compare odds of PSA screening among former and active duty United States (US) military service members based on receipt of primary care from integrated military health facilities versus community providers reimbursed via FFS. MATERIALS AND METHODS: We performed a retrospective study of all active duty and retired male service members (40-64) covered by the TRICARE military health benefit in 2010...
July 14, 2017: Journal of Urology
https://www.readbyqxmd.com/read/28713176/in-the-shadow-of-a-giant-medicare-s-influence-on-private-physician-payments
#3
Jeffrey Clemens, Joshua D Gottlieb
We analyze Medicare's influence on private insurers' payments for physicians' services. Using a large administrative change in reimbursements for surgical versus medical care, we find that private prices follow Medicare's lead. A $1.00 increase in Medicare's fees increases corresponding private prices by $1.16. A second set of Medicare fee changes, which generates area-specific payment shocks, has a similar effect on private reimbursements. Medicare's influence is strongest in areas with concentrated insurers and competitive physician markets, consistent with insurer-doctor bargaining...
February 2017: Journal of Political Economy
https://www.readbyqxmd.com/read/28707258/-connecting-the-dots-a-qualitative-study-of-home-health-nurse-perspectives-on-coordinating-care-for-recently-discharged-patients
#4
Christine D Jones, Jacqueline Jones, Angela Richard, Kathryn Bowles, Dana Lahoff, Rebecca S Boxer, Frederick A Masoudi, Eric A Coleman, Heidi L Wald
BACKGROUND: In 2012, nearly one-third of adults 65 years or older with Medicare discharged to home after hospitalization were referred for home health care (HHC) services. Care coordination between the hospital and HHC is frequently inadequate and may contribute to medication errors and readmissions. Insights from HHC nurses could inform improvements to care coordination. OBJECTIVE: To describe HHC nurse perspectives about challenges and solutions to coordinating care for recently discharged patients...
July 13, 2017: Journal of General Internal Medicine
https://www.readbyqxmd.com/read/28692718/physician-reimbursement-in-medicare-advantage-compared-with-traditional-medicare-and-commercial-health-insurance
#5
Erin Trish, Paul Ginsburg, Laura Gascue, Geoffrey Joyce
Importance: Nearly one-third of Medicare beneficiaries are enrolled in a Medicare Advantage (MA) plan, yet little is known about the prices that MA plans pay for physician services. Medicare Advantage insurers typically also sell commercial plans, and the extent to which MA physician reimbursement reflects traditional Medicare (TM) rates vs negotiated commercial prices is unclear. Objective: To compare prices paid for physician and other health care services in MA, traditional Medicare, and commercial plans...
July 10, 2017: JAMA Internal Medicine
https://www.readbyqxmd.com/read/28692717/medicare-advantage-reimbursement-to-physicians
#6
James C Robinson
No abstract text is available yet for this article.
July 10, 2017: JAMA Internal Medicine
https://www.readbyqxmd.com/read/28690658/influence-of-the-angelina-jolie-announcement-and-insurance-reimbursement-on-practice-patterns-for-hereditary-breast-cancer
#7
Jihyoun Lee, Sungwon Kim, Eunyoung Kang, Suyeon Park, Zisun Kim, Min Hyuk Lee
Lack of awareness, the stigma of carrying a genetic mutation, and economic factors are barriers to acceptance of BRCA genetic testing or appropriate risk management. We aimed to investigate the influence of Angelina Jolie's announcement of her medical experience and also health insurance reimbursement for BRCA gene testing on practice patterns for hereditary breast and ovarian cancer (HBOC). A survey regarding changes in practice patterns for HBOC before and after the announcement was conducted online. The rate of BRCA gene testing was obtained from the National Health Insurance Review and Assessment Service database...
June 2017: Journal of Breast Cancer
https://www.readbyqxmd.com/read/28689572/integrating-quality-palliative-and-end-of-life-care-into-the-geriatric-assessment-opportunities-and-challenges
#8
REVIEW
Daniel Swagerty
This article provides an overview of how integrating quality palliative and end-of-life care into geriatric assessment can be a tremendous benefit to older adult patients and their families. Although the quality of palliative and end-of-life care for older adults has improved greatly, there are still many opportunities to improve the quality of life and function for older adult patients in the last few years of their life. More clinical expertise in comprehensive palliative and end-of-life care must be developed and maintained...
August 2017: Clinics in Geriatric Medicine
https://www.readbyqxmd.com/read/28685509/stepwise-approach-to-problematic-hypoglycemia-in-korea-educational-technological-and-transplant-interventions
#9
REVIEW
Sang Man Jin
Impaired awareness of hypoglycemia has been found to be prevalent in 20% to 40% of people with type 1 diabetes. If a similar prevalence exists in Koreans with type 1 diabetes, at a minimum, thousands of people with type 1 diabetes suffer at least one unpredicted episode of severe hypoglycemia per year in Korea. For patients with problematic hypoglycemia, an evidence-based stepwise approach was suggested in 2015. The first step is structured education regarding multiple daily injections of an insulin analog, and the second step is adding a technological intervention, such as continuous subcutaneous insulin infusion or real-time continuous glucose monitoring...
June 2017: Endocrinology and Metabolism
https://www.readbyqxmd.com/read/28682298/wound-care-centers-critical-thinking-and-treatment-strategies-for-wounds
#10
Jean de Leon, Gregory A Bohn, Lawrence DiDomenico, Regina Fearmonti, H David Gottlieb, Katherine Lincoln, Jayesh B Shah, Mark Shaw, Horatio S Taveau Iv, Kerry Thibodeaux, John D Thomas, Terry A Treadwell
Many wound care centers (WCCs) provide a specialized level of care using various wound care therapies and are managed by quali ed healthcare professionals (QHPs) from di erent specialty backgrounds such as family medicine, podiatry, and plastic surgery. However, these QHPs are sometimes challenged by reimbursement issues, limited therapy and dressing options, reduced access to multidisciplinary team members, and cost-driven factors unique to WCCs. To help address these issues, a meeting was convened by an expert panel of WCC physicians to discuss best practices for treating complex patients in a WCC...
October 2016: Wounds: a Compendium of Clinical Research and Practice
https://www.readbyqxmd.com/read/28679019/adequately-addressing-pediatric-obesity-challenges-faced-by-primary-care-providers
#11
Marilou Shreve, Allison Scott, Kelly Vowell Johnson
OBJECTIVE: To assess the challenges primary care providers encounter when providing counseling for pediatric patients identified as obese. METHODS: A survey assessed the current challenges and barriers to the screening and treatment of pediatric obesity for providers in northwest Arkansas who provide care to families. The survey consisted of 15 Likert scale questions and 4 open-ended questions. RESULTS: Time, resources, comfort, and cultural issues were reported by providers as the biggest barriers in screening and the treatment of pediatric obesity...
July 2017: Southern Medical Journal
https://www.readbyqxmd.com/read/28667654/idiopathic-pulmonary-fibrosis-ipf-common-practice-in-poland-before-the-antifibrotic-drugs-era
#12
Wojciech Jerzy Piotrowski, Magdalena M Martusewicz-Boros, Adam J Białas, Katarzyna Lewandowska
INTRODUCTION: Idiopathic pulmonary fibrosis (IPF) is a chronic, progressive and debilitating lung disease with a median survival time of 3-5 years. For now, pirfenidone (PIR) and nintedanib (NTB) are the only drugs that can slow down the disease's progression. In Poland, these drugs, although registered for legal use, had not been reimbursed for IPF patients until the end of the year 2016. Aim of the study was to assess what was common practice in terms of diagnosis and treatment in the period before antifibrotic drugs became available for IPF patients in Poland...
2017: Advances in Respiratory Medicine
https://www.readbyqxmd.com/read/28664439/sages-quality-initiative-an-introduction
#13
Anne Lidor, Dana Telem, Curtis Bower, Prashant Sinha, Rocco Orlando, John Romanelli
The Medicare program has transitioned to paying healthcare providers based on the quality of care delivered, not on the quantity. In May 2015, SAGES held its first ever Quality Summit. The goal of this meeting was to provide us with the information necessary to put together a strategic plan for our Society over the next 3-5 years, and to participate actively on a national level to help develop valid measures of quality of surgery. The transition to value-based medicine requires that providers are now measured and reimbursed based on the quality of services they provide rather than the quantity of patients in their care...
August 2017: Surgical Endoscopy
https://www.readbyqxmd.com/read/28664361/documentation-coding-and-billing-what-abdominal-radiologists-need-to-know
#14
REVIEW
Andrew B Rosenkrantz, Andrew J Degnan, Richard Duszak
This article reviews basic concepts of report documentation for abdominal imaging examinations, focusing on practical elements for ensuring appropriate physician reimbursement. Nuances of abdominal radiography, CT, MRI, and ultrasonography codes are highlighted. Special considerations for the coding of 3D-rendering and contrast administration are also described. Greater abdominal radiologist awareness of these codes and their reporting requirements can help ensure proper documentation within radiology reports, thereby optimizing legitimate reimbursement...
June 29, 2017: Abdominal Radiology
https://www.readbyqxmd.com/read/28655476/quality-measures-in-orthopaedic-sports-medicine-a%C3%A2-systematic-review
#15
REVIEW
Geoffrey D Abrams, Daniel R Greenberg, Jason L Dragoo, Marc R Safran, Robin N Kamal
PURPOSE: To report the current quality measures that are applicable to orthopaedic sports medicine physicians. METHODS: Six databases were searched with a customized search term to identify quality measures relevant to orthopaedic sports medicine surgeons: MEDLINE/PubMed, EMBASE, the National Quality Forum (NQF) Quality Positioning System (QPS), the Agency for Healthcare Research and Quality (AHRQ) National Quality Measures Clearinghouse (NQMC), the Physician Quality Reporting System (PQRS) database, and the American Academy of Orthopaedic Surgeons (AAOS) website...
June 24, 2017: Arthroscopy: the Journal of Arthroscopic & related Surgery
https://www.readbyqxmd.com/read/28654621/measuring-provider-performance-for-physicians-participating-in-the-merit-based-incentive-payment-system
#16
Lee Squitieri, Kevin C Chung
In 2017, the Centers for Medicare and Medicaid Services began requiring all eligible providers to participate in the Quality Payment Program or face financial reimbursement penalty. The Quality Payment Program outlines two paths for provider participation: the Merit-Based Incentive Payment System and Advanced Alternative Payment Models. For the first performance period beginning in January of 2017, the Centers for Medicare and Medicaid Services estimates that approximately 83 to 90 percent of eligible providers will not qualify for participation in an Advanced Alternative Payment Model and therefore must participate in the Merit-Based Incentive Payment System program...
July 2017: Plastic and Reconstructive Surgery
https://www.readbyqxmd.com/read/28650410/identification-of-risk-factors-in-lymphatic-surgeries-for-melanoma-a-national-surgical-quality-improvement-program-review
#17
Mona Ascha, Mustafa S Ascha, Brian Gastman
INTRODUCTION: Sentinel lymph node biopsy (SLNB) and lymphadenectomy (LAD) are commonly performed in the staging and care of patients with malignant melanoma. These procedures are accompanied by complications that may result in hospital readmission, negatively affecting patient outcomes and potentially affecting surgical procedure reimbursement. The National Surgical Quality Improvement Program (NSQIP) database offers a large data set allowing physicians to evaluate 30-day readmission for surgical complications...
June 23, 2017: Annals of Plastic Surgery
https://www.readbyqxmd.com/read/28648314/direct-cost-for-treating-chronic-kidney-disease-at-an-outpatient-setting-of-a-tertiary-hospital-evidence-from-a-cross-sectional-study
#18
Rajiv Ahlawat, Pramil Tiwari, Sanjay D'Cruz
BACKGROUND: Chronic kidney disease (CKD) has a high morbidity and mortality in developing countries. And this burden is also increasing rapidly in India. Unaffordability due to high cost of medication and hemodialysis remains one of the major barriers in the successful treatment of CKD. OBJECTIVES: To determine the direct cost involved in treating CKD at an outpatient department of a public tertiary care hospital. METHODS: This cross-sectional study was carried out at a public tertiary care hospital...
May 2017: Value in Health Regional Issues
https://www.readbyqxmd.com/read/28643147/the-perioperative-surgical-home-improving-the-value-and-quality-of-care-in-total-joint-replacement
#19
REVIEW
George F Chimento, Leslie C Thomas
PURPOSE OF REVIEW: The perioperative surgical home (PSH) is a patient-centered, physician-led, multidisciplinary care pathway developed to deliver value-based care based on shared decision-making. Physician and hospital reimbursement will be tied to providing quality care at lower cost, and the PSH model has been used in providing care to patients undergoing lower extremity arthroplasty. The purpose of this review is to discuss the rationale, definition, development, current state, and future direction of the PSH...
June 22, 2017: Current Reviews in Musculoskeletal Medicine
https://www.readbyqxmd.com/read/28642700/pricing-and-reimbursement-of-biosimilars-in-central-and-eastern-european-countries
#20
Paweł Kawalec, Ewa Stawowczyk, Tomas Tesar, Jana Skoupa, Adina Turcu-Stiolica, Maria Dimitrova, Guenka I Petrova, Zinta Rugaja, Agnes Männik, Andras Harsanyi, Pero Draganic
Objectives: The aim of this study was to review the requirements for the reimbursement of biosimilars and to compare the reimbursement status, market share, and reimbursement costs of biosimilars in selected Central and Eastern European (CEE) countries. Methods: A questionnaire-based survey was conducted between November 2016 and January 2017 among experts from the following CEE countries: Bulgaria, Czech Republic, Croatia, Estonia, Hungary, Latvia, Lithuania, Poland, Slovakia, and Romania. The requirements for the pricing and reimbursement of biosimilars were reviewed for each country...
2017: Frontiers in Pharmacology
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