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Physician reimbursement

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https://www.readbyqxmd.com/read/29678531/-restructuring-of-medical-specialist-treatment-using-the-example-of-ambulatory-special-medical-care-asv-taking-a-critical-look-at-its-aims-and-implementation
#1
REVIEW
Robert Dengler, Manfred Cassens
With the GKV-VStG act in 2012, the former section 116b SGB V was transformed into ambulatory special medical care (ASV). This system comprises the diagnosis and therapy of rare or complex diseases which are difficult to treat, in need of a special qualification of doctors, an interdisciplinary cooperation and/or special facilities. For the first time, a uniform regulatory framework was established for the participation of office- as well as hospital-based doctors in ambulatory care. There is no planning of demand or licensed permission...
April 18, 2018: Zeitschrift Für Evidenz, Fortbildung und Qualität Im Gesundheitswesen
https://www.readbyqxmd.com/read/29672366/mohs-micrographic-surgery-volume-and-payment-patterns-among-dermatologists-in-the-medicare-population-2013
#2
Cameron Johnstone, Keith A Joiner, John Pierce, Robert S Krouse
OBJECTIVES: Mohs micrographic surgery (MMS) has expanded markedly in recent years but there is limited information on volume, practice patterns or reimbursement. This study characterizes MMS utilization in the Medicare population. MATERIALS AND METHODS: We analyzed the Medicare Provider Utilization and Payment Data: Physician and Other Supplier Public Use File Calendar Year 2013 data set for provider service volume and reimbursement for dermatologists who did and did not perform MMS procedures...
April 18, 2018: American Journal of Clinical Oncology
https://www.readbyqxmd.com/read/29671080/-lutetium-177-psma-radioligand-therapy-consensus-within-the-framework-of-gkv-funded-care-between-the-university-hospitals-in-aachen-bonn-d%C3%A3-sseldorf-essen-and-cologne-and-the-mdk-nordrhein
#3
REVIEW
H Ahmadzadehfar, P Albers, A Bockisch, M Boegemann, C Böhme, W Burchert, M Dietlein, A Drzezga, U Fabry, G Feldmann, A Heidenreich, A Heinzel, K Herrmann, A Heyll, C Höhling, C Kreuzer, D Laufer, R Mengel, F M Mottaghy, H-W Müller, S C Müller, E Ost, K Rahbar, W Reifenhäuser, M Schäfers, C Schlenkhoff, M Schmidt, I Schmidt-Wolf, C Wildenhain, B Zimmer, M Essler
In the last 3 years, Lutetium-177 prostate-specific membrane antigen radioligand therapy (Lu-177-PSMA-RLT) has received increasing attention in nuclear medicine as a new form of treatment for castration-resistant metastatic prostate cancer. This therapy combines the radionuclide Lutetium-177, which has been therapeutically used in nuclear medicine for many years, with a molecular target of the transmembrane prostate-specific membrane antigen expressed by prostate cancer cells. Since there are no prospective randomized studies on Lu-177-PSMA-RLT and the question of reimbursement has repeatedly been the subject of review by the MDK Nordrhein (Medischenische Dienst der Krankenversicherung), there was a desire because of the increasing number of patients being treated to clarify under which circumstances Lu-177-PSMA-RLT can be reimbursed by German statutory health insurance...
April 18, 2018: Der Urologe. Ausg. A
https://www.readbyqxmd.com/read/29671079/-practice-of-early-detection-of-prostate-cancer-descriptive-survey-in-preparation-for-the-psainform-study
#4
A Simbrich, A Semjonow, N Donner-Banzhoff, H-W Hense
BACKGROUND: The randomized controlled PSAInForm study aims to investigate the effects of a computer-based decision aid which informs men in the age group 55-69 years about advantages and disadvantages of PSA testing. In preparation for the study, the current PSA testing practice in the Münster district was assessed. MATERIALS AND METHODS: The frequencies of early detection examinations, medically indicated PSA tests, and prostate biopsies in the Münster district were determined, using aggregated data from the regional association of Statutory Health Insurance (SHI) Physicians in Westfalen-Lippe...
April 18, 2018: Der Urologe. Ausg. A
https://www.readbyqxmd.com/read/29662915/patient-perspectives-of-midlevel-providers-in-orthopaedic-sports-medicine
#5
Blaine T Manning, Daniel D Bohl, Charles P Hannon, Michael L Redondo, David R Christian, Brian Forsythe, Shane J Nho, Bernard R Bach
Background: Midlevel providers (eg, nurse practitioners and physician assistants) have been integrated into orthopaedic systems of care in response to the increasing demand for musculoskeletal care. Few studies have examined patient perspectives toward midlevel providers in orthopaedic sports medicine. Purpose: To identify perspectives of orthopaedic sports medicine patients regarding midlevel providers, including optimal scope of practice, reimbursement equity with physicians, and importance of the physician's midlevel provider to patients when initially selecting a physician...
April 2018: Orthopaedic Journal of Sports Medicine
https://www.readbyqxmd.com/read/29627120/attending-diabetes-clinics-is-associated-with-a-lower-all-cause-mortality-a-meta-analysis-of-observational-studies-performed-in-italy
#6
E Bonora, M Monami, G Bruno, G Zoppini, E Mannucci
OBJECTIVE: The epidemiological explosion of diabetes is a challenge for Health Systems and the identification of the most appropriate models of care are warranted. The inclusion of primary care physicians in the models is unquestioned whereas the role played by secondary and tertiary care (Diabetes Clinic) is often debated. However, studies focusing on hard endpoints and comparing Diabetes Clinic attendance vs. no attendance are scant. RESEARCH DESIGN AND METHODS: A meta-analysis was performed including all observational cohort studies performed in Italy, reporting crude and/or adjusted estimates of all-cause mortality in patients with diabetes attending or not attending Diabetes Clinics...
March 2, 2018: Nutrition, Metabolism, and Cardiovascular Diseases: NMCD
https://www.readbyqxmd.com/read/29622004/redefining-diagnosis-related-groups-drgs-for-palliative-care-a-cross-sectional-study-in-two-german-centres
#7
Matthias Vogl, Eva Schildmann, Reiner Leidl, Farina Hodiamont, Helen Kalies, Bernd Oliver Maier, Marcus Schlemmer, Susanne Roller, Claudia Bausewein
BACKGROUND: Hospital costs and cost drivers in palliative care are poorly analysed. It remains unknown whether current German Diagnosis-Related Groups, mainly relying on main diagnosis or procedure, reproduce costs adequately. The aim of this study was therefore to analyse costs and reimbursement for inpatient palliative care and to identify relevant cost drivers. METHODS: Two-center, standardised micro-costing approach with patient-level cost calculations and analysis of the reimbursement situation for patients receiving palliative care at two German hospitals (7/2012-12/2013)...
April 5, 2018: BMC Palliative Care
https://www.readbyqxmd.com/read/29618963/value-of-investment-as-a-key-driver-for-prioritization-and-implementation-of-healthcare-software
#8
Seth A Bata, Terry Richardson
Health systems across the nation are recovering from massive financial and resource investments in electronic health record applications. In the midst of these recovery efforts, implementations of new care models, including accountable care organizations and population health initiatives, are underway. The shift from fee-for-service to fee-for-outcomes and fee-for-value payment models calls for care providers to work in new ways. It also changes how physicians are compensated and reimbursed. These changes necessitate that healthcare systems further invest in information technology solutions...
2018: Perspectives in Health Information Management
https://www.readbyqxmd.com/read/29618127/online-ratings-of-neurosurgeons-an-examination-of-web-data-and-its-implications
#9
Michael Cloney, Benjamin Hopkins, Nathan Shlobin, Nader S Dahdaleh
BACKGROUND: Patient satisfaction ratings are increasingly used for hospital rankings, referral base and physician reimbursement. As such, online physician rating websites (PRWs) are quickly becoming a topic of interest. OBJECTIVE: To analyze the distribution of neurosurgeons' ratings on the 3 most widely used PRWs, and examine factors associated with positive and negative ratings. METHODS: We used a key term search to identify board-certified neurosurgeons on 3 widely used PRWs: RateMD...
April 3, 2018: Neurosurgery
https://www.readbyqxmd.com/read/29615376/the-22-modifier-in-reimbursement-for-orthopedic-procedures-hip-arthroplasty-and-obesity-are-worth-the-effort
#10
Eric L Smith, David J Tybor, Hayley D Daniell, Laura A Naccarato, Mary E Pevear, Charles Cassidy
BACKGROUND: Orthopedic surgeons utilize the 22-modifier when billing for complex procedures under the American Medical Association's Current Procedural Terminology (CPT) for reasons such as excessive blood loss, anatomic abnormality, and morbid obesity, cases that would ideally be reimbursed at a higher rate to compensate for additional physician work and time. We investigated how the 22-modifier affects physician reimbursement in knee and hip arthroplasty. METHODS: We queried hospital billing data from 2009 to 2016, identifying all cases performed at our urban tertiary care orthopedic center for knee arthroplasty (CPT codes 27438, 27447, 27487, and 27488) and hip arthroplasty (CPT codes 27130, 27132, 27134, 27236)...
February 21, 2018: Journal of Arthroplasty
https://www.readbyqxmd.com/read/29615363/trends-in-medicare-reimbursement-and-work-relative-value-unit-production-in-radiation-oncology
#11
Charles C Vu, Thomas B Lanni, Sirisha R Nandalur
PURPOSE: Medicare payments to individual physicians are released annually by the CMS. The purpose of this study is to analyze trends in Medicare reimbursement and work relative value unit (wRVU) production to radiation oncologists. MATERIALS AND METHODS: The Medicare Physician Supplier and Other Provider Public Use File and the CMS Physician Fee Schedule Relative Value Files (to calculate wRVUs) for the calendar years 2012 to 2015 were used in this analysis. Medicare reimbursement was aggregated for each calendar year...
March 31, 2018: Journal of the American College of Radiology: JACR
https://www.readbyqxmd.com/read/29609892/communication-skills-training-for-surgical-residents-learning-to-relate-to-the-needs-of-older-adults
#12
Linda Roberts, Charles Cornell, Mathias Bostrom, Sandra Goldsmith, Titilayo Ologhobo, Timothy Roberts, Laura Robbins
BACKGROUND: It is vital for physicians and surgeons to communicate successfully with older adults, who will constitute one-fifth of the US population by 2030. Older adults often perceive themselves as stigmatized and powerless in healthcare settings. Effective communication leads to better patient compliance and satisfaction, which is now a component of Medicare hospital reimbursement and physician and surgeon compensation from hospitals and networks. OBJECTIVE: To increase orthopaedic surgery resident understanding of the unique needs of older adults in order to maintain effective and sensitive communication with this vulnerable population...
March 30, 2018: Journal of Surgical Education
https://www.readbyqxmd.com/read/29602658/effects-of-the-affordable-care-act-on-payer-mix-and-physician-reimbursement-in-hand-surgery
#13
Ibrahim Khansa, Lara Khansa, Gregory D Pearson, Sonu A Jain
PURPOSE: To evaluate the effect of the Affordable Care Act (ACA) on the payer distribution and reimbursement rate for hand surgery at our institution. METHODS: We reviewed records of 4,257 patients who underwent hand surgery at our institution between January 2008 and June 2016; 2,601 patients underwent surgery before the implementation of the ACA, and 1,656 patients after. Type of procedure, insurance status, amount of money billed, and amount collected were recorded...
March 27, 2018: Journal of Hand Surgery
https://www.readbyqxmd.com/read/29597151/purchases-of-prescription-drugs-before-an-alcohol-related-death-a-ten-year-follow-up-study-using-linked-routine-data
#14
Tapio Paljärvi, Pekka Martikainen, Taina Leinonen, Erkki Vuori, Pia Mäkelä
BACKGROUND: Physician's intention to prescribe drugs could potentially be used to improve targeting of alcohol interventions and enhanced disease management to patients with a high risk of severe alcohol-related harm within outpatient settings. METHODS: Comparison of ten-year incidence trajectories of 13.8 million reimbursed purchases of prescription drugs among 303,057 Finnish men and women of whom 7490 ultimately died due to alcohol-related causes (Alc+), 14,954 died without alcohol involvement (Alc-), and 280,613 survived until the end of 2007...
March 23, 2018: Drug and Alcohol Dependence
https://www.readbyqxmd.com/read/29595721/trends-in-physician-payments-for-breast-reconstruction
#15
Clifford C Sheckter, Day Yi, Hina J Panchal, Shantanu N Razdan, Andrea L Pusic, Colleen M McCarthy, Peter G Cordeiro, Joseph J Disa, Babak Mehrara, Evan Matros
BACKGROUND: Prosthetic breast reconstruction rates have risen in the United States, whereas autologous techniques have stagnated. Meanwhile, single-institution data demonstrate that physician payments for prosthetic reconstruction are rising, while payments for autologous techniques are unchanged. This study aims to assess payment trends and variation for tissue expander and free flap breast reconstruction. METHODS: The Blue Health Intelligence database was queried from 2009 to 2013, identifying women with claims for breast reconstruction...
April 2018: Plastic and Reconstructive Surgery
https://www.readbyqxmd.com/read/29593843/a-regional-analysis-of-u-s-insurance-reimbursement-guidelines-for-massage-therapy
#16
Robin S Miccio, Virginia S Cowen
Introduction: Massage techniques fall within the scope of many different health care providers. Physical therapists, occupational therapists, and chiropractors receive insurance reimbursement for health care services, including massage. Although many patients pay out of pocket for massage services, it is unclear how the insurance company reimbursement policies factor provider qualifications into coverage. This project examined regional insurance reimbursement guidelines for massage therapy in relation to the role of the provider of massage services...
March 2018: International Journal of Therapeutic Massage & Bodywork
https://www.readbyqxmd.com/read/29582674/current-procedural-terminology-coding-for-surgical-pathology-a-review-and-one-academic-center-s-experience-with-pathologist-verified-coding
#17
Audrey Deeken-Draisey, Allison Ritchie, Guang-Yu Yang, Margaret Quinn, Linda M Ernst, Ajda Guttormsen, Gyongyi Ella Simionov, Kruti P Maniar
CONTEXT: - The Current Procedural Terminology (CPT) system is a standardized numerical coding system for reporting medical procedures and services, and is the basis for reimbursement of health care providers by Medicare and other third-party payers. Accurate CPT coding is therefore crucial for appropriate compensation as well as for compliance with Medicare policies, and erroneous coding may result in loss of revenues and/or significant monetary penalties for a hospital or practice. OBJECTIVE: - To provide a review of the history, current state, and basic principles of CPT coding, in particular as it applies to the practice of surgical pathology, and to present our experience with initiating a new system of pathologist involvement in the review and verification of CPT codes, including the most common codes that require modification in our practice at the time of sign-out or post-sign-out auditing...
March 27, 2018: Archives of Pathology & Laboratory Medicine
https://www.readbyqxmd.com/read/29582520/pediatric-endocrine-society-survey-of-diabetes-practices-in-the-united-states-what-is-the-current-state
#18
Ines Guttmann-Bauman, Paul Thornton, Soumya Adhikari, Kent Reifschneider, Michael A Wood, Tyler Hamby, Karen Rubin
The Practice Management Committee (PMC) of the Pediatric Endocrine Society (PES) conducted a survey of its membership in February/March 2016 to assess the current state of pediatric diabetes care delivery across multiple practice types in the United States. RESEARCH DESIGN AND METHODS: The PES distributed an anonymous electronic survey (Survey Monkey) via email to its membership and requested that only one survey be completed for each practice. RESULTS: Ninety-three unique entries from the US were entered into analysis...
March 26, 2018: Pediatric Diabetes
https://www.readbyqxmd.com/read/29579210/changes-in-prescription-pattern-pharmaceutical-expenditure-and-quality-of-care-after-introduction-of-reimbursement-restriction-in-diabetes-in-korea
#19
Ji-Young Kim, Seung Ju Kim, Chung Mo Nam, Ki Tae Moon, Eun-Cheol Park
Background: To ensure effective prescription practices and reduce diabetes-related pharmaceutical expenditures, Korea adopted a clinical practice guideline for the reimbursement system. Health care providers cannot receive reimbursement from National Health Insurance(NHI) unless it is for an appropriate prescription under the predefined clinical condition. The aim of this study was to evaluate prescription patterns in oral hypoglycemic agents, costs and effects on patient care since the introduction of the diabetes reimbursement restriction...
April 1, 2018: European Journal of Public Health
https://www.readbyqxmd.com/read/29570048/key-drivers-of-patient-satisfaction-in-lumbar-spine-surgery
#20
Jay M Levin, Robert D Winkelman, Joseph E Tanenbaum, Edward C Benzel, Thomas E Mroz, Michael P Steinmetz
OBJECTIVE The Patient Experience of Care, composed of 9 dimensions derived from the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey, is being used by the Centers for Medicare & Medicaid Services to adjust hospital reimbursement. Currently, there are minimal data on how scores on the constituent HCAHPS items impact the global dimension of satisfaction, the Overall Hospital Rating (OHR). The purpose of this study was to determine the key drivers of overall patient satisfaction in the setting of inpatient lumbar spine surgery...
March 23, 2018: Journal of Neurosurgery. Spine
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