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Physician reimbursement

Daniel H Wiznia, Theodore Zaki, Julianna Maisano, Chang-Yeon Kim, Thomas M Halaszynski, Michael P Leslie
BACKGROUND AND OBJECTIVES: The Affordable Care Act intended to "extend affordable coverage" and "ensure access" for vulnerable patient populations. This investigation examined whether the type of insurance (Medicaid, Medicare, Blue Cross, cash pay) carried by trauma patients influences access to pain management specialty care. METHODS: Investigators phoned 443 board-certified pain specialists, securing office visits with 235 pain physicians from 8 different states...
October 21, 2016: Regional Anesthesia and Pain Medicine
Xiaolei Song, Guanyang Zou, Wen Chen, Siqi Han, Xia Zou, Li Ling
OBJECTIVE: To describe the self-reported health status and service utilization of employed, retired and unemployed migrants in Guangzhou, a mega-city in southern China. METHODS: Cross-sectional study adapted from National Health Service Survey between September and December in 2014. Based on the distribution of occupation of migrants, multi-stage sampling was used to recruit individuals. Logistic regression was applied to explore the factors influencing their service utilization...
October 24, 2016: Tropical Medicine & International Health: TM & IH
Neena Kapoor, Daniel M Blumenthal, Stacy E Smith, Ivan K Ip, Ramin Khorasani
Purpose To determine whether there were sex differences in full professorship after accounting for factors known to influence academic advancement. Materials and Methods Institutional review board approval was obtained for this HIPAA-compliant study, with waiver of informed consent. In this cross-sectional study, the authors used a comprehensive 2014 physician database (5089 academic radiologists, inclusive of all U.S. academic radiologists in 2014; 11.3% of all U.S. radiologists) containing information on physician age, years since residency, National Institutes of Health funding, scientific publications (first or last author and total), clinical trial investigation, and clinical volume measured according to 2013 Medicare reimbursement...
October 21, 2016: Radiology
Amanda N Fader, Tim Xu, Brian J Dunkin, Martin A Makary
BACKGROUND: Surgery is one of the highest priced services in health care, and complications from surgery can be serious and costly. Recently, advances in surgical techniques have allowed surgeons to perform many common operations using minimally invasive methods that result in fewer complications. Despite this, the rates of open surgery remain high across multiple surgical disciplines. METHODS: This is an expert commentary and review of the contemporary literature regarding minimally invasive surgery practices nationwide, the benefits of less invasive approaches, and how minimally invasive compared with open procedures are differentially reimbursed in the United States...
October 17, 2016: Surgical Endoscopy
Isabelle Récoché, Vanessa Rousseau, Robert Bourrel, Maryse Lapeyre-Mestre, Leila Chebane, Fabien Despas, Jean-Louis Montastruc, Emmanuelle Bondon-Guitton
Many patients treated with imatinib, used in cancer treatment, are using several other drugs that could interact with imatinib. Our aim was to study all the drug-drug interactions (DDIs) observed in patients treated with imatinib.We performed 2 observational studies, between the 1st January 2012 and the 31st August 2015 in the Midi-Pyrénées area (South Western France), using the French health insurance reimbursement database and then the French Pharmacovigilance Database (FPVD).A total of 544 patients received at least 1 reimbursement for imatinib...
October 2016: Medicine (Baltimore)
Diana Karpman, Peter Höglund
Orphan drugs designed to treat rare diseases are often overpriced per patient. Novel treatments are sometimes even more expensive for patients with ultra-rare diseases, in part due to the limited number of patients. Pharmaceutical companies that develop a patented life-saving drug are in a position to charge a very high price, which, at best, may enable these companies to further develop drugs for use in rare disease. However, is there a limit to how much a life-saving drug should cost annually per patient? Government interventions and regulations may opt to withhold a life-saving drug solely due to its high price and cost-effectiveness...
October 13, 2016: Pediatric Nephrology: Journal of the International Pediatric Nephrology Association
Cathrine Bell, Mette Kjærgaard Nielsen, Mette Asbjoern Neergaard, Mai-Britt Guldin, Anders Bonde Jensen
CONTEXT: Timely recognition of the terminal phase of life will benefit patients and caregivers as it may facilitate advance care planning and support. OBJECTIVES: To investigate the remaining lifetime of patients entering a physician-assessed terminal phase and to analyse variation in remaining lifetime according to diagnosis and socio-demographic factors. METHODS: Danish national health registers were used to establish a prospective cohort, of adult patients formally registered with drug reimbursement due to terminal illness in 2012 and followed until June 2014...
October 5, 2016: Journal of Pain and Symptom Management
Jonathan Dash, Dagmar M Haller, Johanna Sommer, Noelle Junod Perron
BACKGROUND: Physicians' daily work is increasingly affected by the use of emails, text messages and cell phone calls with their patients. The aim of this study was to describe their use between primary-care physicians and patients in a French-speaking part of Switzerland. METHODS: A cross-sectional mail survey was conducted among all primary-care physicians of Geneva canton (n = 636). The questionnaire focused on the frequency of giving access to, type of use, advantages and disadvantages of email, cell phone calls and text messages communication between physicians and patients...
October 5, 2016: BMC Health Services Research
Wenjing Tao, Janne Agerholm, Bo Burström
BACKGROUND: Reimbursement systems provide incentives to health care providers and may drive physician behaviour. This review assesses the impact of reimbursement system on socioeconomic and racial inequalities in access, utilization and quality of primary care. METHODS: A systematic search was performed in Web of Science and PubMed for English language studies published between 1980 and 2013, supplemented by reference tracking. Articles were selected based on inclusion criteria, and data extraction and critical appraisal were performed by two authors independently...
October 4, 2016: BMC Health Services Research
C Maulsby, R O Valdiserri, J J Kim, N Mahon, A Flynn, E Eriksson, K M Jain, Blessing Enobun, D R Holtgrave
The National HIV AIDS Strategy (NHAS) calls for a more coordinated response to the HIV epidemic. The Global Engagement in Care Convening created a forum for domestic and international experts to identify best practices in HIV care. This manuscript summarizes the meeting discussions and recommendations from meeting notes and an audio recording of the meeting. Recommendations include: further standardization of performance goals and performance measures; additional research; a more robust system to support competing needs of clients receiving services; electronic information exchanges for HIV-related data; an expansion of the role of other health professionals to extend the capacity of physicians and other members of the care team; and revisions to current financing systems to increase reimbursement for and access to services that promote linkage to and retention in HIV care...
October 2016: AIDS Education and Prevention: Official Publication of the International Society for AIDS Education
Christine Petrin, Scott Kahan, M Turner, C Gallagher, W H Dietz
INTRODUCTION: Rates of obesity pharmacotherapy use, bariatric surgery and intensive behavioural counselling have been extremely low. OBJECTIVES: The primary objective of this study was to survey healthcare provider beliefs, practice and knowledge regarding obesity management. METHODS: Primary care physicians (PCPs), OB-GYN physicians and nurse practitioners (NPs) responded to a web-based survey related to drug therapy practice, bariatric surgery referral and reimbursement coding practice...
September 2016: Obesity Science & Practice
Hao Feng, Paula Wu, Marie Leger
Importance: Significant ties exist between clinicians and industry. Little is known about the characteristics of industry payments to dermatologists. Objective: To analyze the nature and extent of industry payments to dermatologists. Design, Setting, and Participants: This was a retrospective review using the publicly available Centers for Medicare and Medicaid Services (CMS) Sunshine Act Open Payment database. Data were downloaded from the publically available CMS website under General Payment and Research Payment data sets...
October 5, 2016: JAMA Dermatology
Shou-Hsia Cheng, Chi-Chen Chen, Hung-Chih Kuo, Chi-Chuan Wang
OBJECTIVES: To examine the long-term effects of drug reimbursement adjustments on drug-switching decisions and to investigate whether patients with complicated or severe conditions are more affected. METHODS: A population-based, longitudinal study with a before-and-after design. Analysis of 141,703 patients with type 2 diabetes covered by the universal health insurance program in Taiwan. Observation of five 6-month phases before and after a drug reimbursement adjustment implemented in October 2009...
October 3, 2016: Journal of Health Services Research & Policy
Yangyang R Yu, Paulette I Abbas, Carolyn M Smith, Kathleen E Carberry, Hui Ren, Binita Patel, Jed G Nuchtern, Monica E Lopez
PURPOSE: As reimbursement programs shift to value-based payment models emphasizing quality and efficient healthcare delivery, there exists a need to better understand process management to unearth true costs of patient care. We sought to identify cost-reduction opportunities in simple appendicitis management by applying a time-driven activity-based costing (TDABC) methodology to this high-volume surgical condition. METHODS: Process maps were created using medical record time stamps...
September 15, 2016: Journal of Pediatric Surgery
Christopher Crowley, Amy R Stuck, Tracy Martinez, Alan C Wittgrove, Feng Zeng, Jesse J Brennan, Theodore C Chan, James P Killeen, Edward M Castillo
BACKGROUND: Almost 70% of hospital admissions for Medicare beneficiaries originate in the emergency department (ED). Research suggests that some of these patients' needs may be better met through home-based care options after evaluation and treatment in the ED. OBJECTIVE: We sought to estimate Medicare cost savings resulting from using the Home Health benefit to provide treatment, when appropriate, as an alternative to inpatient admission from the ED. METHODS: This is a prospective study of patients admitted from the ED...
September 28, 2016: Journal of Emergency Medicine
Chun-Chieh Yeh, Chien-Chang Liao, Chun-Chuan Shih, Long-Bin Jeng, Ta-Liang Chen
Outcomes after surgeries involving physicians as patients have not been researched. This study compares postoperative adverse events between physicians as surgical patients and nonhealth professional controls.Using reimbursement claims data from Taiwan's National Health Insurance Program, we conducted a matched retrospective cohort study of 7973 physicians as surgical patients and 7973 propensity score-matched nonphysician controls receiving in-hospital major surgeries between 2004 and 2010. We compared postoperative major complications, length of hospital stay, intensive care unit (ICU), medical expenditure, and 30-day mortality...
September 2016: Medicine (Baltimore)
Savithri Nageswaran, Shannon L Golden
The objectives of this study were to describe how home healthcare nurses collaborate with other clinicians caring for children with medical complexity, and identify barriers to collaboration within the medical neighborhood. Using qualitative data obtained from 20 semistructured interviews (15 English, 5 Spanish) with primary caregivers of children with medical complexity and 18 home healthcare nurses, researchers inquired about experiences with home healthcare nursing services for these children. During an iterative analysis process, recurrent themes were identified by their prevalence and salience in the data...
October 2016: Home Healthcare Now
Laxmaiah Manchikanti, Vijay Singh, Joshua A Hirsch
UNLABELLED: In the face of the progressive implementation of the Affordable Care Act (ACA), a significant regulatory regime, and the Merit-Based Incentive Payment System (MIPS), the Centers for Medicare and Medicaid Services (CMS) released its proposed 2017 hospital outpatient department (HOPD) and ambulatory surgery center (ASC) payment rules on July 14, 2016, and the physician payment schedule was released July 15, 2016. U.S. health care costs continue to increase, occupying 17.5% of the gross domestic product (GDP) in 2014 and surpassing $3 trillion in overall health care expenditure...
September 2016: Pain Physician
Laxmaiah Manchikanti, Alan D Kaye, Joshua A Hirsch
The Centers for Medicare and Medicaid Services (CMS) released the proposed 2017 Medicare physician fee schedule on July 7, 2016, addressing Medicare payments for physicians providing services either in an office or facility setting, which also includes payments for office expenses and quality provisions for physicians. This proposed rule occurs in the context of numerous policy changes, most notably related to the Medicare Access & CHIP Reauthorization Act of 2015 (MACRA) and its Merit-Based Incentive Payment System (MIPS)...
September 2016: Pain Physician
Laurent G Glance, Yue Li, Andrew W Dick
BACKGROUND: The validity of basing healthcare reimbursement policy on pay-for-performance is grounded in the accuracy of performance measurement. METHODS: Monte Carlo simulation was used to examine the accuracy of performance profiling as a function of statistical methodology, case volume, and the extent to which hospital or physician performance deviates from the average. RESULTS: There is extensive variation in the true-positive rate and false discovery rate as a function of model specification, hospital quality, and hospital case volume...
September 23, 2016: Anesthesiology
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