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https://www.readbyqxmd.com/read/27920322/patients-who-choose-primary-care-physicians-based-on-low-office-visit-price-can-realize-broader-savings
#1
Ateev Mehrotra, Peter J Huckfeldt, Amelia M Haviland, Laura Gascue, Neeraj Sood
Price transparency initiatives encourage patients to save money by choosing physicians with a relatively low price per office visit. Given that the price of such visits represents a small fraction of total spending, the extent of the savings from choosing such physicians has not been clear. Using a national sample of commercial claims data, we compared the care received by patients of high- and low-price primary care physicians. The median price for an established patient's office visit was $60 among low-price physicians and $86 among high-price physicians (price was calculated as reimbursement plus out-of-pocket spending)...
December 1, 2016: Health Affairs
https://www.readbyqxmd.com/read/27898132/community-models-of-care-a-scoping-review
#2
Lindsay Mullins, Lisa E Skemp, Meridean L Maas
Nurse preparation and role in community models of care for older adults is not well documented. The purpose of the current structured scoping literature review was to identify nurse-led or nurse-involved community models of care for older adults, articulate the nurse's role and preparation in the model, and identify Triple Aim policy implications. Literature from 2008 through 2014 yielded 34 models identified in 51 articles. Twenty-one of 34 models were evaluated and none clearly articulated the full impact of a nurse role...
December 1, 2016: Journal of Gerontological Nursing
https://www.readbyqxmd.com/read/27893295/medical-directors-of-breastfeeding-programs-at-academic-medical-centers-duties-and-challenges
#3
Casey B Rosen-Carole
INTRODUCTION: An emerging trend in Academic Medical Centers (AMCs) is to coordinate breastfeeding care, research, and trainee education through "medical director" positions. Little is known about their duties, supports, and challenges. OBJECTIVE: To determine the duties and challenges of directors of breastfeeding medicine in AMCs. METHODS: A survey was distributed four times over a 3-month period to three listservs with a total of 860 members...
November 28, 2016: Breastfeeding Medicine: the Official Journal of the Academy of Breastfeeding Medicine
https://www.readbyqxmd.com/read/27892907/concierge-medicine-a-viable-business-model-for-some-physicians-of-the-future
#4
David P Paul, Michaeline Skiba
Concierge medicine is a medical management structure that has been in existence since the 1990s. Essentially, a typical concierge medical practice limits its number of patients and provides highly personalized attention that includes comprehensive annual physicals, same-day appointments, preventive and wellness care, and fast, 24/7 response time. Concierge medicine has become popular among both physicians and patients/consumers who are frustrated by the limitations imposed by managed care organizations. From many physicians' perspectives, concierge medicine offers greater autonomy, the opportunity to return to a more manageable patient load, and the chance to improve their incomes that have declined because of increasingly lowered reimbursements for their services...
January 2016: Health Care Manager
https://www.readbyqxmd.com/read/27888942/lessons-learned-from-two-decades-of-patient-and-family-centered-care-in-radiology-part-2-building-a-culture
#5
James V Rawson, Layne Mitchell, Lewis Golden, Alisa Murdock, G Rebecca Haines
As reimbursements are increasingly linked to patient experience, physicians and hospitals will need to find ways to incorporate patient and family input into operational decisions. Rather than starting from the beginning, health systems could learn from practitioners who have been experimenting in this space and are willing to share their experience. The authors share lessons learned from two decades of experience incorporating patient and family advisers into the clinical operation of a radiology department and the resulting culture change...
December 2016: Journal of the American College of Radiology: JACR
https://www.readbyqxmd.com/read/27884928/macra-2-0-are-you-ready-for-mips
#6
REVIEW
Joshua A Hirsch, Andrew B Rosenkrantz, Sameer A Ansari, Laxmaiah Manchikanti, Gregory N Nicola
The annual cost of healthcare delivery in the USA now exceeds US$3 trillion. Fee for service methodology is often implicated as a cause of this exceedingly high figure. The Affordable Care Act created the Center for Medicare and Medicaid Innovation (CMMI) to pilot test value based alternative payments for reimbursing physician services. In 2015, the Medicare Access and CHIP Reauthorization Act (MACRA) was passed into law. MACRA has dramatic implications for all US based healthcare providers. MACRA permanently repealed the Medicare Sustainable Growth Rate so as to stabilize physician part B Medicare payments, consolidated pre-existing federal performance programs into the Merit based Incentive Payments System (MIPS), and legislatively mandated new approaches to paying clinicians...
November 24, 2016: Journal of Neurointerventional Surgery
https://www.readbyqxmd.com/read/27882836/comparison-of-pharmacist-and-physician-managed-annual-medicare-wellness-services
#7
Mary Jean Sewell, Daniel M Riche, Joshua W Fleming, Scott S Malinowski, R Terry Jackson
BACKGROUND: Medicare Annual Wellness Visits (AWV) are a benefit provided for Medicare beneficiaries to increase focus on wellness and preventive measures. Pharmacists can conduct AWVs, which offers a potential avenue for outpatient revenue generation. PROGRAM DESCRIPTION: To compare a composite of interventions and screenings and revenue generated by a pharmacist with those made by a physician during a subsequent AWV. A report generated through the electronic health record was used to determine AWVs conducted by a pharmacist or 3 participating physicians from December 2013 to March 2016, including revenue generated...
December 2016: Journal of Managed Care & Specialty Pharmacy
https://www.readbyqxmd.com/read/27881284/perceived-risks-contra-benefits-of-using-biosimilar-drugs-in-ulcerative-colitis-discrete-choice-experiment-among-gastroenterologists
#8
Petra Baji, László Gulácsi, Petra A Golovics, Barbara D Lovász, Márta Péntek, Valentin Brodszky, Fanni Rencz, Péter L Lakatos
BACKGROUND: In middle-income countries, access to biological therapy is limited in ulcerative colitis in terms of the number of patients and the length of therapy. Because of their cost advantages, biosimilars have the potential to improve access to therapy, but physicians have concerns toward their use because of the lack of evidence from randomized clinical trials. OBJECTIVES: To explore the preferences of gastroenterologists for biosimilar drugs in ulcerative colitis as well as to compare our results with results of previous studies on gastroenterologists' preferences toward biosimilars...
September 2016: Value in Health Regional Issues
https://www.readbyqxmd.com/read/27878712/much-ado-about-nothing-the-financial-impact-of-physician-owned-specialty-hospitals
#9
Sujoy Chakravarty
The U.S. hospital industry has recently witnessed a number of policy changes aimed at aligning hospital payments to costs and these can be traced to significant concerns regarding selection of profitable patients and procedures by physician-owned specialty hospitals. The policy responses to specialty hospitals have alternated between payment system reforms and outright moratoriums on hospital operations including one in the recently enacted Affordable Care Act. A key issue is whether physician-owned specialty hospitals pose financial strain on the larger group of general hospitals through cream-skimming of profitable patients, yet there is no study that conducts a systematic analysis relating such selection behavior by physician-owners to financial impacts within hospital markets...
June 2016: Int J Health Econ Manag
https://www.readbyqxmd.com/read/27878710/the-differential-effect-of-compensation-structures-on-the-likelihood-that-firms-accept-new-patients-by-insurance-type
#10
Justin B Bullock, W David Bradford
Adequate access to primary care is not universally achieved in many countries, including the United States, particularly for vulnerable populations. In this paper we use multiple years of the U.S.-based Community Tracking Survey to examine whether a variety of physician compensation structures chosen by practices influence the likelihood that the practice takes new patients from a variety of different types of insurance. Specifically, we examine the roles of customer satisfaction and quality measures on the one hand, and individual physician productivity measures on the other hand, in determining whether or not firms are more likely to accept patients who have private insurance, Medicare, or Medicaid...
March 2016: Int J Health Econ Manag
https://www.readbyqxmd.com/read/27876522/relative-value-unit-based-compensation-incentivization-in-an-academic-vascular-practice-improves-productivity-with-no-early-adverse-impact-on-quality
#11
Nadia Awad, Francis J Caputo, Jeffrey P Carpenter, James B Alexander, José L Trani, Joseph V Lombardi
OBJECTIVE: Given the increased pressure from governmental programs to restructure reimbursements to reflect quality metrics achieved by physicians, review of current reimbursement schemes is necessary to ensure sustainability of the physician's performance while maintaining and ultimately improving patient outcomes. This study reviewed the impact of reimbursement incentives on evidence-based care outcomes within a vascular surgical program at an academic tertiary care center. METHODS: Data for patients with a confirmed 30-day follow-up for the vascular surgery subset of our institution's National Surgical Quality Improvement Program submission for the years 2013 and 2014 were reviewed...
November 19, 2016: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/27870675/comanagement-and-gainsharing-opportunities-for-independent-physicians
#12
Chris McBride, Peter L Althausen
Gainsharing and comanagament programs are both successful means of achieving physician buy-in for all cost containment programs in Orthopaedic Trauma. Under comanagement agreements, physicians are reimbursed for their time and intellectual efforts in program and algorithm creation. The cost is minimal for the hospital in return for the millions of dollars in savings they achieve. Gainsharing models can incentivize physicians to quickly adopt cost-effective implant choices, care plans, and program development...
December 2016: Journal of Orthopaedic Trauma
https://www.readbyqxmd.com/read/27870674/impact-of-hospital-employed-physician-assistants-on-a-level-ii-community-based-orthopaedic-trauma-system
#13
Peter L Althausen, Steven Shannon, Brianne Owens, Daniel Coll, Michael Cvitash, Minggen Lu, Timothy J O'Mara, Timothy J Bray
OBJECTIVES: The American Academy of Orthopedic Surgeons and the Orthopedic Trauma Association have released guidelines for the provision of orthopedic trauma services such as adequate stipends, designated operating rooms, ancillary staff, and guaranteed reimbursement for indigent care. One recommendation included a provision for hospital-based physician assistants (PAs). Given current reimbursement arrangements, PA collections for billable services may not meet their salary and benefit expenses...
December 2016: Journal of Orthopaedic Trauma
https://www.readbyqxmd.com/read/27862243/antidepressant-adherence-patterns-in-older-patients-use-of-a-clustering-method-on-a-prescription-database
#14
David Braunstein, Amélie Hardy, Quentin Boucherie, Elisabeth Frauger, Olivier Blin, Gaétan Gentile, Joëlle Micallef
According to the World Health Organization, depression will become the second most important cause of disability worldwide by 2020. Our objective was to identify patterns of adherence to antidepressant treatments in older patients using several indicators of adherence and to characterize these patterns in term of medication exposure. We conducted a retrospective cohort study using the French National Health Insurance reimbursement database. Incident antidepressant users aged more than 65 were included from July 1, 2010 to June 30, 2011 and followed-up for 18 months...
November 14, 2016: Fundamental & Clinical Pharmacology
https://www.readbyqxmd.com/read/27856087/hemodialysis-hospitalizations-and-readmissions-the-effects-of-payment-reform
#15
Kevin F Erickson, Wolfgang C Winkelmayer, Glenn M Chertow, Jay Bhattacharya
BACKGROUND: In 2004, the Centers for Medicare & Medicaid Services changed reimbursement for physicians and advanced practitioners caring for patients receiving hemodialysis from a capitated to a tiered fee-for-service system, encouraging increased face-to-face visits. This early version of a pay-for-performance initiative targeted a care process: more frequent provider visits in hemodialysis. Although more frequent provider visits in hemodialysis are associated with fewer hospitalizations and rehospitalizations, it is unknown whether encouraging more frequent visits through reimbursement policy also yielded these benefits...
November 14, 2016: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
https://www.readbyqxmd.com/read/27843163/essential-medicines-for-cancer-who-recommendations-and-national-priorities
#16
Jane Robertson, Ronald Barr, Lawrence N Shulman, Gilles B Forte, Nicola Magrini
OBJECTIVE: To examine, for essential anti-cancer medicines, the alignment of national lists of essential medicines and national reimbursable medicines lists with the World Health Organization's (WHO's) Model Lists. METHODS: National medicine lists for 135 countries with per-capita gross national incomes below 25 000 United States dollars in 2015 were compared with WHO's 2013 and 2015 Model Lists of Essential Medicines. Correlations between numbers of anti-cancer medicines included in national lists and gross national income (GNI), government health expenditure and number of physicians per 1000 population were evaluated...
October 1, 2016: Bulletin of the World Health Organization
https://www.readbyqxmd.com/read/27833068/cost-benefit-analysis-of-establishing-an-inferior-vena-cava-filter-clinic
#17
Joshua D Dowell, Summit H Shah, Kyle J Cooper, Vedat Yıldız, Xueliang Pan
PURPOSE: Adverse events associated with retrievable inferior vena cava filters (IVCFs) have generated an increased interest in improving IVCF retrieval rates to improve patient safety and quality care. This study aims to demonstrate the cost-benefit of implementing an IVCF clinic to improve patient care in an institution in the United States. METHODS: An IVCF clinic was established at a single institution in September 2012 and for ten months referring physicians were contacted to facilitate retrieval when appropriate...
November 11, 2016: Diagnostic and Interventional Radiology: Official Journal of the Turkish Society of Radiology
https://www.readbyqxmd.com/read/27817873/drug-safety-and-the-impact-of-drug-warnings-an-interrupted-time-series-analysis-of-diabetes-drug-prescriptions-in-germany-and-denmark
#18
Gisela Hostenkamp, Katharina Elisabeth Fischer, Knut Borch-Johnsen
OBJECTIVE: To analyse the impact of drug safety warnings from the European Medicines Agency (EMA) on drug utilisation and their interaction with information released through national reimbursement bodies. METHODS: Insurance claims data on anti-diabetic drug prescriptions in primary care in Germany and Denmark were analysed using interrupted time series analysis, with EMA drug warnings for thiazolidinediones (TZDs) in 2007 and 2011 as the intervention. Monthly drug utilisation data per substance in defined daily dosages (DDD) consumed per 1000 insurees were retrieved from the Danish national drug prescriptions register and one large statutory sickness fund in Germany...
December 2016: Health Policy
https://www.readbyqxmd.com/read/27806385/reimbursement-based-on-value-in-knee-surgery-what-you-need-to-know-about-the-medicare-access-and-children-s-health-insurance-program-reauthorization-act-of-2015
#19
Khaled J Saleh, Zain Sayeed, Afshin A Anoushiravani, Hussein F Darwiche, Bryan Little, Todd James Frush, Mouhanad M El-Othmani
Health care cost is consuming a large portion of the nation's gross domestic product while placing added economic burdens on physicians and their patients. With total joint replacement being one of the early-targeted procedures in the evolving health care environment, knee surgeons will benefit from developing a critical knowledge on health care reforms and their financial implications. The Medicare Access and Children's Health Insurance Program Reauthorization Act represents a cohesive movement toward value-based payment reform and contains several unchartered rulings that require detailed attention by knee surgeons...
November 2, 2016: Journal of Knee Surgery
https://www.readbyqxmd.com/read/27793155/off-label-use-of-orphan-medicinal-products-a-belgian-qualitative-study
#20
Marc Dooms, David Cassiman, Steven Simoens
BACKGROUND: Off-label use of (orphan) medicinal products for (rare) diseases is quite common but not underpinned by clinical studies to confirm efficacy and safety. No risk-analyses by regulatory agencies are carried out. The objective of this study was to map off-label use of orphan medicinal products in Belgium in terms of attitude towards off-label prescribing, factors influencing off-label prescribing, disclosure of information towards the patient, reporting of off-label use, risks and consequences...
October 28, 2016: Orphanet Journal of Rare Diseases
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