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Reimbursement approaches

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https://www.readbyqxmd.com/read/28212969/lessons-learned-when-introducing-pharmacogenomic-panel-testing-into-clinical-practice
#1
Marc B Rosenman, Brian Decker, Kenneth D Levy, Ann M Holmes, Victoria M Pratt, Michael T Eadon
OBJECTIVES: Implementing new programs to support precision medicine in clinical settings is a complex endeavor. We describe challenges and potential solutions based on the Indiana GENomics Implementation: an Opportunity for the Underserved (INGenious) program at Eskenazi Health-one of six sites supported by the Implementing GeNomics In pracTicE network grant of the National Institutes of Health/National Human Genome Research Institute. INGenious is an implementation of a panel of genomic tests...
January 2017: Value in Health: the Journal of the International Society for Pharmacoeconomics and Outcomes Research
https://www.readbyqxmd.com/read/28201829/impact-of-continuous-two-team-approach-in-autologous-breast-reconstruction
#2
A J Bauermeister, A Zuriarrain, M Newman, S A Earle, M A Medina
Background Autologous breast reconstruction has been noted in the literature to provide superior aesthetic outcomes and patient satisfaction. Additionally, free perforator flap tissue transfer has the potential for lower abdominal donor site morbidity. However, it has been noted that the percentage of women who are undergoing autologous breast reconstruction in the United States is decreasing. Factors related to the technical difficulty, prolonged operative times, and decreasing reimbursement have been implicated as the causes...
February 15, 2017: Journal of Reconstructive Microsurgery
https://www.readbyqxmd.com/read/28192148/something-new-in-the-air-paying-for-community-based-environmental-approaches-to-asthma-prevention-and-control-work-group-report-of-the-practice-diagnostics-and-therapeutics-committee-of-the-american-academy-of-allergy-asthma-immunology
#3
Megan M Tschudy, Joshua Sharfstein, Elizabeth Matsui, Charles S Barnes, Stacey Chacker, Rosa Codina, John R Cohn, Megan Sandel, H James Wedner
Despite the recommendation in national asthma guidelines to target indoor environmental exposures, most insurers generally have not covered the outreach, education, environmental assessments, or durable goods integral to home environmental interventions. Emerging payment approaches, however, offer new potential for coverage of home-based environmental intervention costs. These opportunities are becoming available as public and private insurers shift reimbursement to reward better health outcomes and their key characteristic is a focus on the value rather than the volume of services...
February 10, 2017: Journal of Allergy and Clinical Immunology
https://www.readbyqxmd.com/read/28183781/aligning-the-flow-cytometric-evaluation-with-the-diagnostic-need-an-evidence-based-approach
#4
Dawn Williams-Voorbeijpel, Francisco Sanchez, Christine G Roth
AIMS: Elimination of non-value added testing without compromising high-quality clinical care is an important mandate for laboratories in a value-based reimbursement system. The goal of this study was to determine the optimal combination of flow cytometric markers for a screening approach that balances efficiency and accuracy. METHODS: An audit over 9 months of flow cytometric testing was performed, including rereview of all dot plots from positive cases. RESULTS: Of the 807 cases in which leukaemia/lymphoma testing was performed, 23 were non-diagnostic and 189 represented bronchoalveolar lavage specimens...
February 9, 2017: Journal of Clinical Pathology
https://www.readbyqxmd.com/read/28175979/mind-the-treatment-gap-a-global-perspective-on-current-and-future-strategies-for-prevention-of-fragility-fractures
#5
REVIEW
N C W Harvey, E V McCloskey, P J Mitchell, B Dawson-Hughes, D D Pierroz, J-Y Reginster, R Rizzoli, C Cooper, J A Kanis
This narrative review considers the key challenges facing healthcare professionals and policymakers responsible for providing care to populations in relation to bone health. These challenges broadly fall into four distinct themes: (1) case finding and management of individuals at high risk of fracture, (2) public awareness of osteoporosis and fragility fractures, (3) reimbursement and health system policy and (4) epidemiology of fracture in the developing world. Findings from cohort studies, randomised controlled trials, systematic reviews and meta-analyses, in addition to current clinical guidelines, position papers and national and international audits, are summarised, with the intention of providing a prioritised approach to delivery of optimal bone health for all...
February 7, 2017: Osteoporosis International
https://www.readbyqxmd.com/read/28170173/the-3rs-of-cell-therapy
#6
Arnold I Caplan, Chris Mason, Brock Reeve
The 3Rs for a good education are "reading, 'riting, and 'rithmetic." The basis for good health care solutions for the emergent field of cell therapy in the future will also involve 3Rs: regulation, reimbursement, and realization of value. The business models in this new field of cell therapy will involve these 3Rs. This article brings forth realities facing this new industry for its approaches to provide curative health care solutions. Stem Cells Translational Medicine 2017;6:17-21.
January 2017: Stem Cells Translational Medicine
https://www.readbyqxmd.com/read/28169976/the-impact-of-alternative-payment-in-chronically-ill-and-older-patients-in-the-patient-centered-medical-home
#7
Claudia A Salzberg, Asaf Bitton, Stuart R Lipsitz, Cal Franz, Shimon Shaykevich, Lisa P Newmark, Japneet Kwatra, David W Bates
BACKGROUND: Patient-centered medical home (PCMH) has gained prominence as a promising model to encourage improved primary care delivery. There is a paucity of studies that evaluate the impact of payment models in the PCMH. OBJECTIVES: We sought to examine whether coupling coordinated, team-based care transformation plan with a novel reimbursement model affects outcomes related to expenditures and utilization. RESEARCH DESIGN: Interrupted time-series model with a difference-in-differences approach to assess differences between intervention and control groups, across time periods attributable to PCMH transformation and/or payment change...
February 6, 2017: Medical Care
https://www.readbyqxmd.com/read/28166172/cost-and-cost-effectiveness-analysis-of-treatment-options-for-sanders-ii-and-iii-calcaneus-fractures-in-laborers
#8
R Carter Clement, Pamela J Lang, Brett J Pettett, Robert A Overman, Robert F Ostrum, Josh N Tennant
OBJECTIVE: This study compares the cost and cost-effectiveness of treatments options for Sanders II/III displaced intra-articular calcaneus fractures (DIACF's) in laborers. METHODS: Literature on Sanders type II and III fractures was reviewed to determine complication rates and utility values for each treatment option. Costs were calculated using Medicare reimbursement and implant prices from our institution. Monte Carlo simulations were used to analyze a decision-tree to determine the cost and cost-effectiveness of each treatment from a societal perspective...
January 30, 2017: Journal of Orthopaedic Trauma
https://www.readbyqxmd.com/read/28152718/ontario-s-approach-to-tackling-drug-funding-sustainability
#9
Scott Gavura, Robin McLeod, Virginia McLaughlin, Craig Earle, Jessica Arias, Michelle Rey, Hasina Jamal
: 38 Background: One of the challenges facing Ontario relates to managing the rising costs of cancer drug treatments. The annual growth rate of cancer drug spending has increased by 10-20% since 2010, exceeding other therapeutic categories and is expected to continue to grow significantly faster than expenditures in other areas. Paradoxically, the price of a drug seems to have little relation to its demonstrated efficacy ( http://www.asco.org/practice-research/cancer-care-america-2015/focus-cost )...
March 2016: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
https://www.readbyqxmd.com/read/28152692/pathway-map-development-as-an-approach-to-identifying-priority-areas-for-quality-improvement-in-ontario
#10
Jasmin Soobrian, Joan Murphy, Lorraine Elit, Michael F Milosevic, Angelika Gollnow, Jillian Ross, Claire Holloway
: 108 Background: Disease Pathway Management (DPM) is the unifying approach to the way in which Cancer Care Ontario (CCO) sets priorities for cancer control, plans cancer services and improves the quality of care in Ontario. In 2014 DPM began developing a cervical cancer pathway map (CCPM) to map the patient journey along the cervical cancer care continuum. OBJECTIVE: to report on the CPPM development process as a tool to identify key priorities for cervical cancer management in Ontario...
March 2016: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
https://www.readbyqxmd.com/read/28151532/-transcatheter-aortic-valve-implantation-versus-aortic-valve-replacement-cost-analysis-from-the-regional-health-service-and-hospital-perspectives
#11
Elena Berti, Daniela Fortuna, Simona Bartoli, Cristina Ciuca, Anna Orlando, Salvatore Scondotto, Nera Agabiti, Stefano Salizzoni, Tiziana Claudia Aranzulla, Caterina Gandolfo, Rossana De Palma, Francesco Saia
BACKGROUND: The aim of this study was to estimate the cost of transcatheter aortic valve implantation (TAVI) and surgical aortic valve replacement (AVR) procedures, together with the cost of the first-year hospitalizations following the index ones, in 4 Italian regions where diffusion level of TAVI and coverage decisions are different. METHODS: The cost analysis was performed evaluating 372 patients enrolled consecutively from December 1, 2012 to September 30, 2015...
December 2016: Giornale Italiano di Cardiologia
https://www.readbyqxmd.com/read/28140779/social-ecological-perspectives-of-tube-feeding-older-adults-with-advanced-dementia-a-systematic-literature-review
#12
Joy W Douglas, Jeannine C Lawrence, Lori W Turner
Dementia is a progressive, debilitating disease that often results in weight loss, malnutrition, and dehydration. Feeding tubes are often prescribed; however, this practice can lead to complications. The purpose of this systematic review was to examine the use of feeding tubes in elderly demented patients from a social ecological perspective. Results indicated that family members often receive inadequate decision-making education. Many health care professionals lack knowledge of evidence-based guidelines pertaining to feeding tube use...
January 2017: Journal of Nutrition in Gerontology and Geriatrics
https://www.readbyqxmd.com/read/28139425/factors-influencing-the-food-purchases-of-early-care-and-education-providers
#13
Jennifer J Otten, Tad Hirsch, Catherine Lim
BACKGROUND: With the majority of US children enrolled in some form of early care and education, the settings for early care and education represent a valuable opportunity to positively impact young children's diets and their interactions with food. Little evidence exists on how early care and education providers make food purchasing and service decisions for this population of young children. OBJECTIVE: Our aim was to explore the factors that influence early care and education providers' food purchasing and service decisions...
January 27, 2017: Journal of the Academy of Nutrition and Dietetics
https://www.readbyqxmd.com/read/28138988/telemedical-care-and-monitoring-for-patients-with-chronic-heart-failure-has-a-positive-effect-on-survival
#14
Robert Herold, Neeltje van den Berg, Marcus Dörr, Wolfgang Hoffmann
BACKGROUND: Telemedical care and monitoring programs for patients with chronic heart failure have shown beneficial effects on survival in several small studies. The utility in routine care remains unclear. METHODS: We evaluated a large-sized telemedicine program in a routine care setting, enrolling in total 2,622 patients (54.7 percent male, mean age: 73.7 years) with chronic heart failure. We used reimbursement data from a large statutory health insurance and approached a matched control analysis...
January 31, 2017: Health Services Research
https://www.readbyqxmd.com/read/28137263/healthcare-providers-views-on-the-delivery-of-preconception-care-in-a-local-community-setting-in-the-netherlands
#15
M Poels, M P H Koster, A Franx, H F van Stel
BACKGROUND: The attention for preconception care (PCC) has grown substantially in recent years, yet PCC is far from routine in daily practice. One of the major challenges for the implementation of PCC is to identify how it can best be organized and provided within the primary care setting. The aim of this study was to identify bottlenecks and solutions for the delivery of PCC from a healthcare providers' perspective in a local community setting in the Netherlands. METHODS: Health professionals within the region of Zeist, the Netherlands, were invited for a meeting on the local implementation of PCC...
January 31, 2017: BMC Health Services Research
https://www.readbyqxmd.com/read/28133951/cost-effective-approach-to-the-diagnostic-workup-of-b-cell-lymphoproliferative-disorders-via-optimal-integration-of-flow-cytometric-data
#16
E F Mason, E A Morgan, G S Pinkus, O Pozdnyakova
INTRODUCTION: The workup of lymphoproliferative disorders (LPDs) involves the combined use of flow cytometry (FC) and immunohistochemistry (IHC). This often results in duplicate immunophenotypic testing and adds costs that may not be eligible for reimbursement based on the Medicare National Correct Coding Initiative. We aimed to establish a cost-effective diagnostic algorithm based on initial FC categorization to reduce repetitive immunophenotyping. METHODS: We retrospectively reviewed 242 cases of suspected LPDs with concurrent FC and IHC testing over a 12-month period...
January 30, 2017: International Journal of Laboratory Hematology
https://www.readbyqxmd.com/read/28121775/a-cost-benefit-analysis-of-a-state-funded-healthy-homes-program-for-residents-with-asthma-findings-from-the-new-york-state-healthy-neighborhoods-program
#17
Marta Gomez, Amanda L Reddy, Sherry L Dixon, Jonathan Wilson, David E Jacobs
CONTEXT: Despite considerable evidence that the economic and other benefits of asthma home visits far exceed their cost, few health care payers reimburse or provide coverage for these services. OBJECTIVE: To evaluate the cost and savings of the asthma intervention of a state-funded healthy homes program. DESIGN: Pre- versus postintervention comparisons of asthma outcomes for visits conducted during 2008-2012. SETTING: The New York State Healthy Neighborhoods Program operates in select communities with a higher burden of housing-related illness and associated risk factors...
March 2017: Journal of Public Health Management and Practice: JPHMP
https://www.readbyqxmd.com/read/28112566/costs-of-providing-infusion-therapy-for-patients-with-inflammatory-bowel-disease-in-a-hospital-based-infusion-center-setting
#18
Anita Afzali, Kristine Ogden, Michael L Friedman, Jingdong Chao, Anthony Wang
Aims Inflammatory bowel disease (IBD) (e.g., ulcerative colitis [UC] and Crohn's disease [CD]) severely impacts patient quality of life. Moderate to severe disease is often treated with biologics requiring infusion therapy, adding incremental costs beyond drug costs. This study evaluates US hospital-based infusion services costs for treatment of UC or CD patients receiving infliximab or vedolizumab therapy. Materials and methods A model was developed, estimating annual costs of providing monitored infusions using activity-based costing framework approach...
January 23, 2017: Journal of Medical Economics
https://www.readbyqxmd.com/read/28105876/what-drives-continuous-improvement-project-success-in-healthcare
#19
Paul Stelson, Joshua Hille, Chinweike Eseonu, Toni Doolen
Purpose The purpose of this paper is to present findings from a study of factors that affect continuous improvement (CI) project success in hospitals. Design/methodology/approach Quantitative regression analysis was performed on Likert scale survey responses. Qualitative thematic analysis was performed on open-ended survey responses and written reports on CI projects. Findings The paper identifies managerial and employee factors that affect project success. These factors include managerial support, communication, and affective commitment...
February 13, 2017: International Journal of Health Care Quality Assurance
https://www.readbyqxmd.com/read/28103613/tissue-based-next-generation-sequencing-application-in-a-universal-healthcare-system
#20
REVIEW
Seán O Hynes, Brendan Pang, Jacqueline A James, Perry Maxwell, Manuel Salto-Tellez
In the context of solid tumours, the evolution of cancer therapies to more targeted and nuanced approaches has led to the impetus for personalised medicine. The targets for these therapies are largely based on the driving genetic mutations of the tumours. To track these multiple driving mutations the use of next generation sequencing (NGS) coupled with a morphomolecular approach to tumours, has the potential to deliver on the promises of personalised medicine. A review of NGS and its application in a universal healthcare (UHC) setting is undertaken as the technology has a wide appeal and utility in diagnostic, clinical trial and research paradigms...
January 19, 2017: British Journal of Cancer
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