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Reimbursement approaches

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https://www.readbyqxmd.com/read/27909140/longterm-work-productivity-costs-due-to-absenteeism-and-permanent-work-disability-in-patients-with-early-rheumatoid-arthritis-a-nationwide-register-study-of-7831-patients
#1
Janne A Martikainen, Hannu Kautiainen, Vappu Rantalaiho, Kari T Puolakka
OBJECTIVE: To estimate the development and potential disproportional distribution of longterm productivity costs (PC) and their determinants leading to work absenteeism and permanent work disability in working-aged patients with early rheumatoid arthritis (RA). METHODS: A cohort of subjects with early RA was created by identifying the new cases of RA from the national drug reimbursement register that had been granted a special reimbursement for their antirheumatic medications for RA from 2000-2007...
December 2016: Journal of Rheumatology
https://www.readbyqxmd.com/read/27889785/overcoming-cost-implications-of-mutational-analysis-in-patients-with-gastrointestinal-stromal-tumors-a-pragmatic-approach
#2
Patrick Schöffski, Agnieszka Wozniak, Oliver Schöffski, Liesbet van Eycken, Maria Debiec-Rychter
BACKGROUND: Genetic analysis of tissue derived from patients with advanced gastrointestinal stromal tumors (GISTs) is not uniformly applied on a national and international level, even though mutational data can provide clinically relevant prognostic and predictive information, especially in patients qualifying for treatment with expensive targeted agents. METHODS: The current article describes the rationale for genetic testing of GIST tissue, looks at financial implications associated with such analysis and speculates on potential cost savings introduced by routine mutational testing and tailored use of tyrosine kinase inhibitors based on genotyping...
2016: Oncology Research and Treatment
https://www.readbyqxmd.com/read/27886354/a-retrospective-analysis-of-the-merits-and-challenges-associated-with-simultaneous-bilateral-tha-using-the-direct-anterior-approach
#3
Matthew L Brown, Johannes F Plate, David C Holst, Daniel N Bracey, Matthew W Bullock, Jason E Lang
INTRODUCTION: 15%-20% of patients presenting for total hip arthroplasty (THA) have bilateral disease. While simultaneous bilateral THA is of interest to patients and surgeons, debate persists regarding its merits. The majority of previous reports on simultaneous bilateral THA involve patients in the lateral decubitus position, which require repositioning, prepping and draping, and exposure of a fresh wound to pressure and manipulation for the contralateral THA. The purpose of this study was to compare complications, component position, and financial parameters for simultaneous versus staged bilateral THAs using the direct anterior approach (DAA)...
November 14, 2016: Hip International: the Journal of Clinical and Experimental Research on Hip Pathology and Therapy
https://www.readbyqxmd.com/read/27885590/payment-reform-needed-to-address-health-disparities-of-undiagnosed-diabetic-retinopathy-in-the-city-of-chicago
#4
Dustin D French, Jess J Behrens, Kathryn L Jackson, Abel N Kho, Theresa L Walunas, Charlesnika T Evans, Michael Mbagwu, Curtis E Margo, Paul J Bryar
INTRODUCTION: The Affordable Care Act (ACA) has expanded health coverage for thousands of Illinois residents. Expanded coverage, however, does not guarantee appropriate health care. Diabetes and its ocular complications serve as an example of how providers in underserved urban areas may not be able to keep up with new demand for labor- and technology-intensive health care unless changes in reimbursement policies are instituted. METHODS: A retrospective cohort study was conducted using medical encounter information from the Chicago HealthLNK Data Repository (HDR), an assembly of non-duplicated and de-identified patient medical records...
November 24, 2016: Ophthalmology and Therapy
https://www.readbyqxmd.com/read/27884928/macra-2-0-are-you-ready-for-mips
#5
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/27881280/global-budget-for-cyprus-national-health-system-the-promised-land-or-a-no-man-s-land
#6
Panagiotis Petrou
BACKGROUND: Soaring health expenditures worldwide call for potent cost-containment approaches. Global budgets have been used by several countries to harness their health expenditures by constraining the total payable amount to a predefined budget threshold. OBJECTIVES: Cyprus is vacillating on the use of a global budget for its National Health System; nevertheless, its attributes must be scrutinized to rule out potential adverse effects on quality of care and access of patients...
September 2016: Value in Health Regional Issues
https://www.readbyqxmd.com/read/27875835/the-relevance-of-palliative-care-in-hiv-and-aging
#7
Jacqueline Shorthill, Rosanna F DeMarco
The connection between palliative care and HIV infection has deep and wide roots in the United States that go back to the time when many gay men in the early 1980s were dying from a disease we knew little about, and there was no way to help but to alleviate symptoms in hospice and end of life centers across the United States. More individuals (adults and children), families, and communities attribute the success of antiretroviral therapies and other therapeutic approaches to advancing quality of life and life itself today...
2017: Interdisciplinary Topics in Gerontology and Geriatrics
https://www.readbyqxmd.com/read/27858368/valuing-meta-health-effects-for-use-in-economic-evaluations-to-inform-reimbursement-decisions-a-review-of-the-evidence
#8
REVIEW
Richard De Abreu Lourenco, Marion Haas, Jane Hall, Rosalie Viney
OBJECTIVE: This review explores the evidence from the literature regarding how meta-health effects (effects other than health resulting from the consumption of health care) are valued for use in economic evaluations. METHODS: A systematic review of the published literature (the EMBASE, MEDLINE, PsycINFO, CINAHL, EconLit and SocINDEX databases were searched for publications in March 2016, plus manual searching) investigated the associations between study methods and the resulting values for meta-health effects estimated for use in economic evaluations...
November 17, 2016: PharmacoEconomics
https://www.readbyqxmd.com/read/27857828/determining-the-value-of-medical-technologies-to-treat-ultra-rare-disorders-a-consensus-statement
#9
Michael Schlander, Silvio Garattini, Peter Kolominsky-Rabas, Erik Nord, Ulf Persson, Maarten Postma, Jeff Richardson, Steven Simoens, Oriol de Solà-Morales, Keith Tolley, Mondher Toumi
BACKGROUND: In most jurisdictions, policies have been adopted to encourage the development of treatments for rare or orphan diseases. While successful as assessed against their primary objective, these policies have prompted concerns among payers about the economic burden that might be caused by an annual cost per patient in some cases exceeding 100,000 Euro. At the same time, many drugs for rare disorders do not meet conventional standards for cost-effectiveness or 'value for money'...
2016: Journal of Market Access & Health Policy
https://www.readbyqxmd.com/read/27855751/financial-analysis-of-an-intensive-pediatric-continuous-positive-airway-pressure-program
#10
E Brooks Riley, Evan S Fieldston, Melissa S Xanthopoulos, Suzanne E Beck, Mary Kate Menello, Edward Matthews, Carole L Marcus
STUDY OBJECTIVES: Continuous positive airway pressure (CPAP) is effective in treating obstructive sleep apnea in children, but adherence to therapy is low. Our center created an intensive program that aimed to improve adherence. Our objective was to estimate the program's efficacy, cost, revenue and break-even point in a generalizable manner relative to a standard approach. METHODS: The intensive program included device consignment, behavioral psychology counseling and follow-up telephone calls...
November 14, 2016: Sleep
https://www.readbyqxmd.com/read/27852357/a-multifaceted-approach-to-reduction-of-catheter-associated-urinary-tract-infections-in-the-intensive-care-unit-with-an-emphasis-on-stewardship-of-culturing
#11
Katherine M Mullin, Christopher S Kovacs, Cynthia Fatica, Colette Einloth, Elizabeth A Neuner, Jorge A Guzman, Eric Kaiser, Venu Menon, Leticia Castillo, Marc J Popovich, Edward M Manno, Steven M Gordon, Thomas G Fraser
BACKGROUND Catheter-associated urinary tract infections (CAUTIs) are among the most common hospital-acquired infections (HAIs). Reducing CAUTI rates has become a major focus of attention due to increasing public health concerns and reimbursement implications. OBJECTIVE To implement and describe a multifaceted intervention to decrease CAUTIs in our ICUs with an emphasis on indications for obtaining a urine culture. METHODS A project team composed of all critical care disciplines was assembled to address an institutional goal of decreasing CAUTIs...
November 17, 2016: Infection Control and Hospital Epidemiology
https://www.readbyqxmd.com/read/27836506/evaluating-community-health-centers-adoption-of-a-new-global-capitation-payment-echange-study-protocol
#12
H Angier, J P O'Malley, M Marino, K J McConnell, E Cottrell, R L Jacob, S Likumahuwa-Ackman, J Heintzman, N Huguet, S R Bailey, J E DeVoe
Primary care patient-centered medical homes (PCMHs) are an effective healthcare delivery model. Evidence regarding the most effective payment models for increased coordination efforts is sparse. This protocol paper describes the evaluation of an Alternative Payment Methodology (APM) implemented in a subset of Oregon community health centers (CHCs), using a prospective matched observational design. The APM is a primary care payment reform intervention that changed Oregon's Medicaid payment for several CHCs from fee-for-service reimbursement to a per-member-per-month capitated payment...
November 9, 2016: Contemporary Clinical Trials
https://www.readbyqxmd.com/read/27834601/understanding-healthcare-innovation-systems-the-stockholm-region-case
#13
Lisa-Marie Larisch, Isis Amer-Wåhlin, Patrik Hidefjäll
Purpose There is an increasing interest in understanding how innovation processes can address current challenges in healthcare. The purpose of this paper is to analyze the wider socio-economic context and conditions for such innovation processes in the Stockholm region, using the functional dynamics approach to innovation systems (ISs). Design/methodology/approach The analysis is based on triangulation using data from 16 in-depth interviews, two workshops, and additional documents. Using the functional dynamics approach, critical structural and functional components of the healthcare IS were analyzed...
November 21, 2016: Journal of Health Organization and Management
https://www.readbyqxmd.com/read/27799802/bringing-patient-centricity-to-diabetes-medication-access-in-canada
#14
REVIEW
Judith L Glennie, Katharina Kovacs Burns, Paul Oh
Canada must become proactive in addressing type 2 diabetes. With the second highest rate of diabetes prevalence in the developed world, the number of Canadians living with diabetes will soon reach epidemic levels. Against international comparisons, Canada also performs poorly with respect to diabetes-related hospitalizations, mortality rates, and access to medications. Diabetes and its comorbidities pose a significant burden on people with diabetes (PWD) and their families, through out-of-pocket expenses for medications, devices, supplies, and the support needed to manage their illness...
2016: ClinicoEconomics and Outcomes Research: CEOR
https://www.readbyqxmd.com/read/27796858/how-to-develop-and-implement-a-specialized-heart-failure-with-preserved-ejection-fraction-clinical-program
#15
REVIEW
Sanjiv J Shah, Rebecca Cogswell, John J Ryan, Kavita Sharma
Heart failure with preserved ejection fraction (HFpEF), a highly prevalent and complex clinical syndrome with high morbidity and mortality, is often unrecognized and not optimally treated. Clinical trials for HFpEF have been plagued by low enrollment, and clinicians often approach HFpEF patients with "therapeutic nihilism" given the perceived lack of available therapies based on the disappointing results of these prior trials. Due to these challenges, we have pioneered the successful creation of dedicated, specialized HFpEF clinical programs...
December 2016: Current Cardiology Reports
https://www.readbyqxmd.com/read/27788789/a-study-on-the-attitude-toward-kidney-transplantation-and-factors-among-hemodialysis-patients-in-china
#16
B Qiao, L Liu, J Liu, J Xie
BACKGROUND: Kidney transplantation (KT) is the most effective treatment for patients with end-stage renal disease. However, objective data regarding the willingness of patients with end-stage renal disease to undergo transplantation are lacking in China. The purpose of this study was to examine the attitudes and impact factors regarding KT among patients with end-stage renal disease undergoing hemodialysis. METHODS: This study used a cross-sectional approach. Between June and July 2015, a total of 326 hemodialysis outpatients completed a self-designed questionnaire to assess their attitudes toward KT and satisfaction with dialysis...
October 2016: Transplantation Proceedings
https://www.readbyqxmd.com/read/27785781/reflectance-confocal-microscopy-of-skin-in-vivo-from-bench-to-bedside
#17
Milind Rajadhyaksha, Ashfaq Marghoob, Anthony Rossi, Allan C Halpern, Kishwer S Nehal
Following more than two decades of effort, reflectance confocal microscopy (RCM) imaging of skin was granted codes for reimbursement by the US Centers for Medicare and Medicaid Services. Dermatologists in the USA have started billing and receiving reimbursement for the imaging procedure and for the reading and interpretation of images. RCM imaging combined with dermoscopic examination is guiding the triage of lesions into those that appear benign, which are being spared from biopsy, against those that appear suspicious, which are then biopsied...
October 27, 2016: Lasers in Surgery and Medicine
https://www.readbyqxmd.com/read/27766581/redesigning-diabetes-care-defining-the-role-of-endocrinologists-among-alternative-providers
#18
Samir Malkani, Sheri A Keitz, David M Harlan
The current diabetes epidemic threatens to overwhelm the healthcare system unless we redesign how diabetes care is delivered. The number of endocrinologists is grossly inadequate to provide care for all individuals with diabetes, but with the appropriate utilization of the primary care workforce and alternative healthcare providers working together in teams, effective diabetes care can be provided to all. We propose a patient-centered, goal-based approach with resources devoted to care coordination, measurement of outcomes, appropriate use of technology, and measurement of patient satisfaction...
December 2016: Current Diabetes Reports
https://www.readbyqxmd.com/read/27752810/a-perverse-quality-incentive-in-surgery-implications-of-reimbursing-surgeons-less-for-doing-laparoscopic-surgery
#19
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
https://www.readbyqxmd.com/read/27749480/insurance-status-and-hospital-payer-mix-are-linked-with-variation-in-metastatic-site-resection-in-patients-with-advanced-colorectal-cancers
#20
Mark A Healy, Jason C Pradarelli, Robert W Krell, Scott E Regenbogen, Pasithorn A Suwanabol
BACKGROUND: Despite substantially improved survival with metastatic site resection in colorectal cancers, uptake of aggressive surgical approaches remains low among certain patients. It is unknown whether financial determinants of care, such as insurance status, play a role in this treatment gap. OBJECTIVE: We sought to evaluate the effect of insurance status on metastasectomy in patients with advanced colorectal cancers. DESIGN: This was a retrospective cohort study...
November 2016: Diseases of the Colon and Rectum
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