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Reimbursement approaches

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https://www.readbyqxmd.com/read/29678127/a-health-economic-model-to-assess-the-cost-effectiveness-of-optifast-%C3%A2-for-the-treatment-of-obesity-in-usa
#1
Mark Nuijten, Agnieszka Marczewska, Krysmaru Araujo Torress, Bahareh Rasouli, Moreno Perugini
OBJECTIVES: Obesity is associated with high direct medical costs and indirect costs resulting from productivity loss. High prevalence of obesity generates a justified need to identify cost-effective weight loss approaches from a payer's perspective. Within the variety of weight management techniques, OPTIFAST® is a clinically recognized and scientifically proven total meal replacement Low Calorie Diet that provides meaningful results in terms of weight loss and reduction in comorbidities...
April 20, 2018: Journal of Medical Economics
https://www.readbyqxmd.com/read/29677911/detecting-and-resolving-data-conflicts-when-using-international-claims-data-for-research
#2
Christian Haux, Olivier Kalmus, Anna-Lena Trescher, Frank Gabel, Stefan Listl, Petra Knaup
Using claims data for research is well established. However, most claims data analyses are focused on single countries. Multi-national approaches are scarce. The application of different anonymization techniques before data are shared for research as well as differences in the reimbursement systems hamper the use of claims data from multiple countries. This paper analyses data conflicts that occur when international claims data sets are used for research and develops a generic process to detect and resolve these conflicts...
2018: Studies in Health Technology and Informatics
https://www.readbyqxmd.com/read/29667385/chance-of-reimbursement-for-add-on-therapies-in-poland-and-in-the-world-review-of-the-reimbursement-recommendations
#3
Ewa Borowiack, Magdalena Marzec, Anna Nowotarska, Joanna Jarosz, Agata Orkisz, Patrycja Prząda-Machno
INTRODUCTION: Oncology drugs combined with standard therapies (so-called add-on therapies, e.g. bevacizumab, palbociclib) often receive negative recommendations regarding the legitimacy of public financing, issued by government agencies responsible for their assessment, i.e. health technology assessment agencies. The aim of the study was to estimate the scale of the problem related to the reimbursement of add-on therapies used in the treatment of breast and genitourinary cancers in Poland and in the world...
2018: Przegla̧d Epidemiologiczny
https://www.readbyqxmd.com/read/29625615/to-fill-or-not-to-fill-a-qualitative-cross-country-study-on-dentists-decisions-in-managing-non-cavitated-proximal-caries-lesions
#4
F Schwendicke, L A Foster Page, L A Smith, M Fontana, W M Thomson, S R Baker
BACKGROUND: This study aimed to identify barriers and enablers for dentists managing non-cavitated proximal caries lesions using non- or micro-invasive (NI/MI) approaches rather than invasive and restorative methods in New Zealand, Germany and the USA. METHODS: Semi-structured interviews were conducted, focusing on non-cavitated proximal caries lesions (radiographically confined to enamel or the outer dentine). Twelve dentists from New Zealand, 12 from Germany and 20 from the state of Michigan (USA) were interviewed...
April 6, 2018: Implementation Science: IS
https://www.readbyqxmd.com/read/29624799/a-checklist-for-managed-access-programmes-for-reimbursement-co-designed-by-canadian-patients-and-caregivers
#5
Andrea Young, Devidas Menon, Jackie Street, Walla Al-Hertani, Tania Stafinski
INTRODUCTION: Reimbursement decisions on orphan drugs carry significant uncertainty, and as the amount increases, so does the risk of making a wrong decision, where harms outweigh benefits. Consequently, patients often face limited access to orphan drugs. Managed access programmes (MAPs) are a mechanism for managing risk while enabling access to potentially beneficial drugs. Patients and their caregivers have expressed support for these programmes and see patient input as critical to successful implementation...
April 6, 2018: Health Expectations: An International Journal of Public Participation in Health Care and Health Policy
https://www.readbyqxmd.com/read/29623863/-fibronectin-test-in-threatened-preterm-labour-cost-saving-but-not-yet-widely-implemented-in-the-netherlands
#6
T M S van Winden, M M C Bruijn, M A Oudijk, G J van Baaren, A H L C van Kaam, B W J Mol, M Kok
OBJECTIVE: Analysis of national implementation of the foetal fibronectin test in the diagnostics of threatened preterm labour in the Netherlands, and indication of the possible obstacles and consequences of implementation or no implementation. DESIGN: National questionnaire, retrospective cohort study and cost-effectiveness calculation. METHODS: We approached all hospitals in the Netherlands (n = 86) with a questionnaire on use of the fibronectin test...
2018: Nederlands Tijdschrift Voor Geneeskunde
https://www.readbyqxmd.com/read/29623625/applying-a-multicriteria-decision-analysis-mcda-approach-to-elicit-stakeholders-preferences-in-italy-the-case-of-obinutuzumab-for-rituximab-refractory-indolent-non-hodgkin-lymphoma-inhl
#7
Martina Garau, Grace Hampson, Nancy Devlin, Nicola Amedeo Mazzanti, Antonio Profico
BACKGROUND: Healthcare decision makers need to make trade-offs between different elements of value of new treatments. Multicriteria decision analysis (MCDA) provides a framework that can help decision makers to understand stakeholders' preferences and be explicit about the trade-offs that are being made. OBJECTIVE: The objective of this study was to use MCDA to obtain preferences and views on decision criteria across three stakeholder groups (patients, clinicians and payers) in Italy and to use these to assess the performance of obinutuzumab for rituximab-refractory indolent non-Hodgkin lymphoma (iNHL)...
August 22, 2017: PharmacoEconomics open
https://www.readbyqxmd.com/read/29622004/redefining-diagnosis-related-groups-drgs-for-palliative-care-a-cross-sectional-study-in-two-german-centres
#8
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
#9
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/29608503/risk-adjusted-overall-mortality-as-a-quality-measure-in-the-cardiovascular-intensive-care-unit
#10
Michael Goldfarb
Risk-adjusted mortality has been proposed as a quality of care indicator to gauge Cardiovascular Intensive Care Unit (CICU) performance. Mortality is easily measured, readily understandable, and a meaningful outcome for the patient, provider, administrative agencies, and other key stakeholders. Disease-specific risk-adjusted mortality is commonly used in cardiovascular medicine as an indicator of care quality, for external accreditation, and to determine payer reimbursement. However, the evidence base for overall risk-adjusted mortality in the CICU is limited, with most available data coming from the general critical care literature...
March 30, 2018: Cardiology in Review
https://www.readbyqxmd.com/read/29607150/robotic-surgery-video-assisted-thoracic-surgery-and-open-surgery-for-early-stage-lung-cancer-comparison-of-costs-and-outcomes-at-a-single-institute
#11
Pierluigi Novellis, Edoardo Bottoni, Emanuele Voulaz, Umberto Cariboni, Alberto Testori, Luca Bertolaccini, Laura Giordano, Elisa Dieci, Lorenzo Granato, Elena Vanni, Marco Montorsi, Marco Alloisio, Giulia Veronesi
Background: Robotic surgery is increasingly used to resect lung cancer. However costs are high. We compared costs and outcomes for robotic surgery, video-assisted thoracic surgery (VATS), and open surgery, to treat non-small cell lung cancer (NSCLC). Methods: We retrospectively assessed 103 consecutive patients given lobectomy or segmentectomy for clinical stage I or II NSCLC. Three surgeons could choose VATS or open, the fourth could choose between all three techniques...
February 2018: Journal of Thoracic Disease
https://www.readbyqxmd.com/read/29606288/the-impact-of-pay-for-performance-on-the-quality-of-care-in-ophthalmology-empirical-evidence-from-germany
#12
T Herbst, J Foerster, M Emmert
BACKGROUND: Pay-for-performance (P4P) has become a popular approach to increase effectiveness and efficiency in healthcare. So far, there is little evidence regarding the potential of P4P in the German healthcare setting. The aim of this study was to determine the impact of P4P on the quality of care in cataract surgery. METHODS: In 2012, a P4P program was implemented in a German surgical centre for ophthalmology. Five quality measures regarding process quality, outcomes, and patient satisfaction were measured over a period of 4...
March 22, 2018: Health Policy
https://www.readbyqxmd.com/read/29596984/cost-effectiveness-of-biomarker-tests-for-irritable-bowel-syndrome-with-diarrhea-a-framework-for-payers
#13
Christopher V Almario, Benjamin D Noah, Alma Jusufagic, Daniel Lew, Brennan M R Spiegel
BACKGROUND & AIMS: Diagnosis of diarrhea-predominant irritable bowel syndrome (IBS-D) relies on the Rome IV symptom-based criteria, which are imperfect for separating functional vs organic disease. Biomarker tests for IBS-D might be added to symptom data to allow clinicians to make more accurate and precise diagnoses in a cost-effective manner. We tested the economic consequences of using a range of hypothetical IBS-D biomarkers, and explored at what cost and level of accuracy a biomarker becomes cost effective...
March 26, 2018: Clinical Gastroenterology and Hepatology
https://www.readbyqxmd.com/read/29590422/veteran-experiences-seeking-non-pharmacologic-approaches-for-pain
#14
Karleen Giannitrapani, Matthew McCaa, Marie Haverfield, Robert D Kerns, Christine Timko, Steven Dobscha, Karl Lorenz
Introduction: Pain is a longstanding and growing concern among US military veterans. Although many individuals rely on medications, a growing body of literature supports the use of complementary non-pharmacologic approaches when treating pain. Our objective is to characterize veteran experiences with and barriers to accessing alternatives to medication (e.g., non-pharmacologic treatments or non-pharmacologic approaches) for pain in primary care. Materials and Methods: Data for this qualitative analysis were collected as part of the Effective Screening for Pain (ESP) study (2012-2017), a national randomized controlled trial of pain screening and assessment methods...
March 26, 2018: Military Medicine
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
#15
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/29565650/recent-advances-in-theranostics-and-challenges-for-the-future
#16
J Harvey Turner
Theranostic nuclear oncology is on the cusp of adoption into routine clinical management of neuroendocrine tumours (NETs) following publication of the Phase 3 randomized controlled trial, NETTER-1. For the first time, level 1b evidence of efficacy and safety of 68-gallium/177 lutetium-DOTA-octreotatepeptide receptor radionuclide therapy (PRRT), of midgut NETs was established. Multicentre Phase 2 studies of 68-gallium/177 lutetium-PSMA theranostic approaches to management of end-stage metastatic castrate-resistant prostate cancer (mCRPC), are also very encouraging...
March 22, 2018: British Journal of Radiology
https://www.readbyqxmd.com/read/29544345/communicating-a-diagnosis-of-dementia-a-systematic-mixed-studies-review-of-attitudes-and-practices-of-health-practitioners
#17
Lee-Fay Low, Margaret McGrath, Kate Swaffer, Henry Brodaty
The aim of this study is to systematically review practitioners' practices and attitudes in regards to communicating a diagnosis of dementia. A systematic search was conducted of Scopus, Web of Science and PubMed for English language original empirical papers. A sequential explanatory mixed studies analysis approach was used. Twenty-five quantitative descriptive, two intervention, six mixed methods descriptive and 21 qualitative studies were included. Pooled analysis showed that 34% of GPs and 48% of specialists usually/routinely tell the person with dementia their diagnosis, and 89% of GPs and 97% specialists usually/routinely tell the family the diagnosis...
January 1, 2018: Dementia
https://www.readbyqxmd.com/read/29533689/effects-of-arthroscopy-for-femoroacetabular-impingement-syndrome-on-quality-of-life-and-economic-outcomes
#18
Richard C Mather, Shane J Nho, Andrew Federer, Berna Demiralp, Jennifer Nguyen, Asha Saavoss, Michael J Salata, Marc J Philippon, Asheesh Bedi, Christopher M Larson, J W Thomas Byrd, Lane Koenig
BACKGROUND: The diagnosis and treatment of femoroacetabular impingement (FAI) have increased steadily within the past decade, and research indicates clinically significant improvements after treatment of FAI with hip arthroscopy. PURPOSE: This study examined the societal and economic impact of hip arthroscopy by high-volume surgeons for patients with FAI syndrome aged <50 years with noncontroversial diagnosis and indications for surgery. STUDY DESIGN: Economic and decision analysis; Level of evidence, 2...
March 1, 2018: American Journal of Sports Medicine
https://www.readbyqxmd.com/read/29530670/policy-change-is-not-enough-engaging-provider-champions-on-immediate-postpartum-contraception
#19
Ekwutosi M Okoroh, Debra J Kane, Rebekah E Gee, Lyn Kieltyka, Brittni N Frederiksen, Katharyn M Baca, Kristin M Rankin, David A Goodman, Charlan D Kroelinger, Wanda D Barfield
Rates of short interval pregnancies resulting in unintended pregnancies remain high in the United States and contribute to adverse reproductive health outcomes. Long-acting reversible contraception (LARC) methods have annual failure rates of less than 1% compared with 9% for oral contraceptive pills, and are an effective strategy to reduce unintended pregnancies. To increase access to LARCs in the immediate postpartum period, several State Medicaid programs, including those in Iowa (IA) and Louisiana (LA), recently established reimbursement policies to remove the barriers to reimbursement of immediate postpartum LARC insertion...
March 9, 2018: American Journal of Obstetrics and Gynecology
https://www.readbyqxmd.com/read/29524302/treatment-outcomes-of-tb-infected-individuals-attending-public-sector-primary-care-clinics-from-january-2015-to-april-2017-a-retrospective-cohort-study
#20
Eugene Wickett, André Peralta-Santos, Jason Beste, Mary Micikas, Foriest Toe, Julia Rogers, Lassana Jabateh, Bradley H Wagenaar
OBJECTIVES: In June 2015, Partners in Health (PIH) and the Liberian Ministry of Health began a community health worker (CHW) program containing food support, reimbursement of transport and social assistance to address gaps in tuberculosis (TB) treatment exacerbated by the 2014-2015 Ebola-virus disease (EVD) epidemic. The purpose of this article is to analyze the performance of routine clinical TB care and the effects of this CHW program. METHODS: Retrospective cohort study utilizing data from TB patient registers at a census of all health facilities treating TB in southeastern Liberia from January 2015 - April 2017...
March 9, 2018: Tropical Medicine & International Health: TM & IH
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