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Guixiang Zhao, Catherine A Okoro, Jason Hsia, Machell Town
We examined associations of health insurance status with self-perceived poor/fair health and frequent mental distress (FMD) among working-aged US adults from 42 states and the District of Columbia using data from the 2014 Behavioral Risk Factor Surveillance System. After multiple-variable adjustment, compared with adequately insured adults, underinsured and never insured adults were 39% and 59% more likely to report poor/fair health, respectively, and 38% more likely to report FMD. Compared with working-aged adults with employer-based insurance, adults with Medicaid/Medicare or other public insurance coverage were 28% and 13% more likely to report poor/fair health, respectively, and 15% more likely to report FMD...
July 19, 2018: Preventing Chronic Disease
Girishanthy Krishnarajah, Elisabetta Malangone-Monaco, Liisa Palmer, Ellen Riehle, Philip O Buck
BACKGROUND: In the United States (US), diphtheria, tetanus, and acellular pertussis (DTaP) vaccination is recommended at 2, 4, and 6 months (doses 1-3), 15-18 months (dose 4), and 4-6 years (dose 5). The objective of this study (GSK study identifier: HO-14-14383) was to examine DTaP completion and compliance rates among commercially insured and Medicaid-enrolled children. Secondarily, the study aimed at identifying predictors of compliance/completion. METHODS: Truven Health MarketScan Commercial and Multi-State Medicaid databases (2005-2013) were analyzed separately...
July 19, 2018: Human Vaccines & Immunotherapeutics
Jean P Hall, Adele Shartzer, Noelle K Kurth, Kathleen C Thomas
Before the Patient Protection and Affordable Care Act (ACA), many Americans with disabilities were locked into poverty to maintain eligibility for Medicaid coverage. US Medicaid expansion under the ACA allows individuals to qualify for coverage without first going through a disability determination process and declaring an inability to work to obtain Supplemental Security Income. Medicaid expansion coverage also allows for greater income and imposes no asset tests. In this article, we share updates to our previous work documenting greater employment among people with disabilities living in Medicaid expansion states...
July 19, 2018: American Journal of Public Health
Kelly M Hatfield, Raymund B Dantes, James Baggs, Mathew R P Sapiano, Anthony E Fiore, John A Jernigan, Lauren Epstein
OBJECTIVES: To assess the variability in short-term sepsis mortality by hospital among Centers for Medicare and Medicaid Services beneficiaries in the United States during 2013-2014. DESIGN: A retrospective cohort design. SETTING: Hospitalizations from 3,068 acute care hospitals that participated in the Centers for Medicare and Medicaid Services inpatient prospective payment system in 2013 and 2014. PATIENTS: Medicare fee-for-service beneficiaries greater than or equal to 65 years old who had an inpatient hospitalization coded with present at admission severe sepsis or septic shock...
July 17, 2018: Critical Care Medicine
Andrea Larson, Lawrence M Berger, David C Mallinson, Eric Grodsky, Deborah B Ehrenthal
Prenatal care coordination programs direct pregnant Medicaid beneficiaries to medical, social, and educational services to improve birth outcomes. Despite the relevance of service context and treatment level to investigations of program implementation and estimates of program effect, prior investigations have not consistently attended to these factors. This study examines the reach and uptake of Wisconsin's Prenatal Care Coordination (PNCC) program among Medicaid-covered, residence occurrence live births between 2008 and 2012...
July 18, 2018: Journal of Community Health
Joshua M Liao, Anirban Basu, Christoph I Lee
In order to shift US health care towards greater value, the Centers for Medicare & Medicaid Services (CMS) is exploring outpatient episode-based cost measures under the new Quality Payment Program and planning a bundled payment program that will introduce the first ever outpatient episodes of care. One novel approach to capitalize on this paradigm shift and extend bundled payment policies is to engage primary care physicians and specialists by bundling outpatient imaging studies and associated procedures-central tools in disease screening and diagnosis, but also tools that are expensive and susceptible to increasing health care costs and patient harm...
July 18, 2018: Journal of General Internal Medicine
Donald P Rice, Michelle A Ordoveza, Ann M Palmer, George Y Wu, Lisa M Chirch
Direct-acting antiviral therapy is safe and cost-effective for the treatment of hepatitis C virus (HCV) infection. However, variability in drug payment rules represents a barrier to treatment that may disproportionately affect certain populations. We conducted a retrospective cohort study among HIV/HCV coinfected and HCV monoinfected patients using Kaplan-Meier and Fisher's exact test to analyze the time from the prescription of a direct-acting antiviral agent to delivery to the patient. Variables with significance p < ...
July 18, 2018: AIDS Care
Eric M VanEpps, Andrea B Troxel, Elizabeth Villamil, Kathryn A Saulsgiver, Jingsan Zhu, Jo-Yu Chin, Jacqueline Matson, Joseph Anarella, Patrick Roohan, Foster Gesten, Kevin G Volpp
PURPOSE: To determine whether different financial incentives are effective in promoting weight loss among prediabetic Medicaid recipients. DESIGN: Four-group, multicenter, randomized clinical trial. SETTING AND PARTICIPANTS: Medicaid managed care enrollees residing in New York, aged 18 to 64 years, and diagnosed as prediabetic or high risk for diabetes (N = 703). INTERVENTION: In a 16-week program, participants were randomly assigned to one of 4 arms: (1) control (no incentives), (2) process incentives for attending weekly Diabetes Prevention Program sessions, (3) outcome incentives for achieving weekly weight loss goals, and (4) combined process and outcome incentives...
January 1, 2018: American Journal of Health Promotion: AJHP
Karen E Joynt Maddox, E John Orav, Jie Zheng, Arnold M Epstein
BACKGROUND: The Center for Medicare and Medicaid Innovation (CMMI) launched the Bundled Payments for Care Improvement (BPCI) initiative in 2013. A subsequent study showed that the initiative was associated with reductions in Medicare payments for total joint replacement, but little is known about the effect of BPCI on medical conditions. METHODS: We used Medicare claims from 2013 through 2015 to identify admissions for the five most commonly selected medical conditions in BPCI: congestive heart failure (CHF), pneumonia, chronic obstructive pulmonary disease (COPD), sepsis, and acute myocardial infarction (AMI)...
July 19, 2018: New England Journal of Medicine
Wanzhen Gao, David Keleti, Thomas P Donia, Jim Jones, Karen E Michael, Andrea D Gelzer
OBJECTIVES: To investigate the effect of managed care organization (MCO)-implemented postdischarge engagement, supported by other broadly focused interventions, on 30-day hospital readmissions in 6 at-risk Medicaid populations. STUDY DESIGN: Prospective cohort study. METHODS: One-year follow-up analysis of member claims data was performed following an intervention period from January 1, 2014, to December 31, 2014. Postdischarge engagement, supported by additional MCO-initiated interventions, was implemented to reduce 30-day hospital readmissions in Medicaid members having 1 or more dominant chronic conditions...
July 1, 2018: American Journal of Managed Care
Mariétou H Ouayogodé, Ellen Meara, Chiang-Hua Chang, Stephanie R Raymond, Julie P W Bynum, Valerie A Lewis, Carrie H Colla
OBJECTIVES: Alternative payment models, such as accountable care organizations, hold provider groups accountable for an assigned patient population, but little is known about unassigned patients. We compared clinical and utilization profiles of patients attributable to a provider group with those of patients not attributable to any provider group. STUDY DESIGN: Cross-sectional study of 2012 Medicare fee-for-service beneficiaries 21 years and older. METHODS: We applied the Medicare Shared Savings Program attribution approach to assign beneficiaries to 2 mutually exclusive categories: attributable or unattributable...
July 1, 2018: American Journal of Managed Care
Shui Ling Wong, Landon Z Marshall, Kenneth A Lawson
OBJECTIVES: To compare prescription trends, costs, switch patterns, and mean adherence among oral anticoagulants in the Texas Medicaid population. STUDY DESIGN: Secondary analysis of Medicaid prescription claims data. METHODS: All oral anticoagulant prescriptions for patients aged 18 to 63 years with 1 or more prescription claims for an oral anticoagulant from July 1, 2010, to December 31, 2015, were included in utilization and expenditure trend analyses...
July 2018: American Journal of Managed Care
(no author information available yet)
This final rule revises the regulations under the Black Lung Benefits Act (BLBA or Act) governing the payment of medical benefits and maintains the level of care available to miners. The final rule establishes methods for determining the amounts that the Black Lung Disability Trust Fund (Trust Fund) will pay for covered medical services and treatments provided to entitled miners. The Department based the rule on payment formulas that the Centers for Medicare & Medicaid Services (CMS) uses to determine payments under the Medicare program, which are similar to the formulas used by other programs that the Office of Workers' Compensation Programs (OWCP) administers...
June 14, 2018: Federal Register
(no author information available yet)
This final rule finalizes a policy that provides flexibility in the determination of episode spending for Comprehensive Care for Joint Replacement Payment Model (CJR) participant hospitals located in areas impacted by extreme and uncontrollable circumstances for performance years 3 through 5.
June 8, 2018: Federal Register
Kristin N Ray, Jennifer R Marin, Joyce Li, Billie S Davis, Jeremy M Kahn
OBJECTIVE: Many emergency department (ED) transfers of children may be avoidable. Identifying hospital-level variables associated with avoidable transfers may guide system-level interventions to improve pediatric emergency care. We sought to examine hospital characteristics associated with ED transfers deemed "probably avoidable" in a large state Medicaid program. METHODS: We performed a retrospective cohort study using 2009-2013 claims data for Pennsylvania Medicaid beneficiaries...
July 18, 2018: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
Kathleen T Unroe, Nicole R Fowler, Jennifer L Carnahan, Laura R Holtz, Susan E Hickman, Shannon Effler, Russell Evans, Kathryn I Frank, Monica L Ott, Greg Sachs
Optimizing Patient Transfers, Impacting Medical Quality, and Improving Symptoms: Transforming Institutional Care (OPTIMISTIC) is a 2-phase Center for Medicare and Medicaid Innovations demonstration project now testing a novel Medicare Part B payment model for nursing facilities and practitioners in 40 Indiana nursing facilities. The new payment codes are intended to promote high-quality care in place for acutely ill long-stay residents. The focus of the initiative is to reduce hospitalizations through the diagnosis and on-site management of 6 common acute clinical conditions (linked to a majority of potentially avoidable hospitalizations of nursing facility residents): pneumonia, urinary tract infection, skin infection, heart failure, chronic obstructive pulmonary disease or asthma, and dehydration...
July 18, 2018: Journal of the American Geriatrics Society
Alexandra T Magliarditi, Lannah L Lua, Melissa A Kelley, David N Jackson
Objectives The Edinburgh Postnatal Depression Scale (EPDS) identifies women with depressive symptoms in pregnancy. Our primary objective was to determine the prevalence of EPDS screen-positive women delivering on our no prenatal care (laborist) service and to compare these patients to private patients delivering with prenatal care. Methods Retrospective cohort analysis of EPDS scores during January 1, 2015 to June 18, 2015 was conducted. Scores ≥ 10 were considered at-risk. Results were analyzed as an aggregate and then as no prenatal care versus prenatal care...
July 17, 2018: Maternal and Child Health Journal
Ori Liran, Judit Prus, Noa Gordon, Vered Almog, Tsipora Gruenewald, Daniel A Goldstein
OBJECTIVES: A recent theoretical economic model suggested that oversized vials of cancer drugs lead to $1.8 billion of drug wastage annually in the United States. It is currently unknown how precisely this theoretical model is consistent with the real world. We performed a real-world analysis to assess the economic impact of drug wastage. METHODS: We performed a systematic examination of the usage and wastage of all intravenous cancer drugs in the cancer center of a large tertiary care hospital in Israel...
July 12, 2018: Journal of the American Pharmacists Association: JAPhA
Vijaya T Daniel, Didem Ayturk, Doyle V Ward, Beth A McCormick, Heena P Santry
BACKGROUND: An association between lack of insurance and inferior outcomes has been well described for a number of surgical emergencies, yet little is known about the relationship of payor status and outcomes of patients undergoing emergent surgical repair for upper gastrointestinal (UGI) perforations. We evaluated the association of payor status and in-hospital mortality for patients undergoing emergency surgery for UGI perforations in the United States. METHODS: Nationwide Inpatient Sample (NIS) was queried to identify patients between 18 and 64 years of age who underwent emergent (open or laparoscopic) repair for UGI perforations secondary to peptic ulcer disease (2010-2014)...
July 2, 2018: American Journal of Surgery
(no author information available yet)
This interim final rule with comment period makes technical amendments to the regulation to reflect the extension of the transition period from June 30, 2016 to December 31, 2016 that was mandated by the 21st Century Cures Act for phasing in fee schedule adjustments for certain durable medical equipment (DME) and enteral nutrition paid in areas not subject to the Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program (CBP). In addition, this interim final rule with comment period amends the regulation to resume the transition period’s blended fee schedule rates for items furnished in rural areas and non-contiguous areas (Alaska, Hawaii, and United States territories) not subject to the CBP from June 1, 2018 through December 31, 2018...
May 11, 2018: Federal Register
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