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Yuan Jiang, Yang Li, Jinjian Cai, Yanhua Wang, Jia Xu
High resolution range profile (HRRP) plays an important role in wideband radar automatic target recognition (ATR). In order to alleviate the sensitivity to clutter and target aspect, employing a sequence of HRRP is a promising approach to enhance the ATR performance. In this paper, a novel HRRP sequence-matching method based on singular value decomposition (SVD) is proposed. First, the HRRP sequence is decoupled into the angle space and the range space via SVD, which correspond to the span of the left and the right singular vectors, respectively...
February 14, 2018: Sensors
Gloria J Bazzoli, Michael P Thompson, Teresa M Waters
OBJECTIVE: To examine relationships between penalties assessed by Medicare's Hospital Readmission Reduction Program and Value-Based Purchasing Program and hospital financial condition. DATA SOURCES/STUDY SETTING: Centers for Medicare and Medicaid Services, American Hospital Association, and Area Health Resource File data for 4,824 hospital-year observations. STUDY DESIGN: Bivariate and multivariate analysis of pooled cross-sectional data. PRINCIPAL FINDINGS: Safety net hospitals have significantly higher HRRP/VBP penalties, but, unlike nonsafety net hospitals, increases in their penalty rate did not significantly affect their total margins...
February 8, 2018: Health Services Research
Lauren E Birmingham, Willie H Oglesby
BACKGROUND: The Patient Protection and Affordable Care Act established the Hospital Readmission Reduction Program (HRRP) to penalize hospitals with excessive 30-day hospital readmissions of Medicare enrollees for specific conditions. This policy was aimed at increasing the quality of care delivered to patients and decreasing the amount of money paid for potentially preventable hospital readmissions. While it has been established that the number of 30-day hospital readmissions decreased after program implementation, it is unknown whether this effect occurred equally between not-for-profit and proprietary hospitals...
January 19, 2018: BMC Health Services Research
Feixiang Zhao, Yongxiang Liu, Kai Huo, Shuanghui Zhang, Zhongshuai Zhang
A novel radar high-resolution range profile (HRRP) target recognition method based on a stacked autoencoder (SAE) and extreme learning machine (ELM) is presented in this paper. As a key component of deep structure, the SAE does not only learn features by making use of data, it also obtains feature expressions at different levels of data. However, with the deep structure, it is hard to achieve good generalization performance with a fast learning speed. ELM, as a new learning algorithm for single hidden layer feedforward neural networks (SLFNs), has attracted great interest from various fields for its fast learning speed and good generalization performance...
January 10, 2018: Sensors
Min Chen, David C Grabowski
This study examines whether the Hospital Readmissions Reduction Program (HRRP), which penalizes hospitals with excess readmissions for certain conditions, has reduced hospital readmissions and led to unintended consequences. Our analyses of Florida hospital administrative data between 2008 and 2014 find that the HRRP resulted in a reduction in the likelihood of readmissions by 1% to 2% for traditional Medicare (TM) beneficiaries with heart failure, pneumonia, or chronic obstructive pulmonary disease. Readmission rates for Medicare Advantage (MA) beneficiaries and privately insured patients with heart attack and heart failure decreased even more than TM patients with the same target condition (e...
December 1, 2017: Medical Care Research and Review: MCRR
Roger K Khouri, Hechuan Hou, Apoorv Dhir, Juan J Andino, James M Dupree, David C Miller, Chad Ellimoottil
BACKGROUND: The Hospital Readmission Reduction Program (HRRP) penalizes hospitals for high all-cause unplanned readmission rates. Many have expressed concern that hospitals serving patient populations with more comorbidities, lower incomes, and worse self-reported health status may be disproportionately penalized by readmissions that are not clinically related to the index admission. The impact of including clinically unrelated readmissions on hospital performance is largely unknown. We sought to determine if a clinically related readmission measure would significantly alter the assessment of hospital performance...
November 28, 2017: BMC Health Services Research
Tudor Borza, Mary K Oerline, Ted A Skolarus, Edward C Norton, Andrew M Ryan, Chad Ellimoottil, Justin B Dimick, Vahakn B Shahinian, Brent K Hollenbeck
Importance: Readmissions after surgery lead to poor patient outcomes and increased costs. The Hospital Readmissions Reduction Program (HRRP) penalizes hospitals with excess readmissions after specified medical and surgical discharges. Objective: To evaluate the association of the HRRP with readmissions after major joint surgery (targeted) and procedures with historically high rates not under its purview (nontargeted). Design, Setting, and Participants: In this population-based analysis using a 20% Medicare sample, a retrospective cohort study was performed of patients undergoing one of 5 major surgical procedures between January 1, 2006, and November 30, 2014...
November 22, 2017: JAMA Surgery
Ian Duncan, Nhan Huynh
Predictive models for hospital readmission rates are in high demand because of the Centers for Medicare & Medicaid Services (CMS) Hospital Readmission Reduction Program (HRRP). The LACE index is one of the most popular predictive tools among hospitals in the United States. The LACE index is a simple tool with 4 parameters: Length of stay, Acuity of admission, Comorbidity, and Emergency visits in the previous 6 months. The authors applied logistic regression to develop a predictive model for a medium-sized not-for-profit community hospital in California using patient-level data with more specific patient information (including 13 explanatory variables)...
November 17, 2017: Population Health Management
Ankur Gupta, Larry A Allen, Deepak L Bhatt, Margueritte Cox, Adam D DeVore, Paul A Heidenreich, Adrian F Hernandez, Eric D Peterson, Roland A Matsouaka, Clyde W Yancy, Gregg C Fonarow
Importance: Public reporting of hospitals' 30-day risk-standardized readmission rates following heart failure hospitalization and the financial penalization of hospitals with higher rates have been associated with a reduction in 30-day readmissions but have raised concerns regarding the potential for unintended consequences. Objective: To examine the association of the Hospital Readmissions Reduction Program (HRRP) with readmission and mortality outcomes among patients hospitalized with heart failure within a prospective clinical registry that allows for detailed risk adjustment...
January 1, 2018: JAMA Cardiology
Hsueh-Fen Chen, Saleema Karim, Fei Wan, Adrienne Nevola, Michael E Morris, T Mac Bird, J Mick Tilford
BACKGROUND: Previous studies showed that the Hospital Readmissions Reduction Program (HRRP) and the Hospital Value-based Purchasing Program (HVBP) disproportionately penalized hospitals caring for the poor. The Mississippi Delta Region (Delta Region) is among the most socioeconomically disadvantaged areas in the United States. The financial performance of hospitals in the Delta Region under both HRRP and HVBP remains unclear. OBJECTIVE: To compare the differences in financial performance under both HRRP and HVBP between hospitals in the Delta Region (Delta hospitals) and others in the nation (non-Delta hospitals)...
November 2017: Medical Care
Chad Ellimoottil, Roger K Khouri, Apoorv Dhir, Hechuan Hou, David C Miller, James M Dupree
In the Hospital Readmission Reduction Program (HRRP), the Centers for Medicare & Medicaid Services (CMS) utilizes a planned/unplanned algorithm to prevent hospitals from being penalized for scheduled rehospitalizations. We evaluated version 3.0 of the CMS planned readmission algorithm and hypothesized that some readmissions categorized as planned by the HRRP algorithm may actually be unplanned. We identified 143,054 index admissions and 16,116 thirty- day readmissions for 131 hospitals. Only 1252 readmissions were considered planned according to Medicare's readmission algorithm...
October 2017: Journal of Hospital Medicine: An Official Publication of the Society of Hospital Medicine
Xuan Peng, Xunzhang Gao, Yifan Zhang, Xiang Li
This paper proposes a new feature learning method for the recognition of radar high resolution range profile (HRRP) sequences. HRRPs from a period of continuous changing aspect angles are jointly modeled and discriminated by a single model named the discriminative infinite restricted Boltzmann machine (Dis-iRBM). Compared with the commonly used hidden Markov model (HMM)-based recognition method for HRRP sequences, which requires efficient preprocessing of the HRRP signal, the proposed method is an end-to-end method of which the input is the raw HRRP sequence, and the output is the label of the target...
July 20, 2017: Sensors
Karen E Joynt Maddox, Aditi P Sen, Lok Wong Samson, Rachael B Zuckerman, Nancy DeLew, Arnold M Epstein
Increasing emphasis on value in health care has spurred the development of value-based and alternative payment models. Inherent in these models are choices around program scope (broad vs. narrow); selecting absolute or relative performance targets; rewarding improvement, achievement, or both; and offering penalties, rewards, or both. We examined and classified current Medicare payment models-the Hospital Readmissions Reduction Program (HRRP), Hospital Value-Based Purchasing Program (HVBP), Hospital-Acquired Conditions Reduction Program (HACRP), Medicare Advantage Quality Star Rating program, Physician Value-Based Payment Modifier (VM) and its successor, the Merit-Based Incentive Payment System (MIPS), and the Medicare Shared Savings Program (MSSP) on these elements of program design and reviewed the literature to place findings in context...
November 2017: Journal of General Internal Medicine
Amy M Salerno, Leora I Horwitz, Ji Young Kwon, Jeph Herrin, Jacqueline N Grady, Zhenqiu Lin, Joseph S Ross, Susannah M Bernheim
OBJECTIVE: To compare trends in readmission rates among safety net and non-safety net hospitals under the US Hospital Readmission Reduction Program (HRRP). DESIGN: A retrospective time series analysis using Medicare administrative claims data from January 2008 to June 2015. SETTING: We examined 3254 US hospitals eligible for penalties under the HRRP, categorised as safety net or non-safety net hospitals based on the hospital's proportion of patients with low socioeconomic status...
July 13, 2017: BMJ Open
Winta T Mehtsun, Irene Papanicolas, Jie Zheng, E John Orav, Keith D Lillemoe, Ashish K Jha
OBJECTIVE: The aim of this study was to investigate whether the Hospital Readmissions Reduction Program, a national program that introduced financial penalties for high readmission rates for certain medical conditions, had a "spillover" effect on surgical conditions. SUMMARY BACKGROUND DATA: During the past decade, there have been multiple national efforts to improve surgical care. Readmission rates are a key metric for assessing surgical quality. Whether surgical readmission rates have declined, and whether the Hospital Readmissions Reduction Program has had an influence is unclear...
June 27, 2017: Annals of Surgery
Dushyanth Srinivasan, Nihar R Desai
In response to wide variation in quality and outcomes as well as escalating health care costs, the U.S. health care system is moving away from a volume-based payment system to a quality- and value-based system. Medicare, the largest insurer and payer of health care, has accelerated the movement toward value-based care with the development and implementation of myriad alternate payment models and pay-for-performance programs as part of the Affordable Care Act. Given that heart failure affects a significant number of Medicare patients and that these patients account for a disproportionate amount of health care utilization and spending, heart failure has become a focal point for these initiatives...
June 21, 2017: Journal of Cardiac Failure
Berna Demiralp, Fang He, Lane Koenig
OBJECTIVE: To investigate the potential spillover effects of the Hospital Readmissions Reduction Program (HRRP) on readmissions for nontargeted conditions and patient populations. We examine HRRP effects on nontargeted conditions separately and on non-Medicare populations in Florida and California. DATA SOURCES: From 2007-2013, 100 percent Medicare inpatient claims data, 2007-2013 State Inpatient Database (SID) for Florida, and 2007-2011 SID for California. STUDY DESIGN: We conducted an interrupted time series analysis to estimate the change in 30-day all-cause unplanned readmission trends after the start of HRRP using logistic regression...
May 8, 2017: Health Services Research
Zachary L Cox, Pikki Lai, Connie M Lewis, Daniel J Lenihan
Hospitals typically use Center for Medicare and Medicaid Services' (CMS) Hospital Readmission Reduction Program (HRRP) administrative reports as the standard of heart failure (HF) admission quantification. We aimed to evaluate the HF admission population identified by CMS HRRP definition of HF hospital admissions compared with a clinically based HF definition. We evaluated all hospital admissions at an academic medical center over 16 months in patients with Medicare fee-for service benefits and age ≥65 years...
September 2017: Clinical Cardiology
Michael P Thompson, Teresa M Waters, Cameron M Kaplan, Yu Cao, Gloria J Bazzoli
The Hospital Readmissions Reduction Program (HRRP) initiated by the Affordable Care Act levies financial penalties against hospitals with excess thirty-day Medicare readmissions. We sought to understand the penalty burden over the program's first five years, focusing on characteristics of hospitals that received penalties during all five years, how penalties changed over time, and the relationship between baseline and subsequent performance. More than half of participating hospitals were penalized by the Centers for Medicare and Medicaid Services in all five years of the program...
May 1, 2017: Health Affairs
Andrew M Ryan, Sam Krinsky, Julia Adler-Milstein, Cheryl L Damberg, Kristin A Maurer, John M Hollingsworth
Importance: Medicare is experimenting with numerous concurrent reforms aimed at improving quality and value for hospitals. It is unclear if these myriad reforms are mutually reinforcing or in conflict with each other. Objective: To evaluate whether hospital participation in voluntary value-based reforms was associated with greater improvement under Medicare's Hospital Readmission Reduction Program (HRRP). Design, Setting, and Participants: Retrospective, longitudinal study using publicly available national data from Hospital Compare on hospital readmissions for 2837 hospitals from 2008 to 2015...
June 1, 2017: JAMA Internal Medicine
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