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Medicare Wellness Visits

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https://www.readbyqxmd.com/read/27882836/comparison-of-pharmacist-and-physician-managed-annual-medicare-wellness-services
#1
Mary Jean Sewell, Daniel M Riche, Joshua W Fleming, Scott S Malinowski, R Terry Jackson
BACKGROUND: Medicare Annual Wellness Visits (AWV) are a benefit provided for Medicare beneficiaries to increase focus on wellness and preventive measures. Pharmacists can conduct AWVs, which offers a potential avenue for outpatient revenue generation. PROGRAM DESCRIPTION: To compare a composite of interventions and screenings and revenue generated by a pharmacist with those made by a physician during a subsequent AWV. A report generated through the electronic health record was used to determine AWVs conducted by a pharmacist or 3 participating physicians from December 2013 to March 2016, including revenue generated...
December 2016: Journal of Managed Care & Specialty Pharmacy
https://www.readbyqxmd.com/read/27856783/analysis-of-actual-versus-projected-medical-claims-under-the-first-year-of-aca-mandated-coverage
#2
Michael J McCue, Jennifer R Palazzolo
For the individual market, 2014 was the first year Affordable Care Act medical claims experience data were available to set 2016 rates. Accessing Centers for Medicare and Medicaid Services rate data for 175 state insurers, this study compares projected medical claims with actual medical claims of 2014, as well as the cost and utilization of benefit categories for inpatient, outpatient, professional, and prescription drug spending. Actual costs per member per month (pmpm) were greater than projected in 2014 for inpatient, outpatient, and prescription spending but not for professional care...
2016: Inquiry: a Journal of Medical Care Organization, Provision and Financing
https://www.readbyqxmd.com/read/27769219/advanced-practice-pharmacists-a-retrospective-evaluation-of-the-efficacy-and-cost-of-clinical-pharmacist-practitioners-managing-ambulatory-medicare-patients-in-north-carolina-apple-nc
#3
Michèle M Kislan, Adam T Bernstein, Loretta R Fearrington, Timothy J Ives
BACKGROUND: Clinical Pharmacist Practitioners are advanced practicing pharmacists in North Carolina that provide disease-specific management. The purpose of this retrospective cohort study was to compare the efficacy and charges from referrals to a Clinical Pharmacist Practitioner by the primary care provider, to those managed by a primary care provider alone. METHODS: Patients were separated into cohorts depending if they had at least two appointments with a Clinical Pharmacist Practitioner from November 2008 to November 2011...
October 21, 2016: BMC Health Services Research
https://www.readbyqxmd.com/read/27763962/the-role-of-radiographs-and-office-visits-in-the-follow-up-of-healed-intertrochanteric-hip-fractures-an-economic-analysis
#4
Harish Kempegowda, Raveesh Richard, Amrut Borade, Akhil Tawari, Abby M Howenstein, Erik N Kubiak, Michael Suk, Daniel S Horwitz
OBJECTIVES: The purpose of this study was to evaluate the role and the necessity of radiographs and office visits obtained during follow-up of intertrochanteric hip injuries. DESIGN: Retrospective study. SETTING: Two level I trauma centers. PATIENTS: Four hundred sixty-five elderly patients who were surgically treated for an intertrochanteric fracture of the femur at 2 level I trauma centers between January 2009 and August 2014 were retrospectively identified from orthopaedic trauma databases...
December 2016: Journal of Orthopaedic Trauma
https://www.readbyqxmd.com/read/27753746/one-year-outcomes-of-diabetes-self-management-training-among-medicare-beneficiaries-newly-diagnosed-with-diabetes
#5
Larisa M Strawbridge, Jennifer T Lloyd, Ann Meadow, Gerald F Riley, Benjamin L Howell
BACKGROUND: Diabetes is highly prevalent among Medicare beneficiaries, resulting in costly health care utilization. Strategies to improve health outcomes, such as disease self-management, could help reduce the increasing burden of diabetes. OBJECTIVES: Short-term benefits of diabetes self-management training (DSMT) are established; however, longer-term impacts among Medicare beneficiaries are unknown. RESEARCH DESIGN: Claims-based observational study with 1-year follow-up beginning 6 months after diabetes diagnosis...
October 6, 2016: Medical Care
https://www.readbyqxmd.com/read/27611713/emergency-department-visits-following-joint-replacement-surgery-in-an-era-of-mandatory-bundled-payments
#6
Susan Nedza, Donald E Fry, Susan DesHarnais, Eric Spencer, Patrick Yep
OBJECTIVES: The Center for Medicare and Medicaid Services (CMS) is actively testing bundled payments models. This study sought to identify relevant details for 90-day post-discharge Emergency Department (ED) visits of Medicare beneficiaries following total joint replacement (TJR) surgery meeting eligibility for a CMS bundled payment program. METHODS: The CMS research identifiable file for the State of Texas for 2011-2012 was used to identify patients who underwent TJR...
September 9, 2016: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/27590738/cost-of-a-lymphedema-treatment-mandate-10-years-of-experience-in-the-commonwealth-of-virginia
#7
Robert Weiss
Treatment of chronic illness accounts for over 90 % of Medicare spending. Chronic lymphedema places over 3 million Americans at risk of recurrent cellulitis. Health insurers and legislators have taken an active role in fighting attempts to mandate the treatment of lymphedema for fear that provision of the physical therapy and compression materials would result in large and uncontrollable claim costs. The author knows of no open source of lymphedema treatment cost data based on population coverage or claims...
December 2016: Health Economics Review
https://www.readbyqxmd.com/read/27579830/estimated-budget-impact-of-increased-use-of-mirabegron-a-novel-treatment-for-overactive-bladder
#8
Sinem Perk, Ronald C Wielage, Noll L Campbell, Timothy M Klein, Anthony Perkins, Linda M Posta, Thomas Yuran, Robert W Klein, Daniel B Ng
BACKGROUND: Oral pharmacological treatment for overactive bladder (OAB) consists of antimuscarinics and the beta-3 adrenergic agonist mirabegron. Antimuscarinic adverse events (AEs) such as dry mouth, constipation, and blurry vision can result in frequent treatment discontinuation rates, leaving part of the OAB population untreated. Antimuscarinics also contribute to a patient's anticholinergic cognitive burden (ACB), so the Beers Criteria recommends cautious use of antimuscarinics in elderly patients who take multiple anticholinergic medications or have cognitive impairment...
September 2016: Journal of Managed Care & Specialty Pharmacy
https://www.readbyqxmd.com/read/27574750/estimated-budget-impact-of-increased-use-of-mirabegron-a-novel-treatment-for-overactive-bladder
#9
Sinem Perk, Ronald C Wielage, Noll L Campbell, Timothy M Klein, Anthony Perkins, Linda M Posta, Thomas Yuran, Robert W Klein, Daniel B Ng
BACKGROUND: Oral pharmacological treatment for overactive bladder (OAB) consists of antimuscarinics and the beta-3 adrenergic agonist mirabegron. Antimuscarinic adverse events (AEs) such as dry mouth, constipation, and blurry vision can result in frequent treatment discontinuation rates, leaving part of the OAB population untreated. Antimuscarinics also contribute to a patient's anticholinergic cognitive burden (ACB), so the Beers Criteria recommends cautious use of antimuscarinics in elderly patients who take multiple anticholinergic medications or have cognitive impairment...
September 2016: Journal of Managed Care & Specialty Pharmacy
https://www.readbyqxmd.com/read/27479694/healthcare-resource-utilization-of-second-generation-long-acting-injectable-antipsychotics-in-schizophrenia-risperidone-versus-paliperidone-palmitate
#10
Kruti Joshi, Xiaoyun Pan, Rosa Wang, Erru Yang, Carmela Benson
OBJECTIVE: This retrospective longitudinal cohort study aimed to compare treatment patterns, healthcare resource utilization (HRU), and costs in patients with schizophrenia treated with second-generation antipsychotic long-acting injectables (SGA-LAIs): biweekly risperidone LAI versus once-monthly paliperidone palmitate. METHODS: Patients who initiated risperidone LAI or paliperidone palmitate between 1 July 2007 and 31 December 2012 (index date) were identified from the Truven MarketScan Commercial, Medicare Supplemental, and Medicaid Multi-State insurance databases...
November 2016: Current Medical Research and Opinion
https://www.readbyqxmd.com/read/27458315/an-assessment-model-for-evaluating-outcomes-in-federally-qualified-health-centers-dental-departments-results-of-a-5-year-study
#11
Sharon M Grisanti, Linda D Boyd, Lori Rainchuso
PURPOSE: The purpose of this report was to establish baseline data on 10 oral health performance indicators over 5 fiscal years (2007 to 2008 through 2011 to 2012) for an Iowa health center. The baseline data provides an assessment model and reports outcomes based on the use of the model. Performance indicators show evidence of provider performance, accountability to stakeholders and provide the benchmarks required for dental management to develop future goals to improve oral health outcomes for atrisk populations...
June 2016: Journal of Dental Hygiene: JDH
https://www.readbyqxmd.com/read/27403322/the-agreement-of-patient-reported-versus-observed-medication-adherence-in-type-2-diabetes-mellitus-t2dm
#12
Katherine Kelly, Maria V Grau-Sepulveda, Benjamin A Goldstein, Susan E Spratt, Anne Wolfley, Vicki Hatfield, Monica Murphy, Ellen Jones, Bradi B Granger
OBJECTIVE: Medication adherence in type 2 diabetes mellitus (T2DM) improves glycemic control and is associated with reduced adverse clinical events, and accurately assessing adherence assessment is important. We aimed to determine agreement between two commonly used adherence measures-the self-reported Morisky Medication Adherence Scale (MMAS) and direct observation of medication use by nurse practitioners (NPs) during home visits-and determine the relationship between each measure and glycated hemoglobin (HbA1c)...
2016: BMJ Open Diabetes Research & Care
https://www.readbyqxmd.com/read/27400133/scripted-nurse-visits-a-resource-efficient-palliative-care-model-for-ventricular-assist-devices
#13
Nina R O'Connor, Mary E Moyer, James N Kirkpatrick
BACKGROUND: The Center for Medicare Services (CMS) requires palliative care involvement for patients who receive a destination therapy ventricular assist device (VAD). Creative solutions are needed to meet this requirement in the context of limited palliative care resources. PURPOSE: To evaluate a novel program in which a nurse conducts scripted pre-VAD visits to promote advance care planning and to triage the need for a full palliative care consult. STUDY DESIGN: Prospective pilot study of patients undergoing evaluation for VAD...
December 2016: Journal of Palliative Medicine
https://www.readbyqxmd.com/read/27394148/association-between-age-substance-use-and-outcomes-in-medicare-enrollees-with-prostate-cancer
#14
Ravishankar Jayadevappa, Sumedha Chhatre
OBJECTIVE: To analyze the association between age, substance use, and outcomes in fee-for-service Medicare enrollees with advanced prostate cancer. METHODS: Retrospective longitudinal cohort study of elderly men diagnosed with advanced prostate cancer using SEER-Medicare data between 2000 and 2009. Substance use disorder was identified using claims for alcoholic psychosis, drug psychoses, alcohol dependence syndrome, drug dependence, and non-dependent use of drugs...
July 6, 2016: Journal of Geriatric Oncology
https://www.readbyqxmd.com/read/27385166/the-rise-and-fall-in-out-of-pocket-costs-in-australia-an-analysis-of-the-strengthening-medicare-reforms
#15
Chun Yee Wong, Jessica Greene, Xenia Dolja-Gore, Kees van Gool
After a period of steady decline, out-of-pocket (OOP) costs for general practitioner (GP) consultations in Australia began increasing in the mid-1990s. Following the rising community concerns about the increasing costs, the Australian Government introduced the Strengthening Medicare reforms in 2004 and 2005, which included a targeted incentive for GPs to charge zero OOP costs for consultations provided to children and concession cardholders (older adults and the poor), as well as an increase in the reimbursement for all GP visits...
July 7, 2016: Health Economics
https://www.readbyqxmd.com/read/27371525/younger-dual-eligibles-who-use-federally-qualified-health-centers-have-more-preventable-emergency-department-visits-but-some-have-fewer-hospitalizations
#16
Andrew J Potter, Amal N Trivedi, Brad Wright
OBJECTIVE: To determine whether younger dual-eligibles receiving care at federally qualified health centers (FQHCs) have lower rates of ambulatory care sensitive (ACS) hospitalization and emergency department (ED) visits. DATA SOURCES: We used the 100% Medicare Part A and Part B institutional claims from 2007 to 2010 for dual-eligibles younger than 65 years, enrolled in traditional fee-for-service Medicare, who received care at an FQHC or lived in a primary care service area with an FQHC...
July 1, 2016: Journal of Primary Care & Community Health
https://www.readbyqxmd.com/read/27354313/google-flu-trends-spatial-variability-validated-against-emergency-department-influenza-related-visits
#17
Joseph Jeffrey Klembczyk, Mehdi Jalalpour, Scott Levin, Raynard E Washington, Jesse M Pines, Richard E Rothman, Andrea Freyer Dugas
BACKGROUND: Influenza is a deadly and costly public health problem. Variations in its seasonal patterns cause dangerous surges in emergency department (ED) patient volume. Google Flu Trends (GFT) can provide faster influenza surveillance information than traditional CDC methods, potentially leading to improved public health preparedness. GFT has been found to correlate well with reported influenza and to improve influenza prediction models. However, previous validation studies have focused on isolated clinical locations...
2016: Journal of Medical Internet Research
https://www.readbyqxmd.com/read/27351988/antileukotriene-agents-versus-long-acting-beta-agonists-in-older-adults-with-persistent-asthma-a-comparison-of-add-on-therapies
#18
Shoroq M Altawalbeh, Carolyn T Thorpe, Janice C Zgibor, Sandra Kane-Gill, Yihuang Kang, Joshua M Thorpe
OBJECTIVES: To compare the effectiveness and cardiovascular safety of long-acting beta-agonists (LABAs) with those of leukotriene receptor antagonists (LTRAs) as add-on treatments in older adults with asthma already taking inhaled corticosteroids (ICSs). DESIGN: Retrospective cohort study. SETTING: Medicare fee-for-service (FFS) claims (2009-10) for a 10% random sample of beneficiaries continuously enrolled in Parts A, B, and D in 2009. PARTICIPANTS: Medicare beneficiaries aged 66 and older continuously enrolled in FFS Medicare with Part D coverage with a diagnosis of asthma before 2009 treated exclusively with ICSs plus LABAs or ICSs plus LTRAs (N = 14,702)...
August 2016: Journal of the American Geriatrics Society
https://www.readbyqxmd.com/read/27346648/the-medicare-annual-wellness-visit-in-nursing-homes
#19
EDITORIAL
John E Morley, Patricia Abele
No abstract text is available yet for this article.
July 1, 2016: Journal of the American Medical Directors Association
https://www.readbyqxmd.com/read/27309908/identifying-patterns-of-multimorbidity-in-older-americans-application-of-latent-class-analysis
#20
Heather E Whitson, Kimberly S Johnson, Richard Sloane, Christine T Cigolle, Carl F Pieper, Lawrence Landerman, Susan N Hastings
OBJECTIVES: To define multimorbidity "classes" empirically based on patterns of disease co-occurrence in older Americans and to examine how class membership predicts healthcare use. DESIGN: Retrospective cohort study. SETTING: Nationally representative sample of Medicare beneficiaries in file years 1999-2007. PARTICIPANTS: Individuals aged 65 and older in the Medicare Beneficiary Survey who had data available for at least 1 year after index interview (N = 14,052)...
August 2016: Journal of the American Geriatrics Society
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