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accountable care act

Christina Ludema, Stephen R Cole, Joseph J Eron, Andrew Edmonds, G Mark Holmes, Kathryn Anastos, Jennifer Cocohoba, Mardge Cohen, Hannah L F Cooper, Elizabeth T Golub, Seble Kassaye, Deborah Konkle-Parker, Lisa Metsch, Joel Milam, Tracey E Wilson, Adaora A Adimora
BACKGROUND: Implementation of the Affordable Care Act motivates assessment of health insurance and supplementary programs, such as the AIDS Drug Assistance Program (ADAP) on health outcomes of HIV-infected people in the United States. We assessed the effects of health insurance, ADAP, and income on HIV viral load suppression. METHODS: We used existing cohort data from the HIV-infected participants of the Women's Interagency HIV Study. Cox proportional hazards models were used to estimate the time from 2006 to unsuppressed HIV viral load (>200 copies/mL) among those with Medicaid, private, Medicare, or other public insurance, and no insurance, stratified by the use of ADAP...
November 1, 2016: Journal of Acquired Immune Deficiency Syndromes: JAIDS
Evan M Pucillo, Nancy Christensen-Mayer, Shelly D Poole, Denise M Whitten, Danielle Freeman, Blake R Bohe, Brandon R Swensen, A Gordon Smith, Nicholas E Johnson
BACKGROUND: Team-based care has been shown to offer more comprehensive benefits to patients when compared to standard physician-based care alone in clinics for chronic conditions. However, apart from grant-funded multidisciplinary clinics, there are no reports on the usage of same-day physical therapy (PT) consults within a daily outpatient neuromuscular disease (NMD) physician clinic. OBJECTIVE: To determine the impact of same-day PT consults at the University of Utah's outpatient Clinical Neurosciences Center...
2016: Journal of Multidisciplinary Healthcare
Khaled J Saleh, William O Shaffer
In 2015, the US Congress passed legislation entitled the Medicare Access and CHIP [Children's Health Insurance Program] Reauthorization Act (MACRA), which led to the formation of two reimbursement paradigms: the merit-based incentive payment system (MIPS) and alternative payment models (APMs). The MACRA effectively repealed the Centers for Medicare and Medicaid Services (CMS) sustainable growth rate (SGR) formula while combining several CMS quality-reporting programs. As such, MACRA represents an unparalleled acceleration toward reimbursement models that recognize value rather than volume...
November 2016: Journal of the American Academy of Orthopaedic Surgeons
Matteo Lippi Bruni, Irene Mammi, Cristina Ugolini
Overcrowding in emergency departments generates potential inefficiencies. Using regional administrative data, we investigate the impact that an increase in the accessibility of primary care has on emergency visits in Italy. We consider two measures of avoidable emergency visits recorded at list level for each General Practitioner. We test whether extending practices' opening hours to up to 12 hours/day reduces the inappropriate utilization of emergency services. Since subscribing to the extension program is voluntary, we account for the potential endogeneity of participation in a count model for emergency admissions in two ways: first, we use a two-stage residual inclusion approach...
October 8, 2016: Journal of Health Economics
Steve G Langer
In 1999-2003, SIIM (then SCAR) sponsored the creation of several special topic Primers, one of which was concerned with computer security. About the same time, a multi-society collaboration authored an ACR Guideline with a similar plot; the latter has recently been updated. The motivation for these efforts was the launch of Health Information Portability and Accountability Act (HIPAA). That legislation directed care providers to enable the portability of patient medical records across authorized medical centers, while simultaneously protecting patient confidentiality among unauthorized agents...
October 11, 2016: Journal of Digital Imaging: the Official Journal of the Society for Computer Applications in Radiology
Fredric Blavin
Importance: The Affordable Care Act expanded Medicaid eligibility for millions of low-income adults. The choice for states to expand Medicaid could affect the financial health of hospitals by decreasing the proportion of patient volume and unreimbursed expenses attributable to uninsured patients while increasing revenue from newly covered patients. Objective: To estimate the association between the Medicaid expansion in 2014 and hospital finances by assessing differences between hospitals in states that expanded Medicaid and in those states that did not expand Medicaid...
October 11, 2016: JAMA: the Journal of the American Medical Association
John W Scott, Joaquim M Havens, Lindsey L Wolf, Cheryl K Zogg, John A Rose, Ali Salim, Adil H Haider
BACKGROUND: The Affordable Care Act has the potential to significantly affect access to care for previously uninsured patients in need of emergency general surgical care. Our objective was to determine the relationship between insurance status and disease complexity at presentation among a national sample of emergency general surgical patients. METHODS: Data from the National Emergency Department Sample from 2006-2009 were queried to identify all patients aged 18-64 years old admitted through the emergency department with a primary diagnosis of appendicitis, diverticulitis, inguinal hernia, or bowel obstruction...
October 3, 2016: Surgery
Harrison P Nguyen, John S Barbieri, Howard P Forman, Jean L Bolognia, Marta J VanBeek
An Accountable Care Organization (ACO) is a network of providers that collaborates to manage care and is financially incentivized to realize cost savings while also optimizing standards of care. Since its introduction as part of the 2010 Patient Protection and Affordable Care Act, ACOs have grown to include 16% of Medicare beneficiaries and currently represent Medicare's largest payment initiative. Although ACOs are still in the pilot phase with multiple structural models being assessed, incentives are being introduced to encourage specialist participation, and dermatologists will have the opportunity to influence both the cost savings and quality standard aspects of these organizations...
October 1, 2016: Journal of the American Academy of Dermatology
Hao Feng, Paula Wu, Marie Leger
Importance: Significant ties exist between clinicians and industry. Little is known about the characteristics of industry payments to dermatologists. Objective: To analyze the nature and extent of industry payments to dermatologists. Design, Setting, and Participants: This was a retrospective review using the publicly available Centers for Medicare and Medicaid Services (CMS) Sunshine Act Open Payment database. Data were downloaded from the publically available CMS website under General Payment and Research Payment data sets...
October 5, 2016: JAMA Dermatology
Osamu Ito
In this account, studies on the photosensitizing electron transfer of nanocarbons, such as fullerenes, single-walled carbon nanotubes (SWCNTs), and carbon nanohorns (CNH), performed in our laboratory for about 15 years in the early 21st century have been briefly reviewed. These novel nanocarbons act as excellent electron acceptors, when they are linked to light-absorbing electron donors, such as porphyrins or phthalocyanines. For such molecule-nanocarbon hybrids, the direct confirmation of fast, transient, electron-transfer phenomena must be performed with time-resolved spectroscopic methods, such as transient absorption spectral measurements, in addition to fluorescence time-profile measurements in the wide-wavelength regions...
October 4, 2016: Chemical Record: An Official Publication of the Chemical Society of Japan ... [et Al.]
Joanne Jordan, Louise Rose, Katie N Dainty, Jane Noyes, Bronagh Blackwood
BACKGROUND: Prolonged mechanical ventilation is associated with a longer intensive care unit (ICU) length of stay and higher mortality. Consequently, methods to improve ventilator weaning processes have been sought. Two recent Cochrane systematic reviews in ICU adult and paediatric populations concluded that protocols can be effective in reducing the duration of mechanical ventilation, but there was significant heterogeneity in study findings. Growing awareness of the benefits of understanding the contextual factors impacting on effectiveness has encouraged the integration of qualitative evidence syntheses with effectiveness reviews, which has delivered important insights into the reasons underpinning (differential) effectiveness of healthcare interventions...
October 4, 2016: Cochrane Database of Systematic Reviews
Steven A Safren, James P Hughes, Matthew J Mimiaga, Ayana T Moore, Ruth Khalili Friedman, Kriengkrai Srithanaviboonchai, Mohammed Limbada, Brian D Williamson, Vanessa Elharrar, Vanessa Cummings, Jessica F Magidson, Charlotte A Gaydos, David D Celentano, Kenneth H Mayer
INTRODUCTION: Successful global treatment as prevention (TasP) requires identifying HIV-positive individuals at high risk for transmitting HIV, and having impact via potential infections averted. This study estimated the frequency and predictors of numbers of HIV transmissions and bacterial sexually transmitted infection (STI) acquisition among sexually active HIV-positive individuals in care from three representative global settings. METHODS: HIV-positive individuals (n=749), including heterosexual men, heterosexual women and men who have sex with men (MSM) in HIV care, were recruited from Chiang Mai (Thailand), Rio De Janeiro (Brazil) and Lusaka (Zambia)...
2016: Journal of the International AIDS Society
Moira O'Neill
BACKGROUND: The advancing accountability of nurses and nurse educators requires students to develop knowledge, skills, and judgment on a continuum of focus from individual patients to the broader context of care. METHOD: A dynamic capstone policy course was developed by applying the American Association of Colleges of Nursing's Essentials of Baccalaureate Education for Professional Nursing Practice and capitalizing on related benefits of service-learning pedagogy...
October 1, 2016: Journal of Nursing Education
Pavel Lavitas, Mark Tesell, Tasmina Hydery, Bonnie C Greenwood, Mylissa Price, Kimberly Lenz, Paul Jeffrey
BACKGROUND: Breakthrough direct-acting antivirals set a new standard in the management of hepatitis C virus (HCV) with regard to cure rates and improved tolerability; however, the health care system is challenged by the cost of these medications. OBJECTIVE: To describe the effect of a comprehensive HCV medication management program on optimized regimen use, prior authorization (PA) modifications, and medication cost avoidance in a state Medicaid program. METHODS: This program consists of a 2-tiered prescriber outreach: (1) regimen outreach to promote optimized regimen selection and (2) refill outreach to support medication adherence...
October 2016: Journal of Managed Care & Specialty Pharmacy
David M G Halpin, Marjan Kerkhof, Joan B Soriano, Helga Mikkelsen, David B Price
BACKGROUND: Management guidelines of chronic obstructive pulmonary disease (COPD) are mainly based on results of randomised controlled trials (RCTs), but some authors have suggested limited representativeness of patients included in these trials. No previous studies have applied the full range of selection criteria to a broad COPD patient population in a real-life setting. METHODS: We identified all RCTs of inhaled long-acting bronchodilator therapy, during 1999-2013, at ClinicalTrials...
2016: Respiratory Research
Bonhee Chung
Poor subsistence farmers who live in a semi-arid area of northern Ethiopia build irrigation systems to overcome water shortages. However, there is a high risk of malaria transmission when increased standing water provides more favorable habitats for mosquito breeding. This is a serious problem because there are many barriers to malaria control measures and health care systems in the area. Using a causal loop diagram and computer simulations, the author attempted to visually illustrate positive and negative feedbacks between mosquito and human populations in the context of Simret, which is a small village located in northern Ethiopia and is generally considered a malaria-free area...
August 2016: Korean Journal of Parasitology
A Ribadier, I Varescon
INTRODUCTION: Defense mechanisms have been seen to greatly change over time and across different definitions made by different theoretical currents. Recently with the definition provided by the DSM IV, defense mechanisms have integrated the concept of coping as a defensive factor. These mechanisms are no longer considered just through a psychodynamic approach but also through a cognitive and behavioral one. In recent years, new theories have therefore integrated these two components of the defensive operation...
September 9, 2016: L'Encéphale
Marta Erdal, Ane Johannessen, Tomas Mikal Eagan, Per Bakke, Amund Gulsvik, Rune Grønseth
OBJECTIVES: The objectives of this study were to estimate the impact of recruitment source and outcome definition on the incidence of acute exacerbations of COPD (AECOPD) and explore possible predictors of AECOPD. PATIENTS AND METHODS: During a 1-year follow-up, we performed a baseline visit and four telephone interviews of 81 COPD patients and 132 controls recruited from a population-based survey and 205 hospital-recruited COPD patients. Both a definition based on health care utilization and a symptom-based definition of AECOPD were applied...
2016: International Journal of Chronic Obstructive Pulmonary Disease
Susanne M van Hooft, Jolanda Dwarswaard, Roland Bal, Mathilde M Strating, AnneLoes van Staa
BACKGROUND: A major challenge for nurses in hospital care is supporting chronically ill patients in self-managing their chronic condition. Self-management support requires a broad range of competencies and is often regarded as difficult to implement in daily practice. So far, we have no insight in nurses' behavior in daily practice with regard to self-management support and what factors may influence their behavior. OBJECTIVES: The aim of this survey was to explore (i) the self-reported behavior on self-management support of nurses in a university hospital; and (ii) the factors influencing this behavior...
November 2016: International Journal of Nursing Studies
Hector E James
OBJECTIVE The author describes the creation, structuring, and development of a pediatric neurosurgery telemedicine clinic (TMC) to provide telehealth across geographical, time, social, and cultural barriers. METHODS In July 2009 the University of Florida (UF) Division of Pediatric Neurosurgery received a request from the Southeast Georgia Health District (Area 9-2) to provide a TMC to meet regional needs. The Children's Medical Services (CMS) of the State of Georgia installed telemedicine equipment and site-to-site connectivity...
September 2, 2016: Journal of Neurosurgery. Pediatrics
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