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https://www.readbyqxmd.com/read/28724133/a-nationwide-analysis-of-cost-variation-for-autologous-free-flap-breast-reconstruction
#1
Jessica I Billig, Yiwen Lu, Adeyiza O Momoh, Kevin C Chung
Importance: Cost variation among hospitals has been demonstrated for surgical procedures. Uncovering these differences has helped guide measures taken to reduce health care spending. To date, the fiscal consequence of hospital variation for autologous free flap breast reconstruction is unknown. Objective: To investigate factors that influence cost variation for autologous free flap breast reconstruction. Design, Setting, and Participants: A secondary cross-sectional analysis was performed using the Healthcare Cost and Utilization Project National Inpatient Sample database from 2008 to 2010...
July 19, 2017: JAMA Surgery
https://www.readbyqxmd.com/read/28707110/what-factors-are-associated-with-90-day-episode-of-care-payments-for-younger-patients-with-total-joint-arthroplasty
#2
Shweta Pathak, Cecilia M Ganduglia, Samir S Awad, Wenyaw Chan, John M Swint, Robert O Morgan
BACKGROUND: Total joint arthroplasty (TJA) has been identified as a procedure with substantial variations in inpatient and postacute care payments. Most studies in this area have focused primarily on the Medicare population and rarely have characterized the younger commercially insured populations. Understanding the inpatient and postdischarge care service-component differences across 90-day episodes of care and factors associated with payments for younger patients is crucial for successful implementation of bundled payments in TJA in non-Medicare populations...
July 13, 2017: Clinical Orthopaedics and related Research
https://www.readbyqxmd.com/read/28696250/american-heart-association-s-call-to-action-for-payment-and-delivery-system-reform
#3
REVIEW
Vincent J Bufalino, Scott A Berkowitz, Timothy J Gardner, Ileana L Piña, Madeleine Konig
The healthcare system is undergoing a transition from paying for volume to paying for value. Clinicians, as well as public and private payers, are beginning to implement alternative delivery and payment models, such as the patient-centered medical home, accountable care organizations, and bundled payment arrangements. Implementation of these new models will necessitate delivery system transformation and will actively involve all fields of medical care, in particular medicine and surgery. This call to action, on behalf of the American Heart Association's Expert Panel on Payment and Delivery System Reform, serves to offer support and direction for further involvement by the American Heart Association...
July 10, 2017: Circulation
https://www.readbyqxmd.com/read/28692570/payor-reform-opportunities-for-spine-surgery-part-ii-the-potential-emergence-of-population-health
#4
Jason Scalise, David Jacofsky
The pressures on spine surgery to adopt value-based reimbursement models are being seen in the increased implementation of bundled payment strategies. Given that bundled payment models typically link payments to the initiation of the surgical episode in question, despite their potential cost-saving attributes, financial incentives remain tied to the volume of services being provided. As payors and policy makers look to find savings by focusing on waste and variation of care, more comprehensive models such population health strategies are now being develop and deployed...
July 7, 2017: Clinical Spine Surgery
https://www.readbyqxmd.com/read/28678137/will-bundled-payments-lead-to-health-care-rationing-commentary-on-an-article-by-michele-d-apuzzo-md-et-al-all-cause-versus-complication-specific-readmission-following-total-knee-arthroplasty
#5
https://www.readbyqxmd.com/read/28669568/modeling-the-potential-economic-impact-of-the-medicare-comprehensive-care-for-joint-replacement-episode-based-payment-model
#6
Omar Z Maniya, Richard C Mather, David E Attarian, Bipin Mistry, Aneesh Chopra, Matt Strickland, Kevin A Schulman
BACKGROUND: The Medicare program has initiated Comprehensive Care for Joint Replacement (CJR), a bundled payment mandate for lower extremity joint replacements. We sought to determine the degree to which hospitals will invest in care redesign in response to CJR, and to project its economic impacts. METHODS: We defined 4 potential hospital management strategies to address CJR: no action, light care management, heavy care management, and heavy care management with contracting...
June 8, 2017: Journal of Arthroplasty
https://www.readbyqxmd.com/read/28661798/getting-the-incentives-right-improving-oral-health-equity-with-universal-school-based-caries-prevention
#7
Richard Niederman, Shulamite S Huang, Anna-Lena Trescher, Stefan Listl
Despite significant financial, training, and program investments, US children's caries experience and inequities continued to increase over the last 20 years. We posit that (1) dental insurance payment systems are not aligned with the current best evidence, exacerbating inequities, and (2) system redesign could meet health care's triple aim and reduce children's caries by 80%. On the basis of 2013 to 2016 Medicaid and private payment rates and the caries prevention literature, we find that effective preventive interventions are either (1) consistently compensated less than ineffective interventions or (2) not compensated at all...
May 2017: American Journal of Public Health
https://www.readbyqxmd.com/read/28647838/preoperative-education-for-hip-and-knee-replacement-never-stop-learning
#8
REVIEW
Paul K Edwards, Simon C Mears, C Lowry Barnes
PURPOSE OF REVIEW: Participation in alternative payment models has focused efforts to improve outcomes and patient satisfaction while also lowering cost for elective hip and knee replacement. The purpose of this review is to determine if preoperative education classes for elective hip and knee replacement achieve these goals. RECENT FINDINGS: Recent literature demonstrates that patients who attend education classes prior to surgery have decreased anxiety, better post-operative pain control, more realistic expectations of surgery, and a better understanding of their surgery...
June 24, 2017: Current Reviews in Musculoskeletal Medicine
https://www.readbyqxmd.com/read/28647442/the-impact-of-the-transition-from-volume-to-value-on-heart-failure-care-implications-of-novel-payment-models-and-quality-improvement-initiatives
#9
REVIEW
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 transitioning away from a volume based payment system to a quality- and value-based system. Medicare, the largest insurer and payer of healthcare, has accelerated the movement towards value-based care with the development and implementation of myriad alternative 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 these patients account for a disproportionate amount of healthcare utilization and spending, heart failure has become a focal point for these initiatives...
June 21, 2017: Journal of Cardiac Failure
https://www.readbyqxmd.com/read/28644939/an-economic-analysis-of-mac-versus-walant-a-trigger-finger-release-surgery-case-study
#10
Jason L Codding, Suneel B Bhat, Asif M Ilyas
BACKGROUND: There has been recent interest in wide awake hand surgery, also referred to as "wide awake local anesthesia with no tourniquet" (WALANT) surgery. Using a model of single trigger finger release (TFR) surgery, a hypothesis was made that WALANT would result in decreased hospital time and cost than patients receiving sedation with monitored anesthetic care (MAC). METHODS: Consecutive cases of single TFR surgery with MAC were compared with WALANT. All surgeries were performed in the same manner, at the same facility, and by the same surgeon...
July 2017: Hand: Official Journal of the American Association for Hand Surgery
https://www.readbyqxmd.com/read/28629906/can-bundled-payments-be-successful-in-the-medicaid-population-for-primary-joint-arthroplasty
#11
P Maxwell Courtney, Tori Edmiston, Brian Batko, Brett R Levine
BACKGROUND: Although some bundled payment models have had success in total joint arthroplasty, concerns exist about access to care for higher cost patients who use more resources. The purpose of this study is to determine whether Medicaid patients have increased hospital costs and more resource utilization in a 90-day episode of care than Medicare or privately insured patients. METHODS: We retrospectively reviewed a consecutive series of 7268 primary hip and knee arthroplasty patients at a single institution...
May 25, 2017: Journal of Arthroplasty
https://www.readbyqxmd.com/read/28622969/probability-of-undiagnosed-obstructive-sleep-apnea-does-not-correlate-with-adverse-pulmonary-events-nor-length-of-stay-in-hip-and-knee-arthroplasty-using-intrathecal-opioid
#12
Matthew J Thompson, Bryce N Clinger, Robert M Simonds, Camille J Hochheimer, Laura A Lahaye, Gregory J Golladay
BACKGROUND: Recent emphasis on bundled payments and outcomes tracking has increased the focus on preoperative optimization in patients undergoing elective lower extremity arthroplasty. Since patients with obstructive sleep apnea (OSA) have an increased risk of adverse perioperative pulmonary events, screening for undiagnosed OSA is sometimes included as part of preoperative risk assessment. However, there are limited data regarding quantification of OSA risk in lower extremity arthroplasty patients, and little is known about the utility of quantitative OSA screening and the risk of pulmonary complications in hip and knee arthroplasty patients who receive intrathecal morphine anesthetic...
April 14, 2017: Journal of Arthroplasty
https://www.readbyqxmd.com/read/28622186/a-90-day-bundled-payment-for-primary-single-level-lumbar-discectomy-decompression-what-does-big-data-say
#13
Nikhil Jain, Sohrab S Virk, Frank M Phillips, Elizabeth Yu, Safdar N Khan
Episode-based bundling may become the major form of reimbursement for many elective spine procedures. As the amount for a 90-day episode of care is not known for a lumbar discectomy, we analyzed the previous reimbursements from Commercial payers (2007-Q2 2015), Medicare Advantage (2007-Q2 2015), and Medicare (2005-2012) for a primary single-level lumbar discectomy/decompression. Distribution of payments among various service providers was studied and a 90-day bundle was simulated. Depending on the payer type, the average facility costs constituted 59...
June 15, 2017: Clinical Spine Surgery
https://www.readbyqxmd.com/read/28590385/post-discharge-care-duration-charges-and-outcomes-among-medicare-patients-after-primary-total-hip-and-knee-arthroplasty
#14
Karthikeyan E Ponnusamy, Zan Naseer, Mostafa H El Dafrawy, Louis Okafor, Clayton Alexander, Robert S Sterling, Harpal S Khanuja, Richard L Skolasky
BACKGROUND: In April 2016, the U.S. Centers for Medicare & Medicaid Services initiated mandatory 90-day bundled payments for total hip and knee arthroplasty for much of the country. Our goal was to determine duration of care, 90-day charges, and readmission rates by discharge disposition and U.S. region after hip or knee arthroplasty. METHODS: Using the 2008 Medicare Provider Analysis and Review database 100% sample, we identified patients who had undergone elective primary total hip or knee arthroplasty...
June 7, 2017: Journal of Bone and Joint Surgery. American Volume
https://www.readbyqxmd.com/read/28586574/bundled-payment-for-physician-group-practices-and-organized-delivery-systems
#15
Barry Liss
No abstract text is available yet for this article.
2017: MD Advisor: a Journal for New Jersey Medical Community
https://www.readbyqxmd.com/read/28583761/bundled-payments-for-care-improvement-boom-or-bust
#16
Brian M Curtin, Robert D Russell, Susan M Odum
BACKGROUND: As early implementors of the Centers for Medicare and Medicaid Services (CMS) Bundled Payments for Care Improvement (BPCI) initiative, our private practice sought to compare our readmission rates, post-acute care utilization, and length of stay for the first year under BPCI compared to baseline data. METHODS: We used CMS data to compare total expenditures of all diagnosis-related groups (DRGs). Medicare patients who underwent orthopedic surgery between 2009 and 2012 were defined as non-BPCI (n = 8415) and were compared to Medicare BPCI patients (n = 4757) who had surgery in 2015...
May 15, 2017: Journal of Arthroplasty
https://www.readbyqxmd.com/read/28569737/nursing-care-management-influence-on-bundled-payments-erratum
#17
(no author information available yet)
No abstract text is available yet for this article.
March 2017: Orthopaedic Nursing
https://www.readbyqxmd.com/read/28562404/bundle-payment-program-initiative-roles-of-a-nurse-navigator-and-home-health-professionals
#18
Heather Peiritsch
With the passage of the Affordable Care Act, The Centers for Medicare and Medicaid (CMS) introduced a new value-based payment model, the Bundle Payment Care Initiative. The CMS Innovation (Innovation Center) authorized hospitals to participate in a pilot to test innovative payment and service delivery models that have a potential to reduce Medicare expenditures while maintaining or improving the quality of care for beneficiaries. A hospital-based home care agency, Abington Jefferson Health Home Care Department, led the initiative for the development and implementation of the Bundled Payment Program...
June 2017: Home Healthcare Now
https://www.readbyqxmd.com/read/28562307/the-eye-of-the-beholder-a-discussion-of-value-and-quality-from-the-perspective-of-families-of-children-and-youth-with-special-health-care-needs
#19
Betsy Anderson, Julie Beckett, Nora Wells, Meg Comeau
There is broad agreement that increasing the cost-effectiveness and quality of health care services, thereby achieving greater value, is imperative given this country's current spiraling costs and poor health outcomes. However, how individuals or stakeholder groups define value may differ significantly. Discussion of value in the context of health care, in particular value-based purchasing and value-based insurance design, must acknowledge that there is no universal consensus definition as to what constitutes value...
May 2017: Pediatrics
https://www.readbyqxmd.com/read/28561691/improving-quality-and-value-of-cancer-care-for-older-adults
#20
Erika E Ramsdale, Valerie Csik, Andrew E Chapman, Arash Naeim, Beverly Canin
The concepts of quality and value have become ubiquitous in discussions about health care, including cancer care. Despite their prominence, these concepts remain difficult to encapsulate, with multiple definitions and frameworks emerging over the past few decades. Defining quality and value for the care of older adults with cancer can be particularly challenging. Older adults are heterogeneous and often excluded from clinical trials, severely limiting generalizable data for this population. Moreover, many frameworks for quality and value focus on traditional outcomes of survival and toxicity and neglect goals that may be more meaningful for older adults, such as quality of life and functional independence...
2017: American Society of Clinical Oncology Educational Book
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