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https://www.readbyqxmd.com/read/29037365/a-look-ahead-into-advanced-alternative-payment-models-in-vascular-surgery
#1
Taylor A Smith, Jordan Knepper, Karen Woo, Jill Rathbun, Brad Johnson
No abstract text is available yet for this article.
November 2017: Journal of Vascular Surgery. Venous and Lymphatic Disorders
https://www.readbyqxmd.com/read/29033158/revision-total-knee-arthroplasty-for-periprosthetic-joint-infection-is-associated-with-increased-postoperative-morbidity-and-mortality-relative-to-noninfectious-revisions
#2
Venkat Boddapati, Michael C Fu, David J Mayman, Edwin P Su, Peter K Sculco, Alexander S McLawhorn
BACKGROUND: Periprosthetic joint infection (PJI) after primary total knee arthroplasty (TKA) is a devastating complication. The short-term morbidity profile of revision TKA performed for PJI relative to non-PJI revisions is poorly characterized. The purpose of this study is to determine 30-day postoperative outcomes after revision TKA for PJI, relative to primary TKA and aseptic revision TKA. METHODS: The American College of Surgeons National Surgical Quality Improvement Program from 2005 to 2015 was queried for primary and revision TKA cases...
September 23, 2017: Journal of Arthroplasty
https://www.readbyqxmd.com/read/29021109/design-and-impact-of-bundled-payment-for-detox-and-follow-up-care
#3
Amity E Quinn, Dominic Hodgkin, Jennifer N Perloff, Maureen T Stewart, Mary Brolin, Nancy Lane, Constance M Horgan
INTRODUCTION: Recent payment reforms promote movement from fee-for-service to alternative payment models that shift financial risk from payers to providers, incentivizing providers to manage patients' utilization. Bundled payment, an episode-based fixed payment that includes the prices of a group of services that would typically treat an episode of care, is expanding in the United States. Bundled payment has been recommended as a way to pay for comprehensive SUD treatment and has the potential to improve treatment engagement after detox, which could reduce detox readmissions, improve health outcomes, and reduce medical care costs...
November 2017: Journal of Substance Abuse Treatment
https://www.readbyqxmd.com/read/28983431/evaluation-of-policy-options-for-increasing-the-availability-of-primary-care-services-in-rural-washington-state
#4
Mark W Friedberg, Grant R Martsolf, Chapin White, David I Auerbach, Ryan Kandrack, Rachel O Reid, Emily Butcher, Hao Yu, Simon Hollands, Xiaoyu Nie
The Washington State legislature has recently considered several policy options to address a perceived shortage of primary care physicians in rural Washington. These policy options include opening the new Elson S. Floyd College of Medicine at Washington State University in 2017; increasing the number of primary care residency positions in the state; expanding educational loan-repayment incentives to encourage primary care physicians to practice in rural Washington; increasing Medicaid payment rates for primary care physicians in rural Washington; and encouraging the adoption of alternative models of primary care, such as medical homes and nurse-managed health centers, that reallocate work from physicians to nurse practitioners (NPs) and physician assistants (PAs)...
January 2017: Rand Health Quarterly
https://www.readbyqxmd.com/read/28983220/similar-cost-savings-of-bundled-payment-initiatives-applied-to-lower-extremity-total-joint-arthroplasty-can-be-achieved-applying-both-models-2-and-3
#5
Allyson Alfonso, Lorraine Hutzler, Bill Robb, Chad Beste, André Blom, Joseph Bosco
BACKGROUND: In an effort to control cost and increase value, Medicare is transitioning from fee-for-service to value-based alternative payment models (APMs). The Bundled Payments for Care Improvement (BPCI) initiative represents one such voluntary APM. BPCI offers four different bundling options: model 1 covers all Diagnosis Related Groups (DRGs) and Models 2-4 cover 48 clinical episodes, including 186 separate DRGs. QUESTIONS/PURPOSES: The purpose of this investigation is to analyze and compare the cost savings achieved by two different BPCI program participants, provider A and provider B, enrolled in different models of BPCI (Models 2 and 3) for lower extremity joint replacements (LEJRs)...
October 2017: HSS Journal: the Musculoskeletal Journal of Hospital for Special Surgery
https://www.readbyqxmd.com/read/28981388/where-are-the-opportunities-for-reducing-health-care-spending-within-alternative-payment-models
#6
Gabrielle B Rocque, Courtney P Williams, Kelly M Kenzik, Bradford E Jackson, Karina I Halilova, Margaret M Sullivan, Rod P Rocconi, Andres Azuero, Elizabeth A Kvale, Warner K Huh, Edward E Partridge, Maria Pisu
PURPOSE: The Oncology Care Model (OCM) is a highly controversial specialty care model developed by the Centers for Medicare & Medicaid aimed to provide higher-quality care at lower cost. Because oncologists will be increasingly held accountable for spending as well as quality within new value-based health care models like the OCM, they need to understand the drivers of total spending for their patients. METHODS: This retrospective cohort study included patients ≥ 65 years of age with primary fee-for-service Medicare insurance who received antineoplastic therapy at 12 cancer centers in the Southeast from 2012 to 2014...
October 5, 2017: Journal of Oncology Practice
https://www.readbyqxmd.com/read/28976250/recommendations-from-the-first-national-academic-consortium-of-telehealth
#7
Judd E Hollander, Theresa M Davis, Charles Doarn, Jason C Goldwater, Stephen Klasko, Curtis Lowery, Dimitrios Papanagnou, Peter Rasmussen, Frank D Sites, Danica Stone, Brendan G Carr
In January 2015, the US Secretary of Health and Human Services announced targets for the transformation of Medicare reimbursement from a fee-for-service model to payments based on alternative payment models. People now use technology for virtually everything - from paying bills to purchasing almost anything; it is therefore natural to think that they will use technology to take ownership of their own health care. The remote provision of health care, where providers and patients are not in the same location, will allow patients to receive the right care, at the right time, at the right place, and in the manner they consider right for them...
October 4, 2017: Population Health Management
https://www.readbyqxmd.com/read/28963077/payment-and-care-for-hematopoietic-cellular-transplant-patients-toward-a-specialized-medical-home-for-complex-care-patients
#8
James L Gajewski, Mark B McClellan, Navneet S Majhail, Parameswaran N Hari, Christopher N Bredeson, Richard T Maziarz, Charles F LeMaistre, Michael C Lill, Stephanie H Farnia, Krishna V Komanduri, Michael J Boo
Patient-centered medical home models are fundamental to the advanced alternative payment models (APM) defined in the Medicare Access and Children's Health Insurance Plan (CHIP) Reauthorization Act (MACRA). The patient-centered medical home is a model of health care delivery supported by alternative payment mechanisms and designed to promote coordinated medical care that is simultaneously patient-centric and population-oriented. This transformative care model requires shifting reimbursement to include a per-patient payment intended to cover services not previously reimbursed such as disease management over time...
September 26, 2017: Biology of Blood and Marrow Transplantation
https://www.readbyqxmd.com/read/28961643/hospital-value-based-purchasing-the-association-between-patient-experience-and-clinical-outcome
#9
D Rob Haley, Hanadi Hamadi, Mei Zhao, Jing Xu, Yi Wang
The Affordable Care Act of 2010 introduced a Hospital Value-Based Purchasing Total Performance Score for payment purposes and to evaluate hospital quality of care. In fiscal year 2016, Total Performance Score was composed of (1) Clinical Processes of Care, (2) Patient Experience of Care, (3) Outcome, and (4) Efficiency domains. The objective of this study was to examine the association between the Patient Experience of Care and Outcome domains. The Donabedian model of structure, process, and outcome was used as a conceptual framework for this study...
September 28, 2017: Health Care Manager
https://www.readbyqxmd.com/read/28956027/the-impact-of-changes-in-medicare-s-physician-payment-system-on-critical-care
#10
Charles E Hobson, Azra Bihorac, Mehrnaz Hadian, Daniel L Herr, Thomas G Rainey, Frank B Cerra, Lena M Napolitano, John W Hoyt
In 2015 President Obama signed the Medicare Access and CHIP Reauthorization Act (MACRA) which repealed the Sustainable Growth Rate (SGR) mechanism for Medicare physician reimbursement and mandated that CMS develop alternative payment methodologies to "reward health care providers for giving better care not more just more care." MACRA makes 3 major changes to Medicare reimbursements: (1) it ends the SGR formula; (2) it establishes a new framework to reward physicians based on performance and health outcomes rather than volume; and (3) it aims to combine existing quality reporting programs into one streamlined system...
February 2017: Crit Connect
https://www.readbyqxmd.com/read/28954711/risk-adjusted-regional-outcomes-in-elective-medicare-colorectal-surgery
#11
Donald E Fry, Susan M Nedza, Michael Pine, Agnes M Reband, Chun-Jung Huang, Gregory Pine
BACKGROUND: Regional differences in utilization of services in healthcare are commonly understood, but risk-adjusted evaluation of outcomes has not been done. METHODS: Risk-adjusted adverse outcomes (AOs) for elective Medicare colorectal resections were studied for 2012-2014. Risk-adjusted metrics were inpatient deaths, prolonged postoperative length-of-stay, 90-day post-discharge deaths, and 90-day relevant post-discharge readmissions. The nine Census Bureau regions of the U...
September 20, 2017: American Journal of Surgery
https://www.readbyqxmd.com/read/28952981/reporting-from-the-front-lines-implementing-oregon-s-alternative-payment-methodology-in-federally-qualified-health-centers
#12
Erika K Cottrell, Jennifer D Hall, Glenn Kautz, Heather Angier, Sonja Likumahuwa-Ackman, Laura Sisulak, Sara Keller, David C Cameron, Jennifer E DeVoe, Deborah J Cohen
Alternative payment models have been proposed as a way to facilitate patient-centered medical home model implementation, yet little is known about how payment reform translates into changes in care delivery. We conducted site visits, observed operations, and conducted interviews within 3 Federally Qualified Health Center organizations that were part of Oregon's Alternative Payment Methodology demonstration project. Data were analyzed using an immersion-crystallization approach. We identified several care delivery changes during the early stages of implementation, as well as challenges associated with this new model of payment...
September 25, 2017: Journal of Ambulatory Care Management
https://www.readbyqxmd.com/read/28944726/paying-for-cures-how-can-we-afford-it-managed-care-pharmacy-stakeholder-perceptions-of-policy-options-to-address-affordability-of-prescription-drugs
#13
Kai Yeung, Kangho Suh, Anirban Basu, Louis P Garrison, Aasthaa Bansal, Josh J Carlson
BACKGROUND: High-priced medications with curative potential, such as the newer hepatitis C therapies, have contributed to the recent growth in pharmaceutical expenditure. Despite the obvious benefits, health care decision makers are just beginning to grapple with questions of how to value and pay for curative therapies that may feature large upfront cost, followed by health benefits that are reaped over a patient's lifespan. Alternative policy options have been proposed to promote high value and financially sustainable use of these therapies...
October 2017: Journal of Managed Care & Specialty Pharmacy
https://www.readbyqxmd.com/read/28942856/what-is-an-advanced-alternative-payment-model
#14
Vivienne J Halpern, Paula K Shireman, Karen Woo, Jill Rathbun, Brad Johnson
No abstract text is available yet for this article.
October 2017: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/28930760/medical-education-and-health-care-delivery-a-call-to-better-align-goals-and-purposes
#15
David P Sklar, Paul A Hemmer, Steven J Durning
The transformation of the U.S. health care system is under way, driven by the needs of an aging population, rising health care spending, and the availability of health information. However, the speed and effectiveness of the transformation of health care delivery will depend, in large part, upon engagement of the health professions community and changes in clinicians' practice behaviors. Current efforts to influence practice behaviors emphasize changes in the health payment system with incentives to move from fee-for-service to alternative payment models...
September 14, 2017: Academic Medicine: Journal of the Association of American Medical Colleges
https://www.readbyqxmd.com/read/28885288/early-effects-of-medicare-s-bundled-payment-for-care-improvement-bpci-program-for-lumbar-fusion
#16
Brook I Martin, Jon D Lurie, Farrokh R Farrokhi, Kevin J McGuire, Sohail K Mirza
STUDY DESIGN: Retrospective analysis of Medicare claims linked to hospital participation in the Center for Medicare and Medicaid Innovation's episode-based Bundled Payment for Care Improvement (BPCI) program for lumbar fusion. OBJECTIVES: To describe the early effects of BPCI participation for lumbar fusion on 90-day reimbursement, procedure volume, reoperation, and readmission. SUMMARY OF BACKGROUND DATA: Initiated on January 1st, 2013, BPCI's voluntary bundle payment program provides a predetermined payment for services related to a Diagnosis Related Group-defined "triggering event" over a defined time period...
September 6, 2017: Spine
https://www.readbyqxmd.com/read/28885240/advancing-value-based-population-health-management-through-payer-provider-partnerships-improving-outcomes-for-children-with-complex-conditions
#17
Pamela Peele, Donna Keyser, John Lovelace, Deborah Moss
Population health management (PHM) approaches to improve cost and quality remain limited. To address this gap, stakeholders within an integrated delivery and financing system in Western Pennsylvania designed, implemented, and tested a value-based care model for children with medically complex conditions that could be scaled across the broader pediatric population. The model included: (1) a multilevel, interdisciplinary infrastructure; (2) actionable analytics reports to guide continuous quality improvement; (3) alternative provider payments; (4) consumer-directed spending accounts; and (5) shared savings with practices...
September 1, 2017: Journal for Healthcare Quality: Official Publication of the National Association for Healthcare Quality
https://www.readbyqxmd.com/read/28876455/the-age-friendly-health-system-imperative
#18
Terry Fulmer, Kedar S Mate, Amy Berman
The unprecedented changes happening in the American healthcare system have many on high alert as they try to anticipate legislative actions. Significant efforts to move from volume to value, along with changing incentives and alternative payment models, will affect practice and the health system budget. In tandem, growth in the population aged 65 and older is celebratory and daunting. The John A. Hartford Foundation is partnering with the Institute for Healthcare Improvement to envision an age-friendly health system of the future...
September 6, 2017: Journal of the American Geriatrics Society
https://www.readbyqxmd.com/read/28857975/finding-like-minded-partners-to-span-the-continuum-of-care
#19
Bruce Lawrence
This is an era of profound industry transformation, characterized by such forces as acceleration away from inpatient-centered care and toward alternative payment models, rising rates of chronic disease, and an aging population. Add to this mix physician and nurse shortages and a newfound understanding that today's patients are informed consumers, and the reality becomes clear: Healthcare providers must be adaptable, agile, and innovative to survive. Sometimes, the best way forward in transformative times is collaboration with other like-minded organizations...
October 2017: Frontiers of Health Services Management
https://www.readbyqxmd.com/read/28857887/reporting-from-the-front-lines-implementing-oregon-s-alternative-payment-methodology-in-federally-qualified-health-centers
#20
Erika K Cottrell, Jennifer D Hall, Glenn Kautz, Heather Angier, Sonja Likumahuwa-Ackman, Laura Sisulak, Sara Keller, David C Cameron, Jennifer E DeVoe, Deborah J Cohen
Alternative payment models have been proposed as a way to facilitate patient-centered medical home model implementation, yet little is known about how payment reform translates into changes in care delivery. We conducted site visits, observed operations, and conducted interviews within 3 Federally Qualified Health Center organizations that were part of Oregon's Alternative Payment Methodology demonstration project. Data were analyzed using an immersion-crystallization approach. We identified several care delivery changes during the early stages of implementation, as well as challenges associated with this new model of payment...
October 2017: Journal of Ambulatory Care Management
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