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https://www.readbyqxmd.com/read/29595721/trends-in-physician-payments-for-breast-reconstruction
#1
Clifford C Sheckter, Day Yi, Hina J Panchal, Shantanu N Razdan, Andrea L Pusic, Colleen M McCarthy, Peter G Cordeiro, Joseph J Disa, Babak Mehrara, Evan Matros
BACKGROUND: Prosthetic breast reconstruction rates have risen in the United States, whereas autologous techniques have stagnated. Meanwhile, single-institution data demonstrate that physician payments for prosthetic reconstruction are rising, while payments for autologous techniques are unchanged. This study aims to assess payment trends and variation for tissue expander and free flap breast reconstruction. METHODS: The Blue Health Intelligence database was queried from 2009 to 2013, identifying women with claims for breast reconstruction...
April 2018: Plastic and Reconstructive Surgery
https://www.readbyqxmd.com/read/29588607/cost-analysis-of-a-growth-guidance-system-compared-with-traditional-and-magnetically-controlled-growing-rods-for-early-onset-scoliosis-a-us-based-integrated-health-care-delivery-system-perspective
#2
Scott J Luhmann, Eoin M McAughey, Stacey J Ackerman, David B Bumpass, Richard E McCarthy
Purpose: Treating early-onset scoliosis (EOS) with traditional growing rods (TGR) is effective but requires periodic surgical lengthening, risking complications. Alternatives include magnetically controlled growing rods (MCGR) that lengthen noninvasively and the growth guidance system (GGS), which obviate the need for active, distractive lengthenings. Previous studies have reported promising clinical effectiveness for GGS; however the direct medical costs of GGS compared to TGR and MCGR have not yet been explored...
2018: ClinicoEconomics and Outcomes Research: CEOR
https://www.readbyqxmd.com/read/29560404/can-an-arthroplasty-risk-score-predict-bundled-care-events-after-total-joint-arthroplasty
#3
Blair S Ashley, Paul Maxwell Courtney, Daniel J Gittings, Jenna A Bernstein, Gwo Chin Lee, Eric L Hume, Atul F Kamath
Background: The validated Arthroplasty Risk Score (ARS) predicts the need for postoperative triage to an intensive care setting. We hypothesized that the ARS may also predict hospital length of stay (LOS), discharge disposition, and episode-of-care cost (EOCC). Methods: We retrospectively reviewed a series of 704 patients undergoing primary total hip and knee arthroplasty over 17 months. Patient characteristics, 90-day EOCC, LOS, and readmission rates were compared before and after ARS implementation...
March 2018: Arthroplasty Today
https://www.readbyqxmd.com/read/29553283/improving-quality-of-care-in-oncology-through-healthcare-payment-reform
#4
Lonnie Wen, Christine Divers, Melissa Lingohr-Smith, Jay Lin, Scott Ramsey
OBJECTIVES: To provide an overview of alternative payment models (APMs) and describe how leading national organizations involved with oncology care and payment are linking quality improvement initiatives and payment reform. STUDY DESIGN: Literature review. METHODS: For this review, we summarized the literature on APMs and their goals of improving healthcare quality while jointly controlling the cost of care. We described the types of APMs that have been examined in the real-world setting, specifically in the area of oncology, and how they have affected the quality of oncology care...
March 1, 2018: American Journal of Managed Care
https://www.readbyqxmd.com/read/29544708/society-of-gynecologic-oncology-future-of-physician-payment-reform-task-force-report-the-endometrial-cancer-alternative-payment-model-ecap
#5
Emily M Ko, Laura J Havrilesky, Ronald D Alvarez, Oliver Zivanovic, Leslie R Boyd, Elizabeth L Jewell, Patrick F Timmins, Randall S Gibb, Anuja Jhingran, David E Cohn, Sean C Dowdy, Matthew A Powell, Eva Chalas, Yongmei Huang, Jill Rathbun, Jason D Wright
Health care in the United States is in the midst of a significant transformation from a "fee for service" to a "fee for value" based model. The Medicare Access and CHIP Reauthorization Act of 2015 has only accelerated this transition. Anticipating these reforms, the Society of Gynecologic Oncology developed the Future of Physician Payment Reform Task Force (PPRTF) in 2015 to develop strategies to ensure fair value based reimbursement policies for gynecologic cancer care. The PPRTF elected as a first task to develop an Alternative Payment Model for thesurgical management of low risk endometrial cancer...
March 12, 2018: Gynecologic Oncology
https://www.readbyqxmd.com/read/29539282/financial-incentives-and-vulnerable-populations-will-alternative-payment-models-help-or-hurt
#6
Karen E Joynt Maddox
There is broad agreement that fee-for-service reimbursement does too little to encourage the provision of efficient, high-value care. Consequently, Medicare and other payers are increasingly moving toward alternative payment models (APMs), which disrupt the fee-for-service system by incorporating..
March 15, 2018: New England Journal of Medicine
https://www.readbyqxmd.com/read/29504199/transformation-of-the-health-care-industry-curb-your-enthusiasm
#7
Lawton R Burns, Mark V Pauly
Policy Points: Policymakers seek to transform the US health care system along two dimensions simultaneously: alternative payment models and new models of provider organization. This transformation is supposed to transfer risk to providers and make them more accountable for health care costs and quality. The transformation in payment and provider organization is neither happening quickly nor shifting risk to providers. The impact on health care cost and quality is also weak or nonexistent. In the longer run, decision makers should be prepared to accept the limits on transformation and carefully consider whether to advocate solutions not yet supported by evidence...
March 2018: Milbank Quarterly
https://www.readbyqxmd.com/read/29504023/effect-of-payment-model-on-patient-outcomes-in-outpatient-physical-therapy
#8
Derek Charles, Sylvester Boyd, Logan Heckert, Austin Lake, Kevin Petersen
Although the literature has well recognized the effectiveness of physical therapy for treating musculoskeletal injuries, reimbursement is evolving towards value-based or alternative payment models and away from procedure orientated, fee-for-service in the outpatient setting. Alternative models include cased-based clinics, pay-for-performance, out-of-network services, accountable care organizations, and concierge practices. There is the possibility that alternative payment models could produce different and even superior patient outcomes...
2018: Journal of Allied Health
https://www.readbyqxmd.com/read/29496977/evolving-federal-and-state-health-care-policy-toward-a-more-integrated-and-comprehensive-care-delivery-system-for-children-with-medical-complexity
#9
Carolyn S Langer, Richard C Antonelli, Lisa Chamberlain, Richard J Pan, David Keller
Irrespective of any future changes in federal health policy, the momentum to shift from fee-for-service to value-based payment systems is likely to persist. Public and private payers continue to move toward alternative payment models that promote novel care-delivery systems and greater accountability for health outcomes. With a focus on population health, patient-centered medical homes, and care coordination, alternative payment models hold the potential to promote care-delivery systems that address the unique needs of children with medical complexity (CMC), including nonmedical needs and the social determinants of health...
March 2018: Pediatrics
https://www.readbyqxmd.com/read/29496293/estimating-potential-for-savings-for-low-risk-endometrial-cancer-using-the-endometrial-cancer-alternative-payment-model-ecap-a-companion-paper-to-the-society-of-gynecologic-oncology-report-on-the-endometrial-cancer-alternative-payment-model
#10
REVIEW
Jason D Wright, Laura J Havrilesky, David E Cohn, Yongmei Huang, Jill Rathbun, Laurel W Rice, Carol L Brown, Ronald D Alvarez, Emily M Ko
OBJECTIVE: To design an endometrial cancer (EC) alternative payment (ECAP) model focused on surgical management of EC, as well as identify drivers of cost in order to develop opportunities for cost-savings while maintaining quality of care. METHODS: National practice patterns and reimbursements were compared between private payers (MarketScan data, years 2009-13) and public payers (Medicare, year 2014) of EC patients who underwent hysterectomy. An episode of care for EC included the hysterectomy, stratified by surgical approach (laparotomy versus robotic versus laparoscopy), and in- and outpatient reimbursements from 30days preoperatively to 60days postoperatively...
February 26, 2018: Gynecologic Oncology
https://www.readbyqxmd.com/read/29473945/home-based-primary-care-beyond-extension-of-the-independence-at-home-demonstration
#11
James Rotenberg, Bruce Kinosian, Peter Boling, George Taler
The Independence at Home (IAH) Demonstration Year 2 results confirmed that the first-year savings were 10 times as great as those of the pioneer accountable care organizations during their initial 2 years. We update projected savings from nationwide conversion of the IAH demonstration, incorporating Year 2 results and improving attribution of IAH-qualified (IAH-Q) Medicare beneficiaries to home-based primary care (HBPC) practices. Applying IAH qualifying criteria to beneficiaries in the Medicare 5% claims file, the effect of expanding HBPC to the 2...
April 2018: Journal of the American Geriatrics Society
https://www.readbyqxmd.com/read/29456494/the-influence-of-feedback-on-task-switching-performance-a-drift-diffusion-modeling-account
#12
Russell Cohen Hoffing, Povilas Karvelis, Samuel Rupprechter, Peggy Seriès, Aaron R Seitz
Task-switching is an important cognitive skill that facilitates our ability to choose appropriate behavior in a varied and changing environment. Task-switching training studies have sought to improve this ability by practicing switching between multiple tasks. However, an efficacious training paradigm has been difficult to develop in part due to findings that small differences in task parameters influence switching behavior in a non-trivial manner. Here, for the first time we employ the Drift Diffusion Model (DDM) to understand the influence of feedback on task-switching and investigate how drift diffusion parameters change over the course of task switch training...
2018: Frontiers in Integrative Neuroscience
https://www.readbyqxmd.com/read/29452560/health-care-efficiencies-consolidation-and-alternative-models-vs-health-care-and-antitrust-regulation-irreconcilable-differences
#13
Michael W King
Despite the U.S. substantially outspending peer high income nations with almost 18% of GDP dedicated to health care, on any number of statistical measurements from life expectancy to birth rates to chronic disease, 1 the U.S. achieves inferior health outcomes. In short, Americans receive a very disappointing return on investment on their health care dollars, causing economic and social strain. 2 Accordingly, the debates rage on: what is the top driver of health care spending? Among the culprits: poor communication and coordination among disparate providers, paperwork required by payors and regulations, well-intentioned physicians overprescribing treatments, drugs and devices, outright fraud and abuse, and medical malpractice litigation...
November 2017: American Journal of Law & Medicine
https://www.readbyqxmd.com/read/29442297/a-single-center-cost-analysis-of-treating-primary-and-metastatic-brain-cancers-with-either-brain-laser-interstitial-thermal-therapy-litt-or-craniotomy
#14
Eric C Leuthardt, Jeff Voigt, Albert H Kim, Pete Sylvester
BACKGROUND: Brain laser interstitial thermal therapy (LITT) under magnetic resonance imaging (MRI) guidance has recently gained US clinical approval for the ablation of soft, neurological tissue. LITT is a minimally invasive alternative to craniotomy. OBJECTIVE: While safety and efficacy are the focus of most current LITT studies, it is unclear how acute care costs (inpatient care ± aftercare) of LITT compare to craniotomy in an academic medical center. Therefore, the purpose of this analysis is to examine these costs of using brain LITT under MRI guidance compared to craniotomy in complex anatomies...
March 2017: PharmacoEconomics Open
https://www.readbyqxmd.com/read/29439895/adding-value-to-total-joint-arthroplasty-care-in-an-academic-environment-the-utah-experience
#15
Christopher E Pelt, Mike B Anderson, Jill A Erickson, Jeremy M Gililland, Christopher L Peters
BACKGROUND: Adding value in a university-based academic health care system provides unique challenges when compared to other health care delivery models. Herein, we describe our experience in adding value to joint arthroplasty care at the University of Utah, where the concept of value-based health care reform has become an embraced and driving force. METHODS: To improve the value, new resources were needed for care redesign, physician leadership, and engagement in alternative payment models...
February 10, 2018: Journal of Arthroplasty
https://www.readbyqxmd.com/read/29433071/applying-crash-data-to-injury-claims-an-investigation-of-determinant-factors-in-severe-motor-vehicle-accidents
#16
Darren Shannon, Finbarr Murphy, Martin Mullins, Julian Eggert
An extensive number of research studies have attempted to capture the factors that influence the severity of vehicle impacts. The high number of risks facing all traffic participants has led to a gradual increase in sophisticated data collection schemes linking crash characteristics to subsequent severity measures. This study serves as a departure from previous research by relating injuries suffered in road traffic accidents to expected trauma compensation payouts and deriving a quantitative cost function. Data from the National Highway Traffic Safety Administration's (NHTSA) Crash Injury Research (CIREN) database for the years 2005-2014 is combined with the Book of Quantum, an Irish governmental document that offers guidelines on the appropriate compensation to be awarded for injuries sustained in accidents...
February 9, 2018: Accident; Analysis and Prevention
https://www.readbyqxmd.com/read/29406371/pediatric-specialty-care-model-for-management-of-chronic-respiratory-failure-cost-and-savings-implications-and-misalignment-with-payment-models
#17
Robert J Graham, Michael L McManus, Angie Mae Rodday, Ruth Ann Weidner, Susan K Parsons
OBJECTIVE: To describe program design, costs, and savings implications of a critical care-based care coordination model for medically complex children with chronic respiratory failure. DESIGN: All program activities and resultant clinical outcomes were tracked over 4 years using an adapted version of the Care Coordination Measurement Tool. Patient characteristics, program activity, and acute care resource utilization were prospectively documented in the adapted version of the Care Coordination Measurement Tool and retrospectively cross-validated with hospital billing data...
February 3, 2018: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/29393807/health-care-service-use-among-elderly-seasonal-migrators
#18
Molly Moore Jeffery, Julian Wolfson, Sarah K Meier, Bryan E Dowd, Jean M Abraham, Robert L Kane
Elderly seasonal migrators share time between homes in different states, presenting challenges for care coordination and patient attribution methods. Medicare has prioritized alternative payment models, putting health care providers at risk for quality and value of services delivered to their attributed patients, regardless of the location of care. Little research is available to guide providers and payers on the service use of seasonal migrators. The authors use claims data on fee-for-service (FFS) Medicare beneficiaries' locations throughout the year to (1) identify seasonal migrators and (2) describe the care they receive in each seasonal home, focusing on primary care and emergency department (ED) visits and the relationships between the two...
February 2, 2018: Population Health Management
https://www.readbyqxmd.com/read/29379954/principles-for-a-framework-for-alternative-payment-models
#19
Sam Nussbaum, Mark McClellan, Grischa Metlay
No abstract text is available yet for this article.
January 29, 2018: JAMA: the Journal of the American Medical Association
https://www.readbyqxmd.com/read/29378585/barriers-and-facilitators-to-implementation-uptake-and-sustainability-of-community-based-health-insurance-schemes-in-low-and-middle-income-countries-a-systematic-review
#20
REVIEW
Racha Fadlallah, Fadi El-Jardali, Nour Hemadi, Rami Z Morsi, Clara Abou Abou Samra, Ali Ahmad, Khurram Arif, Lama Hishi, Gladys Honein-AbouHaidar, Elie A Akl
BACKGROUND: Community-based health insurance (CBHI) has evolved as an alternative health financing mechanism to out of pocket payments in low- and middle-income countries (LMICs), particularly in areas where government or employer-based health insurance is minimal. This systematic review aimed to assess the barriers and facilitators to implementation, uptake and sustainability of CHBI schemes in LMICs. METHODS: We searched six electronic databases and grey literature...
January 29, 2018: International Journal for Equity in Health
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