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Alternative payment model

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https://www.readbyqxmd.com/read/29920193/time-driven-activity-based-costing-in-fracture-care-is-this-a-more-accurate-way-to-prepare-for-alternative-payment-models
#1
Dylan L McCreary, Melissa White, Sandy Vang, Brad Plowman, Brian P Cunningham
OBJECTIVES: To use surgical treatment of isolated ankle fractures as a model to compare time-driven activity-based costing (TDABC) and our institution's traditional cost accounting (TCA) method to measure true cost expenditure around a specific episode of care. METHODS: Level I trauma center ankle fractures treated between 2012 and 2016 were identified through a registry. Inclusion criteria were age greater than 18 years and same-day ankle fracture operation. Exclusion criteria were pilon fractures, vascular injuries, soft-tissue coverage, and external fixation...
July 2018: Journal of Orthopaedic Trauma
https://www.readbyqxmd.com/read/29796605/cost-savings-associated-with-an-alternative-payment-model-for-integrating-behavioral-health-in-primary-care
#2
Kaile M Ross, Emma C Gilchrist, Stephen P Melek, Patrick D Gordon, Sandra L Ruland, Benjamin F Miller
Financially supporting and sustaining behavioral health services integrated into primary care settings remains a major barrier to widespread implementation. Sustaining Healthcare Across Integrated Primary Care Efforts (SHAPE) was a demonstration project designed to prospectively examine the cost savings associated with utilizing an alternative payment methodology to support behavioral health services in primary care practices with integrated behavioral health services. Six primary care practices in Colorado participated in this project...
May 23, 2018: Translational Behavioral Medicine
https://www.readbyqxmd.com/read/29791190/the-comprehensive-primary-care-initiative-effects-on-spending-quality-patients-and-physicians
#3
Deborah Peikes, Stacy Dale, Arkadipta Ghosh, Erin Fries Taylor, Kaylyn Swankoski, Ann S O'Malley, Timothy J Day, Nancy Duda, Pragya Singh, Grace Anglin, Laura L Sessums, Randall S Brown
The Comprehensive Primary Care Initiative (CPC), a health care delivery model developed by the Centers for Medicare and Medicaid Services (CMS), tested whether multipayer support of 502 primary care practices across the country would improve primary care delivery, improve care quality, or reduce spending. We evaluated the initiative's effects on care delivery and outcomes for fee-for-service Medicare beneficiaries attributed to initiative practices, relative to those attributed to matched comparison practices...
May 23, 2018: Health Affairs
https://www.readbyqxmd.com/read/29768698/financial-viability-of-emergency-department-observation-unit-billing-models
#4
Christopher W Baugh, Pawan Suri, Christopher G Caspers, Michael A Granovsky, Keith Neal, Michael A Ross
BACKGROUND: Outpatients receive observation services to determine the need for inpatient admission. These services are usually provided without the use of condition-specific protocols and in an unstructured manner, scattered throughout a hospital in areas typically designated for inpatient care. Emergency department observation units (EDOUs) use protocolized care to offer an efficient alternative with shorter lengths of stay, lower costs and higher patient satisfaction. EDOU growth is limited by existing policy barriers that prevent a "two-service" model of separate professional billing for both emergency and observation services...
May 16, 2018: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/29762075/predicting-length-of-hospice-stay-an-application-of-quantile-regression
#5
Brystana G Kaufman, David Klemish, Cordt T Kassner, Jerome P Reiter, Fan Li, Matthew Harker, Emily C O'Brien, Donald H Taylor, Nrupen A Bhavsar
BACKGROUND: Use of the Medicare hospice benefit has been associated with high-quality care at the end of life, and hospice length of use in particular has been used as a proxy for appropriate timing of hospice enrollment. Quantile regression has been underutilized as an alternative tool to model distributional changes in hospice length of use and hospice payments outside of the mean. OBJECTIVE: To test for heterogeneity in the relationship between patient characteristics and hospice outcomes across the distribution of hospice days...
May 15, 2018: Journal of Palliative Medicine
https://www.readbyqxmd.com/read/29743214/advancing-primary-care-through-alternative-payment-models-lessons-from-the-united-states-canada
#6
Andrew Bazemore, Robert L Phillips, Richard Glazier, Joshua Tepper
The United States and Canada share high costs, poor health system performance, and challenges to the transformation of primary care, in part due to the limitations of their fee-for-service payment models. Rapidly advancing alternative payment models (APMs) in both countries promise better support for the essential tasks of primary care. These include interdisciplinary teams, care coordination, self-management support, and ongoing communication. This article reviews learnings from a 2017 binational symposium of 150 experts in policy and research that included a discussion of ongoing APM experiments in the United States and Canada...
May 2018: Journal of the American Board of Family Medicine: JABFM
https://www.readbyqxmd.com/read/29735000/value-and-payment-in-sleep-medicine
#7
Emerson M Wickwire, Tilak Verma
Value, like beauty, exists in the eye of the beholder. This article places the value of clinical sleep medicine services in historical context and presents a vision for the value-based sleep of the future. First, the history of value and payment in sleep medicine is reviewed from the early days of the field, to innovative disruption, to the widespread adoption of home sleep apnea testing. Next, the importance of economic perspective is discussed, with emphasis on cost containment and cost-shifting between payers, employers, providers, and patients...
April 30, 2018: Journal of Clinical Sleep Medicine: JCSM: Official Publication of the American Academy of Sleep Medicine
https://www.readbyqxmd.com/read/29733731/assessing-medicare-s-approach-to-covering-new-drugs-in-bundled-payments-for-oncology
#8
L Daniel Muldoon, Pamela M Pelizzari, Kelsey A Lang, Joe Vandigo, Bruce S Pyenson
New oncology therapies can contribute to survival or quality of life, but payers and policy makers have raised concerns about the cost of these therapies. Similar concerns extend beyond cancer. In seeking a solution, payers are increasingly turning toward value-based payment models in which providers take financial risk for costs and outcomes. These models, including episode payment and bundled payment, create financial gains for providers who reduce cost, but they also create concerns about potential stinting on necessary treatments...
May 2018: Health Affairs
https://www.readbyqxmd.com/read/29724229/financial-management-of-large-multi-center-trials-in-a-challenging-funding-milieu
#9
Olivia Lovegreen, Danielle Riggs, Myrlene A Staten, Patricia Sheehan, Anastassios G Pittas
BACKGROUND: Randomized clinical trials that have public health implications but no or low potential for commercial gain are predominantly funded by governmental (e.g., National Institutes of Health (NIH)) and not-for-profit organizations. Our objective was to develop an alternative clinical trial site funding model for judicious allocation of declining public research funds. METHODS: In the Vitamin D and Type 2 Diabetes (D2d) study, an NIH-supported, large clinical trial testing the effect of vitamin D supplementation on incident diabetes in 2423 participants at high risk for diabetes, a hybrid financial management model for supporting collaborating clinical sites was developed and applied...
May 3, 2018: Trials
https://www.readbyqxmd.com/read/29696343/the-significance-of-land-cover-delineation-on-soil-erosion-assessment
#10
Nikolaos Efthimiou, Emmanouil Psomiadis
The study aims to evaluate the significance of land cover delineation on soil erosion assessment. To that end, RUSLE (Revised Universal Soil Loss Equation) was implemented at the Upper Acheloos River catchment, Western Central Greece, annually and multi-annually for the period 1965-92. The model estimates soil erosion as the linear product of six factors (R, K, LS, C, and P) considering the catchment's climatic, pedological, topographic, land cover, and anthropogenic characteristics, respectively. The C factor was estimated using six alternative land use delineations of different resolution, namely the CORINE Land Cover (CLC) project (2000, 2012 versions) (1:100,000), a land use map conducted by the Greek National Agricultural Research Foundation (NAGREF) (1:20,000), a land use map conducted by the Greek Payment and Control Agency for Guidance and Guarantee Community Aid (PCAGGCA) (1:5,000), and the Landsat 8 16-day Normalized Difference Vegetation Index (NDVI) dataset (30 m/pixel) (two approximations) based on remote sensing data (satellite image acquired on 07/09/2016) (1:40,000)...
April 25, 2018: Environmental Management
https://www.readbyqxmd.com/read/29691171/risk-adjustment-is-necessary-in-medicare-bundled-payment-models-for-total-hip-and-knee-arthroplasty
#11
P Maxwell Courtney, Daniel D Bohl, Edmund C Lau, Kevin L Ong, Joshua J Jacobs, Craig J Della Valle
BACKGROUND: Concerns exist that high-risk patients in alternative payment models may face difficulties with access to care without proper risk adjustment. The purpose of this study is to identify the effect of medical and orthopedic specific risk factors on the cost of a 90-day episode of care following total hip (THA) and knee arthroplasty (TKA). METHODS: We queried the Medicare 5% Limited Data Set for all patients undergoing primary THA and TKA from 2010 to 2014...
March 17, 2018: Journal of Arthroplasty
https://www.readbyqxmd.com/read/29595721/trends-in-physician-payments-for-breast-reconstruction
#12
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
#13
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
#14
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
#15
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
#16
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...
May 2018: Gynecologic Oncology
https://www.readbyqxmd.com/read/29539282/financial-incentives-and-vulnerable-populations-will-alternative-payment-models-help-or-hurt
#17
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
#18
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
#19
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
#20
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
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