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"Value-based payment"

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https://www.readbyqxmd.com/read/28545159/the-value-transformation-of-health-care-impact-on-neuromuscular-and-electrodiagnostic-medicine
#1
Pushpa Narayanaswami, Millie Suk, Lyell K Jones
INTRODUCTION: Beginning in 2017, most physicians who participate in Medicare are subject to the Medicare Access and CHIP Reauthorization Act (MACRA), the milestone legislation that signals the US health care system's transition from volume-based to value-based care. METHODS: Review of emerging trends in development of value-based healthcare systems in the US. RESULTS: MACRA and the resulting Quality Payment Program (QPP) create two participation pathways, the Merit-based Incentive Payment System (MIPS) and the Advanced Alternative Payment Model (AAPM) pathway...
May 25, 2017: Muscle & Nerve
https://www.readbyqxmd.com/read/28539004/building-better-medicaid-care
#2
Joey Berlin
The trend away from fee-for-service and toward value-based payment models in the Texas Medicaid program shows some early promise.
May 1, 2017: Texas Medicine
https://www.readbyqxmd.com/read/28537786/designing-a-community-based-population-health-model
#3
Christopher J Durovich, Peter W Roberts
The pace of change from volume-based to value-based payment in health care varies dramatically among markets. Regardless of the ultimate disposition of the Affordable Care Act, employers and public-private payers will continue to increase pressure on health care providers to assume financial risk for populations in the form of shared savings, bundled payments, downside risk, or even capitation. This article outlines a suggested road map and practical considerations for health systems that are building or planning to build population health capabilities to meet the needs of their local markets...
May 24, 2017: Population Health Management
https://www.readbyqxmd.com/read/28536768/quality-measures-and-pediatric-radiology-suggestions-for-the-transition-to-value-based-payment
#4
REVIEW
Richard E Heller, Brian D Coley, Stephen F Simoneaux, Daniel J Podberesky, Marta Hernanz-Schulman, Richard L Robertson, Lane F Donnelly
Recent political and economic factors have contributed to a meaningful change in the way that quality in health care, and by extension value, are viewed. While quality is often evaluated on the basis of subjective criteria, pay-for-performance programs that link reimbursement to various measures of quality require use of objective and quantifiable measures. This evolution to value-based payment was accelerated by the 2015 passage of the Medicare Access and CHIP (Children's Health Insurance Program) Reauthorization Act (MACRA)...
June 2017: Pediatric Radiology
https://www.readbyqxmd.com/read/28511946/national-incidence-of-patient-safety-indicators-in-the-total-hip-arthroplasty-population
#5
Joseph E Tanenbaum, Derrick M Knapik, Glenn D Wera, Steven J Fitzgerald
BACKGROUND: The Centers for Medicare & Medicaid Services use the incidence of patient safety indicators (PSIs) to determine health care value and hospital reimbursement. The national incidence of PSI has not been quantified in the total hip arthroplasty (THA) population, and it is unknown if patient insurance status is associated with PSI incidence after THA. METHODS: All patients in the Nationwide Inpatient Sample (NIS) who underwent THA in 2013 were identified using the International Classification of Diseases, Ninth Revision, Clinical Modification codes...
April 12, 2017: Journal of Arthroplasty
https://www.readbyqxmd.com/read/28483891/impact-of-gaps-in-merit-based-incentive-payment-system-measures-on-marginalized-populations
#6
Kyle Eggleton, Winston Liaw, Andrew Bazemore
As the United States enters a new era of value-based payment heavy in emphasis on primary care measurement, careful examination of selected measures and their potential impact on outcomes and vulnerable populations is essential. Applying a theoretical model of health care quality as a coding matrix, we used a directed content analysis approach to categorize individual Merit Based Incentive Payment System (MIPS) measures. We found that most MIPS measures related to aspects of clinical effectiveness, whereas few, if any, related to aspects of access, patient experience, or interpersonal care...
May 2017: Annals of Family Medicine
https://www.readbyqxmd.com/read/28476495/outcomes-over-90-day-episodes-of-care-in-medicare-fee-for-service-beneficiaries-receiving-joint-arthroplasty
#7
Addie Middleton, Yu-Li Lin, James E Graham, Kenneth J Ottenbacher
BACKGROUND: In an effort to improve quality and reduce costs, payments are being increasingly tied to value through alternative payment models, such as episode-based payments. The objective of this study was to better understand the pattern and variation in outcomes among Medicare beneficiaries receiving lower extremity joint arthroplasty over 90-day episodes of care. METHODS: Observed rates of mortality, complications, and readmissions were calculated over 90-day episodes of care among Medicare fee-for-service beneficiaries who received elective knee arthroplasty and elective or nonelective hip arthroplasty procedures in 2013-2014 (N = 640,021)...
March 30, 2017: Journal of Arthroplasty
https://www.readbyqxmd.com/read/28472226/value-based-payment-models-for-community-health-centers-time-to-cautiously-take-the-plunge
#8
Jay Bhatia, Rachel Tobey, Michael Hochman
No abstract text is available yet for this article.
May 4, 2017: JAMA: the Journal of the American Medical Association
https://www.readbyqxmd.com/read/28448782/amcp-partnership-forum-driving-value-and-outcomes-in-oncology
#9
(no author information available yet)
Innovation in cancer treatment has provided a wealth of recently available therapeutic agents and a healthy drug pipeline that promises to change the way we approach this disease and the lives of those affected in the years to come. However, the majority of these new agents, many of which are targeted to specific genomic features of various tumors, may challenge the health care system's ability to afford cancer care. This innovation drives the need to focus on the value of the treatments provided to patients with cancer and on methods to optimize the efficiency of the dollars we spend, in addition to the clinical value itself...
May 2017: Journal of Managed Care & Specialty Pharmacy
https://www.readbyqxmd.com/read/28441671/swimming-upstream-creating-a-culture-of-high-value-care
#10
Reshma Gupta, Christopher Moriates
As health system leaders strategize the best ways to encourage the transition toward value-based health care, the underlying culture-defined as a system of shared assumptions, values, beliefs, and norms existing within an environment-continues to shape clinician practice patterns. The current prevailing medical culture contributes to overtesting, overtreatment, and health care waste. Choosing Wisely lists, appropriateness criteria, and guidelines codify best practices, but academic medicine as a whole must recognize that faculty and trainees are all largely still operating within the same cultural climate...
May 2017: Academic Medicine: Journal of the Association of American Medical Colleges
https://www.readbyqxmd.com/read/28441271/alternative-payment-models-and-urology
#11
Deborah R Kaye, David C Miller, Chad Ellimoottil
PURPOSE OF REVIEW: The Medicare Access and CHIP Reauthorization Act (MACRA) is a historic bill that was recently passed that establishes how quality measurement and practice patterns will affect physician reimbursement. Alternative payment models (APMs) are an essential component of MACRA and Medicare's vision of paying for high-value care. This review describes APMs in the context of MACRA and their impact on urology. RECENT FINDINGS: The majority of urologists will be affected by MACRA...
April 22, 2017: Current Opinion in Urology
https://www.readbyqxmd.com/read/28416322/nephrologists-and-integrated-kidney-disease-care-roles-and-skills-essential-for-nephrologists-for-future-success
#12
Allen R Nissenson, Franklin W Maddux
As the costs of caring for patients with end-stage renal disease have grown, so has the pressure to provide high-quality care at a lower cost. Prompted in large part by regulatory and legislative changes, reimbursement is shifting from a fee-for-service environment to one of value-based payment models. Nephrologists in this new environment are increasingly responsible not only for direct patient care, but also for population management and the associated clinical outcomes for this vulnerable population. This Perspective article aims to recognize the key role and skills needed in order to successfully practice within these new value-based care models...
April 14, 2017: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
https://www.readbyqxmd.com/read/28410917/the-relative-contribution-of-provider-and-ed-level-factors-to-variation-among-the-top-15-reasons-for-ed-admission
#13
Imad Khojah, Suhui Li, Qian Luo, Griffin Davis, Jessica E Galarraga, Michael Granovsky, Ori Litvak, Samuel Davis, Robert Shesser, Jesse M Pines
STUDY OBJECTIVE: We examine adult emergency department (ED) admission rates for the top 15 most frequently admitted conditions, and assess the relative contribution in admission rate variation attributable to the provider and hospital. METHODS: This was a retrospective, cross-sectional study of ED encounters (≥18years) from 19 EDs and 603 providers (January 2012-December 2013), linked to the Area Health Resources File for county-level information on healthcare resources...
April 6, 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28405531/will-the-meikirch-model-a-new-framework-for-health-induce-a-paradigm-shift-in-healthcare
#14
REVIEW
Johannes Bircher, Eckhart G Hahn
Over the past decades, scientific medicine has realized tremendous advances. Yet, it is felt that the quality, costs, and equity of medicine and public health have not improved correspondingly and, both inside and outside the USA, may even have changed for the worse. An initiative for improving this situation is value-based healthcare, in which value is defined as health outcomes relative to the cost of achieving them. Value-based healthcare was advocated in order to stimulate competition among healthcare providers and thereby reduce costs...
March 6, 2017: Curēus
https://www.readbyqxmd.com/read/28397131/making-a-medical-home-for-ibd-patients
#15
REVIEW
Lawrence R Kosinski, Joel Brill, Miguel Regueiro
PURPOSE OF REVIEW: The transformation from fee for service to fee for value requires structural changes to the way gastroenterologists manage patients with inflammatory bowel disease (IBD). A team-based approach using technology to engage patients is necessary for success. The Patient-Centered Medical Home (PCMH) represents a unique model that brings together these essential features. This paper describes how the PCMH model has been successfully applied to the management of patients with IBD...
May 2017: Current Gastroenterology Reports
https://www.readbyqxmd.com/read/28353502/looking-under-the-streetlight-a-framework-for-differentiating-performance-measures-by-level-of-care-in-a-value-based-payment-environment
#16
James M Naessens, Monica B Van Such, Robert E Nesse, James A Dilling, Stephen J Swensen, Kristine M Thompson, Janis M Orlowski, Paula J Santrach
The majority of quality measures used to assess providers and hospitals are based on easily obtained data, focused on a few dimensions of quality, and developed mainly for primary/community care and population health. While this approach supports efforts focused on addressing the triple aim of health care, many current quality report cards and assessments do not reflect the breadth or complexity of many referral center practices.In this article, the authors highlight the differences between population health efforts and referral care and address issues related to value measurement and performance assessment...
March 28, 2017: Academic Medicine: Journal of the Association of American Medical Colleges
https://www.readbyqxmd.com/read/28353384/professional-practice-evaluation-for-pathologists-the-development-life-and-death-of-the-evalumetrics-program
#17
Keith E Volmar, Shannon J McCall, Ronald B Schifman, Michael L Talbert, Joseph A Tworek, Keren I Hulkower, Anthony J Guidi, Raouf E Nakhleh, Rhona J Souers, Christine P Bashleben, Barbara J Blond
CONTEXT: - In 2008, the Joint Commission (JC) implemented a standard mandating formal monitoring of physician professional performance as part of the process of granting and maintaining practice privileges. OBJECTIVE: - To create a pathology-specific management tool to aid pathologists in constructing a professional practice-monitoring program, thereby meeting the JC mandate. DESIGN: - A total of 105 College of American Pathologists (CAP)-defined metrics were created...
April 2017: Archives of Pathology & Laboratory Medicine
https://www.readbyqxmd.com/read/28348093/value-based-payments-likely-to-survive-affordable-care-act-repeal-coverage-patient-protections-may-be-at-risk
#18
Bridget M Kuehn
No abstract text is available yet for this article.
March 28, 2017: Circulation
https://www.readbyqxmd.com/read/28333869/macra-a-new-age-for-physician-payments
#19
Kent Kwasind Huston
The Medicare Access and CHIP Reauthorization Act (MACRA) of 2015 introduced a new system of physician payments in the United States. This legislation and the complex rules written to enact the law intend to force a shift away from volume-based payments and into so called value-based payments. Physicians and other clinicians will be graded via quality and cost metrics and payments will be adjusted based on performance. Robust use of certified electronic health records is required under MACRA. Physicians will follow one of two payment reform tracks known as the Merit-Based Incentive Payment System (MIPS) and the Alternative Payment Model (APM) pathways...
April 2017: Journal of Clinical Rheumatology: Practical Reports on Rheumatic & Musculoskeletal Diseases
https://www.readbyqxmd.com/read/28306149/medicare-access-and-chip-reauthorization-act-what-do-geriatrics-healthcare-professionals-need-to-know-about-the-quality-payment-program
#20
Kathleen T Unroe, Peter A Hollmann, Alanna C Goldstein, Michael L Malone
Commencing in 2017, the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015 will change how Medicare pays health professionals. By enacting MACRA, Congress brought an end to the (un)sustainable growth rate formula while also setting forth a vision for how to transform the U.S. healthcare system so that clinicians deliver higher-quality care with smarter spending by the Centers for Medicare and Medicaid Services (CMS). In October 2016, CMS released the first of what stakeholders anticipate will be a number of (annual) rules related to implementation of MACRA...
April 2017: Journal of the American Geriatrics Society
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