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"Value-based payment"

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https://www.readbyqxmd.com/read/28717900/elements-of-program-design-in-medicare-s-value-based-and-alternative-payment-models-a-narrative-review
#1
Karen E Joynt Maddox, Aditi P Sen, Lok Wong Samson, Rachael B Zuckerman, Nancy DeLew, Arnold M Epstein
Increasing emphasis on value in health care has spurred the development of value-based and alternative payment models. Inherent in these models are choices around program scope (broad vs. narrow); selecting absolute or relative performance targets; rewarding improvement, achievement, or both; and offering penalties, rewards, or both. We examined and classified current Medicare payment models-the Hospital Readmissions Reduction Program (HRRP), Hospital Value-Based Purchasing Program (HVBP), Hospital-Acquired Conditions Reduction Program (HACRP), Medicare Advantage Quality Star Rating program, Physician Value-Based Payment Modifier (VM) and its successor, the Merit-Based Incentive Payment System (MIPS), and the Medicare Shared Savings Program (MSSP) on these elements of program design and reviewed the literature to place findings in context...
July 17, 2017: Journal of General Internal Medicine
https://www.readbyqxmd.com/read/28694275/the-chief-primary-care-medical-officer-restoring-continuity
#2
Noemi Doohan, Jennifer DeVoe
The year 2016 marked the 20th anniversary of the hospitalist profession, with more than 50,000 physicians identifying as hospitalists. The Achilles heel of hospitalist medicine, however, is discontinuity. Despite many current payment and delivery systems rewarding this discontinuity and severing long-term relationships between patient and primary care teams at the hospital door, primary care does not stop being important when a person is admitted to the hospital. The notion of a broken primary care continuum is not an academic construct, it causes real harm to patients...
July 2017: Annals of Family Medicine
https://www.readbyqxmd.com/read/28685850/return-on-investment-roi-analyses-of-an-inpatient-lay-health-worker-model-on-30-day-readmission-rates-in-a-rural-community-hospital
#3
Roberto Cardarelli, Gregory Bausch, Joan Murdock, Michelle Renee Chyatte
PURPOSE: The purpose of the study was to assess the return-on-investment (ROI) of an inpatient lay health worker (LHW) model in a rural Appalachian community hospital impacting 30-day readmission rates. METHODS: The Bridges to Home (BTH) study completed an evaluation in 2015 of an inpatient LHW model in a rural Kentucky hospital that demonstrated a reduction in 30-day readmission rates by 47.7% compared to a baseline period. Using the hospital's utilization and financial data, a validated ROI calculator specific to care transition programs was used to assess the ROI of the BTH model comparing 3 types of payment models including Diagnosis Related Group (DRG)-only payments, pay-for-performance (P4P) contracts, and accountable care organizations (ACOs)...
July 7, 2017: Journal of Rural Health
https://www.readbyqxmd.com/read/28673817/a-state-led-framework-for-value-based-purchasing-to-incent-integration
#4
Katherine Shea Barrett, Katherine L Record, Vivian Haime
Addressing healthcare costs requires incenting providers to address both physical and behavioral health conditions, as well as social determinants of health. The most complex, and expensive, patients are often those with comorbid mental illness and/or addiction, who are at higher risk for exposure to violence, food insecurity, unstable housing and other adversities that negatively affect health. Yet today's value-based payment models and associated quality measures do not incent providers to address patients' behavioral and social needs...
June 22, 2017: Healthcare
https://www.readbyqxmd.com/read/28671354/preparing-for-value-based-payment-five-essential-skills-for-success
#5
Arnold E Cuenca
No abstract text is available yet for this article.
May 2017: Family Practice Management
https://www.readbyqxmd.com/read/28669857/aggregation-to-promote-health-in-an-era-of-data-and-value-based-payment
#6
Winston Liaw, Andrew W Bazemore, Robert L Phillips
No abstract text is available yet for this article.
June 29, 2017: Healthcare
https://www.readbyqxmd.com/read/28665677/value-based-payment-models-in-oncology-will-they-help-or-hinder-patient-access-to-new-treatments
#7
Sonal Shah, Greg Reh
No abstract text is available yet for this article.
April 2017: American Journal of Managed Care
https://www.readbyqxmd.com/read/28652243/clinical-pathways-recommendations-for-putting-patients-at-the-center-of-value-based-care
#8
Edward Abrahams, Alan Balch, Patricia Goldsmith, Marcia Kean, Amy M Miller, Gilbert Omenn, Ellen Sonet, John Sprandio, Courtney Tyne, Kimberly Westrich
Two major trends that have been affecting the provision of oncology care in the United States are a shift from volume-based to value-based care and a push toward patient-centered healthcare. However, these two trends are not always completely aligned with each other. Value-based payment models, including clinical pathways, are one strategy being implemented by oncology stakeholders to help encourage the uptake of value-based oncology care. If structured with the patient in mind, they can improve quality of care for patients with cancer, decrease inappropriate care while enabling appropriate personalization of care, and constrain rising prices by demanding a stronger link between cost and value...
June 26, 2017: Clinical Cancer Research: An Official Journal of the American Association for Cancer Research
https://www.readbyqxmd.com/read/28651925/engaging-small-independent-practices-in-value-based-payment-building-aledade-s-medicare-acos
#9
Brian W Powers, Farzad Mostashari, Emily Maxson, Kimberly Lynch, Amol S Navathe
No abstract text is available yet for this article.
June 23, 2017: Healthcare
https://www.readbyqxmd.com/read/28648871/creation-of-an-open-framework-for-point-of-care-computer-assisted-reporting-and-decision-support-tools-for-radiologists
#10
Tarik K Alkasab, Bernardo C Bizzo, Lincoln L Berland, Sujith Nair, Pari V Pandharipande, H Benjamin Harvey
Decreasing unnecessary variation in radiology reporting and producing guideline-concordant reports is fundamental to radiology's success in value-based payment models and good for patient care. In this article, we present an open authoring system for point-of-care clinical decision support tools integrated into the radiologist reporting environment referred to as the computer-assisted reporting and decision support (CAR/DS) framework. The CAR/DS authoring system, described herein, includes: (1) a definition format for representing radiology clinical guidelines as structured, machine-readable Extensible Markup Language documents and (2) a user-friendly reference implementation to test the fidelity of the created definition files with the clinical guideline...
June 22, 2017: Journal of the American College of Radiology: JACR
https://www.readbyqxmd.com/read/28633411/surgeon-level-variability-in-outcomes-cost-and-comorbidity-adjusted-cost-for-elective-lumbar-decompression-and-fusion
#11
Silky Chotai, Ahilan Sivaganesan, John A Sielatycki, Kristin R Archer, Richard Call, Matthew J McGirt, Clinton J Devin
BACKGROUND: The costs and outcomes following degenerative spine surgery may vary from surgeon to surgeon. Patient factors such as comorbidities may increase the health care cost. These variations are not well studied. OBJECTIVE: To understand the variation in outcomes, costs, and comorbidity-adjusted cost for surgeons performing lumbar laminectomy and fusions surgery. METHODS: A total of 752 patients undergoing laminectomy and fusion, performed by 7 surgeons, were analyzed...
June 14, 2017: Neurosurgery
https://www.readbyqxmd.com/read/28631999/adapting-healthcare-quality-measures-to-transgender-individuals
#12
Landon D Hughes, Olivia K G Berzin, Musetta Leung, Catherine Hersey, Sarah Grallert
The healthcare system's rapid shift toward value-based payment poses unique quality measurement challenges and new foci for researchers and policy makers. Quality measures that use sex-specific criteria may inappropriately include or exclude transgender individuals. More large-scale studies must be conducted to incorporate transgender individuals into measures that use sex-specific criteria, and "measure stewards" should consider the existing clinical guidelines and recommendations regarding transgender individuals when developing measures...
June 20, 2017: LGBT Health
https://www.readbyqxmd.com/read/28602536/national-incidence-of-reportable-quality-metrics-in-the-knee-arthroplasty-population
#13
Joseph E Tanenbaum, Derrick M Knapik, Steven J Fitzgerald, Randall E Marcus
BACKGROUND: The Centers for Medicare and Medicaid Services (CMS) characterizes adverse quality events in the inpatient setting as patient safety indicators (PSI). The incidence of PSI has not been quantified in the total knee arthroplasty (TKA) population. METHODS: All patients in the Nationwide Inpatient Sample who underwent primary TKA during an inpatient episode in 2013 were identified using International Classification of Disease, Ninth Revision, Clinical Modification codes...
May 19, 2017: Journal of Arthroplasty
https://www.readbyqxmd.com/read/28598890/comparing-population-based-risk-stratification-model-performance-using-demographic-diagnosis-and-medication-data-extracted-from-outpatient-electronic-health-records-versus-administrative-claims
#14
Hadi Kharrazi, Winnie Chi, Hsien-Yen Chang, Thomas M Richards, Jason M Gallagher, Susan M Knudson, Jonathan P Weiner
BACKGROUND: There is an increasing demand for electronic health record (EHR)-based risk stratification and predictive modeling tools at the population level. This trend is partly due to increased value-based payment policies and the increasing availability of EHRs at the provider level. Risk stratification models, however, have been traditionally derived from claims or encounter systems. This study evaluates the challenges and opportunities of using EHR data instead of or in addition to administrative claims for risk stratification...
August 2017: Medical Care
https://www.readbyqxmd.com/read/28591975/an-overview-of-home-based-primary-care-learning-from-the-field
#15
Sarah Klein, Martha Hostetter, Douglas McCarthy
ISSUE: Homebound and functionally limited individuals are often unable to access office-based primary care, leading to unmet needs and increased health care spending. GOAL: Show how home-based primary care affects outcomes and costs for Medicare and Medicaid beneficiaries with complex care needs. METHODS: Qualitative synthesis of expert perspectives and the experiences of six case-study sites. FINDINGS AND CONCLUSIONS: Successful home-based primary care practices optimize care by: fielding interdisciplinary teams, incorporating behavioral care and social supports into primary care, responding rapidly to urgent and acute care needs, offering palliative care, and supporting family members and caregivers...
June 2017: Issue Brief of the Commonwealth Fund
https://www.readbyqxmd.com/read/28590954/current-valuation-of-pathology-service
#16
Jonathan L Myles, Diana M Cardona, Todd Klemp, Ayanna Wooding, W Stephen Black-Schaffer
Health care reform has accelerated as the existing health care system undergoes continuing financial stress. Medicare's new value-based payment system, commonly referred to as MACRA, provides opportunities for physicians to participate in this new system in a variety of ways. However, many of the value-based adjustments are based on existing valuations of services through traditional mechanisms. To achieve appropriate valuation of pathologist's services in the new payment models, it is imperative that we continue to achieve proper valuation of services through the traditional mechanisms...
July 2017: Advances in Anatomic Pathology
https://www.readbyqxmd.com/read/28577702/the-role-of-patient-reported-outcome-measures-in-value-based-payment-reform
#17
Lee Squitieri, Kevin J Bozic, Andrea L Pusic
The U.S. health care system is currently experiencing profound change. Pressure to improve the quality of patient care and control costs have caused a rapid shift from traditional volume-driven fee-for-service reimbursement to value-based payment models. Under the 2015 Medicare Access and Children's Health Insurance Program Reauthorization Act, providers will be evaluated on the basis of quality and cost efficiency and ultimately receive adjusted reimbursement as per their performance. Although current performance metrics do not incorporate patient-reported outcome measures (PROMs), many wonder whether and how PROMs will eventually fit into value-based payment reform...
June 2017: Value in Health: the Journal of the International Society for Pharmacoeconomics and Outcomes Research
https://www.readbyqxmd.com/read/28576295/alternative-payment-models-lead-to-strategic-care-coordination-workforce-investments
#18
Clese E Erikson, Patricia Pittman, Alicia LaFrance, Susan A Chapman
BACKGROUND: Care coordination is generally viewed as a key to success for health systems seeking to adapt to a range of new value-based payment policies. PURPOSE: This study explores care coordination staffing in four health systems participating in new payment models, including Medicaid payment reform and Accountable Care Organizations. METHODS: Comparative case study design is used to describe models of care coordination. Analysis of 43 semi-structured interviews with leadership, clinicians, and care coordination staff at four health systems engaged in value-based contracts...
April 13, 2017: Nursing Outlook
https://www.readbyqxmd.com/read/28570449/quality-measures-in-breast-reconstruction-a-systematic-review
#19
Rahim N Nazerali, Micaela A Finnegan, Vasu Divi, Gordon K Lee, Robin N Kamal
BACKGROUND: The importance of providing quality care over quantity of care, and its positive effects on health care expenditure and health, has motivated a transition toward value-based payments. The Centers for Medicare and Medicaid Services and private payers are establishing programs linking financial incentives and penalties to adherence to quality measures. As payment models based on quality measures are transitioned into practice, it is beneficial to identify current quality measures that address breast reconstruction surgery as well as understand gaps to inform future quality measure development...
May 31, 2017: Annals of Plastic Surgery
https://www.readbyqxmd.com/read/28562404/bundle-payment-program-initiative-roles-of-a-nurse-navigator-and-home-health-professionals
#20
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
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