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https://www.readbyqxmd.com/read/29204975/characteristics-and-disparities-among-primary-care-practices-in-the-united-states
#1
David Michael Levine, Jeffrey A Linder, Bruce E Landon
BACKGROUND: Despite new incentives for US primary care, concerns abound that patient-centered practice capabilities are lagging. OBJECTIVE: Describe the practice structure, patient-centered capabilities, and payment relationships of US primary care practices; identify disparities in practice capabilities. DESIGN: Analysis of the 2015 Medical Organizations Survey (MOS), part of the nationally representative Medical Expenditure Panel Survey (MEPS)...
December 4, 2017: Journal of General Internal Medicine
https://www.readbyqxmd.com/read/29200334/performance-and-participation-of-physicians-in-year-one-of-medicare-s-value-based-payment-modifier-program
#2
Karen E Joynt Maddox, Arnold M Epstein, Lok Wong Samson, Lena M Chen
In 2015 Medicare launched the Physician Value-Based Payment Modifier program, the largest US ambulatory care pay-for-performance program to date and a precursor to the forthcoming Merit-based Incentive Payment System. In its first year, the program included practices with a hundred or more clinicians. We found that 1,010 practices met this criterion, 899 of which had at least one attributed beneficiary. Of these latter practices, 263 (29.3 percent) failed to report performance data and received a 1 percent reporting-based penalty...
December 2017: Health Affairs
https://www.readbyqxmd.com/read/29188286/association-of-dermatologist-density-with-the-volume-and-costs-of-dermatology-procedures-among-medicare-beneficiaries
#3
Sally Y Tan, Daphne Tsoucas, Arash Mostaghimi
Importance: The persistent shortage of dermatologists in the United States affects access to care and patient outcomes. Objective: To characterize the effect of geographic variations in dermatologist density on the provision of dermatology procedures within Medicare. Design, Setting, and Participants: This was a cross-sectional study using the 2013 Medicare Provider Utilization and Payment Database. Dermatology-related procedures were defined by the top 50 billing codes accounting for more than 95% of procedures billed by dermatologists...
November 29, 2017: JAMA Dermatology
https://www.readbyqxmd.com/read/29182351/the-influence-of-provider-characteristics-and-market-forces-on-response-to-financial-incentives
#4
Brock O'Neil, Mark Tyson, Amy J Graves, Daniel A Barocas, Sam S Chang, David F Penson, Matthew J Resnick
OBJECTIVES: Alternative payment models, such as accountable care organizations, use financial incentives as levers for change to facilitate the transition from volume to value. However, implementation raises concerns about adverse changes in market competition and the resultant physician response. We sought to identify physician characteristics and market-level factors associated with variation in response to financial incentives for cancer care that may ultimately be leveraged in risk-shared payment models...
November 2017: American Journal of Managed Care
https://www.readbyqxmd.com/read/29153847/effect-of-incentive-payments-on-chronic-disease-management-and-health-services-use-in-british-columbia-canada-interrupted-time-series-analysis
#5
M Ruth Lavergne, Michael R Law, Sandra Peterson, Scott Garrison, Jeremiah Hurley, Lucy Cheng, Kimberlyn McGrail
We studied the effects of incentive payments to primary care physicians for the care of patients with diabetes, hypertension, and Chronic Obstructive Pulmonary Disease (COPD) in British Columbia, Canada. We used linked administrative health data to examine monthly primary care visits, continuity of care, laboratory testing, pharmaceutical dispensing, hospitalizations, and total h ealth care spending. We examined periods two years before and two years after each incentive was introduced, and used segmented regression to assess whether there were changes in level or trend of outcome measures across all eligible patients following incentive introduction, relative to pre-intervention periods...
November 10, 2017: Health Policy
https://www.readbyqxmd.com/read/29135661/reconsidering-the-affordable-care-act-s-restrictions-on-physician-owned-hospitals-analysis-of-cms-data-on-total-hip-and-knee-arthroplasty
#6
P Maxwell Courtney, Brian Darrith, Daniel D Bohl, Nicholas B Frisch, Craig J Della Valle
BACKGROUND: Concerns about financial incentives and increased costs prompted legislation limiting the expansion of physician-owned hospitals in 2010. Supporters of physician-owned hospitals argue that they improve the value of care by improving quality and reducing costs. The purpose of the present study was to determine whether physician-owned and non-physician-owned hospitals differ in terms of costs, outcomes, and patient satisfaction in the setting of total hip arthroplasty (THA) and total knee arthroplasty (TKA)...
November 15, 2017: Journal of Bone and Joint Surgery. American Volume
https://www.readbyqxmd.com/read/29133491/exploring-attributes-of-high-value-primary-care
#7
Melora Simon, Niteesh K Choudhry, Jim Frankfort, David Margolius, Julia Murphy, Luis Paita, Thomas Wang, Arnold Milstein
PURPOSE: Medicare's merit-based incentive payment system and narrowing of physician networks by health insurers will stoke clinicians' and policy makers' interest in care delivery attributes associated with value as defined by payers. METHODS: To help define these attributes, we analyzed 2009 to 2011 commercial health insurance claims data for more than 40 million preferred provider organization patients attributed to over 53,000 primary care practice sites. We identified sites ranking favorably on both quality and low total annual per capita health care spending ("high-value") and sites ranking near the median ("average-value")...
November 2017: Annals of Family Medicine
https://www.readbyqxmd.com/read/29126109/do-prospective-payment-systems-ppss-lead-to-desirable-providers-incentives-and-patients-outcomes-a-systematic-review-of-evidence-from-developing-countries
#8
Si Ying Tan, G J Melendez-Torres
The reform of provider payment systems, from retrospective to prospective payment, has been heralded as the right move to contain costs in the light of rising health expenditures in many countries. However, there are concerns on quality trade-off. The heightened attention given to prospective payment system (PPS) reforms and the rise of empirical evidence regarding PPS interventions among developing countries suggest that a systematic review is necessary to understand the effects of PPS reforms in developing countries...
November 6, 2017: Health Policy and Planning
https://www.readbyqxmd.com/read/29116661/complying-with-the-emergency-medical-treatment-and-labor-act-emtala-challenges-and-solutions
#9
Charleen Hsuan, Jill R Horwitz, Ninez A Ponce, Renee Y Hsia, Jack Needleman
The Emergency Medical Treatment and Labor Act (EMTALA), which requires Medicare-participating hospitals to provide emergency care to patients regardless of their ability to pay, plays an important role in protecting the uninsured. Yet many hospitals do not comply. This study examines the reasons for noncompliance and proposes solutions. We conducted 11 semistructured key informant interviews with hospitals, hospital associations, and patient safety organizations in the Centers for Medicare and Medicaid Services region with the highest number of EMTALA complaints filed...
November 8, 2017: Journal of Healthcare Risk Management: the Journal of the American Society for Healthcare Risk Management
https://www.readbyqxmd.com/read/29075552/patient-copayments-provider-incentives-and-income-effects-theory-and-evidence-from-the-essential-medications-list-under-china-s-2009-healthcare-reform
#10
Brian K Chen, Y Tony Yang, Karen Eggleston
Expanding access through insurance expansion can increase healthcare utilization through moral hazard. Reforming provider incentives to introduce more supply-side cost sharing is increasingly viewed as crucial for affordable, sustainable access. Using both difference-in-differences and segmented regression analyses on a panel of 1,466 hypertensive and diabetic patients, we empirically examine Shandong province's initial implementation of China's 2009 Essential Medications List policy. The policy reduced drug sale markups to providers but also increased drug coverage benefits for patients...
March 2017: World Medical & Health Policy
https://www.readbyqxmd.com/read/29073234/the-effects-of-patient-cost-sharing-on-inpatient-utilization-cost-and-outcome
#11
Yuan Xu, Ning Li, Mingshan Lu, Elijah Dixon, Robert P Myers, Rachel J Jelley, Hude Quan
BACKGROUND: Health insurance and provider payment reforms all over the world beg a key empirical question: what are the potential impacts of patient cost-sharing on health care utilization, cost and outcomes? The unique health insurance system and rich electronic medical record (EMR) data in China provides us a unique opportunity to study this topic. METHODS: Four years (2010 to 2014) of EMR data from one medical center in China were utilized, including 10,858 adult patients with liver diseases...
2017: PloS One
https://www.readbyqxmd.com/read/28983431/evaluation-of-policy-options-for-increasing-the-availability-of-primary-care-services-in-rural-washington-state
#12
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/28963147/episodic-payments-bundling-part-i
#13
REVIEW
D J Jacofsky
Episodic, or bundled payments, is a concept now familiar to most in the healthcare arena, but the models are often misunderstood. Under a traditional fee-for-service model, each provider bills separately for their services which creates financial incentives to maximise volumes. Under a bundled payment, a single entity, often referred to as a convener (maybe the hospital, the physician group, or a third party) assumes the risk through a payer contract for all services provided within a defined episode of care, and receives a single (bundled) payment for all services provided for that episode...
October 2017: Bone & Joint Journal
https://www.readbyqxmd.com/read/28956027/the-impact-of-changes-in-medicare-s-physician-payment-system-on-critical-care
#14
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: Critical Connections: the Complete News Source for Critical Care Professionals
https://www.readbyqxmd.com/read/28929875/using-structured-incentives-to-increase-value-for-money-in-an-academic-health-sciences-centre
#15
Guy J Hébert, Connie Colasante, Renate G Ilse, Alan J Forster
As healthcare continues to consume more and more of provincial government spending, there is a continuing pressure to improve efficiency and cut overall costs. In this increasingly constrained healthcare system, value for money is a growing focus of discussions around accountability and system sustainability; healthcare leaders are required to find ways of measuring, enforcing, and reporting on that value. In 2014, our organization began implementing an innovative system of structured incentives, linking distribution of Ministry of Health and Long-Term Care academic physician funding to quality and performance goals...
July 2017: Healthcare Management Forum
https://www.readbyqxmd.com/read/28893814/physician-support-of-smoking-cessation-after-diagnosis-of-lung-bladder-or-upper-aerodigestive-tract-cancer
#16
Amanda Farley, Constantinos Koshiaris, Jason Oke, Ronan Ryan, Lisa Szatkowski, Richard Stevens, Paul Aveyard
PURPOSE: Smoking cessation after a diagnosis of lung, bladder, and upper aerodigestive tract cancer appears to improve survival, and support to quit would improve cessation. The aims of this study were to assess how often general practitioners provide active smoking cessation support for these patients and whether physician behavior is influenced by incentive payments. METHODS: Using electronic primary care records from the UK Clinical Practice Research Datalink, 12,393 patients with incident cases of cancer diagnosed between 1999 and 2013 were matched 1 to 1 to patients with incident cases of coronary heart disease (CHD) diagnosed during the same time...
September 2017: Annals of Family Medicine
https://www.readbyqxmd.com/read/28891235/financial-arrangements-for-health-systems-in-low-income-countries-an-overview-of-systematic-reviews
#17
REVIEW
Charles S Wiysonge, Elizabeth Paulsen, Simon Lewin, Agustín Ciapponi, Cristian A Herrera, Newton Opiyo, Tomas Pantoja, Gabriel Rada, Andrew D Oxman
BACKGROUND: One target of the Sustainable Development Goals is to achieve "universal health coverage, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all". A fundamental concern of governments in striving for this goal is how to finance such a health system. This concern is very relevant for low-income countries. OBJECTIVES: To provide an overview of the evidence from up-to-date systematic reviews about the effects of financial arrangements for health systems in low-income countries...
September 11, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/28874487/high-levels-of-capitation-payments-needed-to-shift-primary-care-toward-proactive-team-and-nonvisit-care
#18
Sanjay Basu, Russell S Phillips, Zirui Song, Asaf Bitton, Bruce E Landon
Capitated payments in the form of fixed monthly payments to cover all of the costs associated with delivering primary care could encourage primary care practices to transform the way they deliver care. Using a microsimulation model incorporating data from 969 US practices, we sought to understand whether shifting to team- and non-visit-based care is financially sustainable for practices under traditional fee-for-service, capitated payment, or a mix of the two. Practice revenues and costs were computed for fee-for-service payments and a range of capitated payments, before and after the substitution of team- and non-visit-based services for low-complexity in-person physician visits...
September 1, 2017: Health Affairs
https://www.readbyqxmd.com/read/28766194/macra-and-the-changing-medicare-payment-landscape
#19
Steven L Chen, Matthew R Coffron
BACKGROUND: The Medicare Access and CHIP Reauthorization Act (MACRA) is being implemented in 2017 by the Centers for Medicare and Medicaid Services (CMS) as the Quality Payment Program (QPP) and will have important and far reaching effects on how physicians are reimbursed and on how they practice. The QPP modifies the Medicare physician payment system by eliminating the Sustainable Growth Rate formula and incorporating the existing Physician Quality Reporting System, EHR Incentive Program, and the Value Modifier into a single new Merit-based Incentive Payment System (MIPS)...
August 1, 2017: Annals of Surgical Oncology
https://www.readbyqxmd.com/read/28748535/financial-incentives-and-physician-practice-participation-in-medicare-s-value-based-reforms
#20
Adam M Markovitz, Patricia P Ramsay, Stephen M Shortell, Andrew M Ryan
OBJECTIVES: To evaluate whether greater experience and success with performance incentives among physician practices are related to increased participation in Medicare's voluntary value-based payment reforms. DATA SOURCES/STUDY SETTING: Publicly available data from Medicare's Physician Compare (n = 1,278; January 2012 to November 2013) and nationally representative physician practice data from the National Survey of Physician Organizations 3 (NSPO3; n = 907,538; 2013)...
July 26, 2017: Health Services Research
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