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https://www.readbyqxmd.com/read/28108823/which-clinical-and-patient-factors-influence-the-national-economic-burden-of-hospital-readmissions-after-total-joint-arthroplasty
#1
Steven M Kurtz, Edmund C Lau, Kevin L Ong, Edward M Adler, Frank R Kolisek, Michael T Manley
BACKGROUND: The Affordable Care Act of 2010 advanced the economic model of bundled payments for total joint arthroplasty (TJA), in which hospitals will be financially responsible for readmissions, typically at 90 days after surgery. However, little is known about the financial burden of readmissions and what patient, clinical, and hospital factors drive readmission costs. QUESTIONS/PURPOSES: (1) What is the incidence, payer mix, and demographics of THA and TKA readmissions in the United States? (2) What patient, clinical, and hospital factors are associated with the cost of 30- and 90-day readmissions after primary THA and TKA? (3) Are there any differences in the economic burden of THA and TKA readmissions between payers? (4) What types of THA and TKA readmissions are most costly to the US hospital system? METHODS: The recently developed Nationwide Readmissions Database from the Healthcare Cost and Utilization Project (2006 hospitals from 21 states) was used to identify 719,394 primary TJAs and 62,493 90-day readmissions in the first 9 months of 2013 based on International Classification of Diseases, 9th Revision, Clinical Modification codes...
January 20, 2017: Clinical Orthopaedics and related Research
https://www.readbyqxmd.com/read/28108639/prevalence-of-epilepsy-seizures-as-a-comorbidity-of-neurologic-disorders-in-nursing-homes
#2
Angela K Birnbaum, Ilo E Leppik, Kenneth Svensden, Lynn E Eberly
OBJECTIVE: To determine the prevalence of epilepsy/seizure (epi/sz) comorbid with other neurologic disorders in elderly nursing home residents and to examine demographic and regional variability and associations with clinical characteristics. METHODS: We studied 5 cross-sectional cohorts of all residents in any Medicare/Medicaid-certified nursing home in the United States on July 15 of each year from 2003 to 2007. Epi/sz was identified by ICD-9 codes (345.xx or 780...
January 20, 2017: Neurology
https://www.readbyqxmd.com/read/28108154/collaborative-design-of-a-health-care-experience-survey-for-persons-with-disability
#3
Lisa I Iezzoni, Holly Matulewicz, Sarah A Marsella, Kimberley S Warsett, Dennis Heaphy, Karen Donelan
BACKGROUND: When assessing results of health care delivery system reforms targeting persons with disability, quality metrics must reflect the experiences and perspectives of this population. OBJECTIVE: For persons with disability and researchers to develop collaboratively a survey that addresses critical quality questions about a new Massachusetts health care program for persons with disability dually-eligible for Medicare and Medicaid. METHODS: Persons with significant physical disability or serious mental health diagnoses participated fully in all research activities, including co-directing the study, co-moderating focus groups, performing qualitative analyses, specifying survey topics, cognitive interviewing, and refining survey language...
January 8, 2017: Disability and Health Journal
https://www.readbyqxmd.com/read/28107295/healthcare-transformation-and-changing-roles-for-nursing
#4
Susan W Salmond, Mercedes Echevarria
Factors driving healthcare transformation include fragmentation, access problems, unsustainable costs, suboptimal outcomes, and disparities. Cost and quality concerns along with changing social and disease-type demographics created the greatest urgency for the need for change. Caring for and paying for medical treatments for patients suffering from chronic health conditions are a significant concern. The Affordable Care Act includes programs now led by the Centers for Medicare & Medicaid Services aiming to improve quality and control cost...
January 2017: Orthopaedic Nursing
https://www.readbyqxmd.com/read/28106631/top-10-medicare-reimbursement-regulations-currently-impacting-wound-care-practices
#5
Kathleen D Schaum
No abstract text is available yet for this article.
February 2017: Advances in Skin & Wound Care
https://www.readbyqxmd.com/read/28106610/-opt-out-and-access-to-anesthesia-care-for-elective-and-urgent-surgeries-among-u-s-medicare-beneficiaries
#6
Eric C Sun, Franklin Dexter, Thomas R Miller, Laurence C Baker
BACKGROUND: In 2001, the Centers for Medicare and Medicaid Services issued a rule allowing U.S. states to "opt out" of the regulations requiring physician supervision of nurse anesthetists in an effort to increase access to anesthesia care. Whether "opt out" has successfully achieved this goal remains unknown. METHODS: Using Medicare administrative claims data, we examined whether "opt out" reduced the distance traveled by patients, a common measure of access, for patients undergoing total knee arthroplasty, total hip arthroplasty, cataract surgery, colonoscopy/sigmoidoscopy, esophagogastroduodenoscopy, appendectomy, or hip fracture repair...
January 19, 2017: Anesthesiology
https://www.readbyqxmd.com/read/28106520/impact-of-area-deprivation-index-on-coronary-stent-utilization-in-a-medicare-nationwide-cohort
#7
Tushar A Tuliani, Maithili Shenoy, Milind Parikh, Kenneth Jutzy, Anthony Hilliard
Area Deprivation Index (ADI) is a marker of neighborhood deprivation. This study investigates utilization of coronary bare-metal stent (BMS) and drug-eluting stent (DES) in Medicare patients across hospitals with varying ADI. Data were abstracted using Diagnosis-Related Group (DRG) codes 249 (BMS without major complications or comorbidities [MCC]), 246, and 247 (DES with and without MCC, respectively) from the 2011-2012 Medicare Provider Utilization and Payment Data Inpatient File, which was linked to American Hospital Association data (to determine bed size, location, ownership, teaching status), and ADI for each hospital zip code was obtained...
January 20, 2017: Population Health Management
https://www.readbyqxmd.com/read/28106518/a-case-report-cornerstone-health-care-reduced-the-total-cost-of-care-through-population-segmentation-and-care-model-redesign
#8
Dale E Green, Bruce H Hamory, Grace E Terrell, Jasmine O'Connell
Over the course of a single year, Cornerstone Health Care, a multispecialty group practice in North Carolina, redesigned the underlying care models for 5 of its highest-risk populations-late-stage congestive heart failure, oncology, Medicare-Medicaid dual eligibles, those with 5 or more chronic conditions, and the most complex patients with multiple late-stage chronic conditions. At the 1-year mark, the results of the program were analyzed. Overall costs for the patients studied were reduced by 12.7% compared to the year before enrollment...
January 20, 2017: Population Health Management
https://www.readbyqxmd.com/read/28105902/cost-effectiveness-of-using-adjunctive-porcine-small-intestine-submucosa-tri-layer-matrix-compared-with-standard-care-in-managing-diabetic-foot-ulcers-in-the-us
#9
J F Guest, D Weidlich, H Singh, J La Fontaine, A Garrett, C J Abularrage, C R Waycaster
OBJECTIVE: To estimate the cost-effectiveness of using tri-layer porcine small intestine submucosa (SIS; Oasis Ultra) as an adjunct to standard care compared with standard care alone in managing diabetic foot ulcers (DFUs) in the US, from the perspective of Medicare. METHOD: A Markov model was constructed to simulate the management of diabetic neuropathic lower extremity ulcers over a period of one year in the US. The model was used to estimate the cost-effectiveness of initially using adjunctive SIS compared with standard care alone to treat a DFU in the US at 2016 prices...
January 2, 2017: Journal of Wound Care
https://www.readbyqxmd.com/read/28105639/persistent-variation-in-medicare-payment-authorization-for-home-hemodialysis-treatments
#10
Adam S Wilk, Richard A Hirth, Wei Zhang, John R C Wheeler, Marc N Turenne, Tammie A Nahra, Kathryn K Sleeman, Joseph M Messana
OBJECTIVE: To analyze variation in medical care use attributable to Medicare's decentralized claims adjudication process as exemplified in home hemodialysis (HHD) therapy. DATA SOURCES/STUDY SETTING: Secondary data analysis using 2009-2012 paid Medicare claims for HHD and in-center hemodialysis (IHD). STUDY DESIGN: We compared variation across Medicare administrative contractors (MACs) in predicted paid treatments per standardized patient-month for HHD and IHD patients...
January 19, 2017: Health Services Research
https://www.readbyqxmd.com/read/28105636/cost-utility-of-osteoarticular-allograft-versus-endoprosthetic-reconstruction-for-primary-bone-sarcoma-of-the-knee-a-markov-analysis
#11
Robert J Wilson, Lina M Sulieman, Jacob P VanHouten, Jennifer L Halpern, Herbert S Schwartz, Clinton J Devin, Ginger E Holt
BACKGROUND: The most cost-effective reconstruction after resection of bone sarcoma is unknown. The goal of this study was to compare the cost effectiveness of osteoarticular allograft to endoprosthetic reconstruction of the proximal tibia or distal femur. METHODS: A Markov model was used. Revision and complication rates were taken from existing studies. Costs were based on Medicare reimbursement rates and implant prices. Health-state utilities were derived from the Health Utilities Index 3 survey with additional assumptions...
January 20, 2017: Journal of Surgical Oncology
https://www.readbyqxmd.com/read/28105542/hospice-in-heart-failure-why-when-and-what-then
#12
Jeffrey L Spiess
Hospice is a model of care for patients nearing the end of their lives that emphasizes symptom management, quality of life (QOL), and support of the patient and caregiving family through the death of the patient and the family's bereavement. It is associated with high patient and caregiver satisfaction and appears to not shorten lifespan for appropriately referred patients. Patients with advanced heart failure are being referred to hospice care more often than in the past, but the majority of deaths occur without this benefit...
January 20, 2017: Heart Failure Reviews
https://www.readbyqxmd.com/read/28104069/outcomes-among-older-patients-receiving-implantable-cardioverter-defibrillators-for-secondary-prevention-from-the-ncdr-icd-registry
#13
Jarrod K Betz, David F Katz, Pamela N Peterson, Ryan T Borne, Sana M Al-Khatib, Yongfei Wang, Carolina Malta Hansen, David D McManus, Jehu S Mathew, Frederick A Masoudi
BACKGROUND: Clinical trials of implantable cardioverter-defibrillators (ICDs) for secondary prevention of sudden cardiac death were conducted nearly 2 decades ago and enrolled few older patients. OBJECTIVES: This study assessed morbidity and mortality of older patients receiving ICDs for secondary prevention in contemporary clinical practice. METHODS: We identified 12,420 Medicare beneficiaries from the National Cardiovascular Data Registry ICD Registry undergoing first-time secondary prevention ICD implantation between 2006 and 2009 in 956 U...
January 24, 2017: Journal of the American College of Cardiology
https://www.readbyqxmd.com/read/28103923/risk-adjustment-methods-for-all-payer-comparative-performance-reporting-in-vermont
#14
Karl Finison, MaryKate Mohlman, Craig Jones, Melanie Pinette, David Jorgenson, Amy Kinner, Tim Tremblay, Daniel Gottlieb
BACKGROUND: As the emphasis in health reform shifts to value-based payments, especially through multi-payer initiatives supported by the U.S. Center for Medicare & Medicaid Innovation, and with the increasing availability of statewide all-payer claims databases, the need for an all-payer, "whole-population" approach to facilitate the reporting of utilization, cost, and quality measures has grown. However, given the disparities between the different populations served by Medicare, Medicaid, and commercial payers, risk-adjustment methods for addressing these differences in a single measure have been a challenge...
January 19, 2017: BMC Health Services Research
https://www.readbyqxmd.com/read/28103123/disease-burden-of-patients-with-asthma-copd-overlap-in-a-us-claims-database-impact-of-icd-9-coding-based-definitions
#15
Keele E Wurst, Samantha St Laurent, David Hinds, Kourtney J Davis
The inclusion of an asthma/chronic obstructive pulmonary disease (COPD) overlap syndrome (ACOS) population in the 2015 Global Initiative for Chronic Obstructive Lung Disease strategic documents has raised questions about the profile of these patients in clinical practice, as they are mostly excluded from asthma and COPD clinical trials. We estimated the disease burden, co-morbidities, and respiratory treatments of patients with asthma/COPD overlap, utilizing the Truven MarketScan commercial and Medicare databases...
January 19, 2017: COPD
https://www.readbyqxmd.com/read/28102988/medicaid-program-the-use-of-new-or-increased-pass-through-payments-in-medicaid-managed-care-delivery-systems-final-rule
#16
(no author information available yet)
This rule finalizes changes to the pass-through payment transition periods and the maximum amount of pass-through payments permitted annually during the transition periods under Medicaid managed care contract(s) and rate certification(s). This final rule prevents increases in pass-through payments and the addition of new pass-through payments beyond those in place when the pass-through payment transition periods were established, in the final Medicaid managed care regulations effective July 5, 2016.
18, 2017: Federal Register
https://www.readbyqxmd.com/read/28102985/medicare-program-changes-to-the-medicare-claims-and-entitlement-medicare-advantage-organization-determination-and-medicare-prescription-drug-coverage-determination-appeals-procedures-final-rule
#17
(no author information available yet)
This final rule revises the procedures that the Department of Health and Human Services (HHS) follows at the Administrative Law Judge (ALJ) level for appeals of payment and coverage determinations for items and services furnished to Medicare beneficiaries, enrollees in Medicare Advantage (MA) and other Medicare competitive health plans, and enrollees in Medicare prescription drug plans, as well as appeals of Medicare beneficiary enrollment and entitlement determinations, and certain Medicare premium appeals...
17, 2017: Federal Register
https://www.readbyqxmd.com/read/28102984/medicare-and-medicaid-program-conditions-of-participation-for-home-health-agencies-final-rule
#18
(no author information available yet)
This final rule revises the conditions of participation (CoPs) that home health agencies (HHAs) must meet in order to participate in the Medicare and Medicaid programs. The requirements focus on the care delivered to patients by HHAs, reflect an interdisciplinary view of patient care, allow HHAs greater flexibility in meeting quality care standards, and eliminate unnecessary procedural requirements. These changes are an integral part of our overall effort to achieve broad- based, measurable improvements in the quality of care furnished through the Medicare and Medicaid programs, while at the same time eliminating unnecessary procedural burdens on providers...
13, 2017: Federal Register
https://www.readbyqxmd.com/read/28102909/the-effects-of-hospital-characteristics-on-delays-in-breast-cancer-diagnosis-in-appalachian-communities-a-population-based-study
#19
Christopher J Louis, Jonathan R Clark, Marianne M Hillemeier, Fabian Camacho, Nengliang Yao, Roger T Anderson
PURPOSE: Despite being generally accepted that delays in diagnosing breast cancer are of prognostic and psychological concern, the influence of hospital characteristics on such delays remains poorly understood, especially in rural and underserved areas. However, hospital characteristics have been tied to greater efficiency and warrant further investigation as they may have implications for breast cancer care in these areas. METHODS: Study data were derived from the Kentucky, North Carolina, Ohio, and Pennsylvania state central cancer registries (2006-2008)...
January 19, 2017: Journal of Rural Health
https://www.readbyqxmd.com/read/28102893/the-evolving-health-policy-landscape-and-suggested-geriatric-tenets-to-guide-future-responses
#20
Robert L Kane, Debra Saliba, Peter Hollmann
Speculation is rampant about what the new leadership in the White House and continued Republican leadership of both houses of Congress will do about health care. The concordance in party affiliation between President Trump and the congressional majority makes revisions in policy that is relevant to the health of older adults a virtual certainty. Past Republican legislative proposals and the current appointments to lead Health and Human Services (HHS) and the Centers for Medicare & Medicaid Services (CMS) presage several potential areas of change...
January 19, 2017: Journal of the American Geriatrics Society
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