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PMID:28502681
Autor:Qureshi R; Puvanesarajah V; Jain A; Kebaish K; Shimer A; Shen F; Hassanzadeh H
Endereço:Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia, USA.
Título:Cost Implications of Primary Versus Revision Surgery in Adult Spinal Deformity.
Fonte:World Neurosurg; 104:68-73, 2017 Aug.
ISSN:1878-8769
País de publicação:United States
Idioma:eng
Resumo:BACKGROUND: Adult spinal deformity (ASD) is an important problem to consider in the elderly. Although studies have examined the complications of ASD surgery and have compared functional and radiographic results of primary surgery versus revision, no studies have compared the costs of primary procedures with revisions. We assessed the in-hospital costs of these 2 surgery types in patients with ASD. METHODS: The PearlDiver Database, a database of Medicare records, was used in this study. Mutually exclusive groups of patients undergoing primary or revision surgery were identified. Patients in each group were queried for age, sex, and comorbidities. Thirty-day readmission rates, 30-day and 90-day complication rates, and postoperative costs of care were assessed with multivariate analysis. For analyses, significance was set at P < 0.001. RESULTS: The average reimbursement of the primary surgery cohort was $57,078 ± $30,767. Reimbursement of revision surgery cohort was $52,999 ± $27,658. The adjusted difference in average costs between the 2 groups is $4773 ± $1069 (P < 0.001). The 30-day and 90-day adjusted difference in cost of care when sustaining any of the major medical complications in primary surgery versus revision surgery was insignificant. CONCLUSIONS: Patients undergoing primary and revision corrective procedures for ASD have similar readmission rates, lengths of stays, and complication rates. Our data showed a higher cost of primary surgery compared with revision surgery, although costs of sustaining postoperative complications were similar. This finding supports the decision to perform revision procedures in patients with ASD when indicated because neither outcomes nor costs are a hindrance to correction.
Tipo de publicação: JOURNAL ARTICLE


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PMID:28384693
Autor:Skinner JS; Volpp KG
Endereço:The Dartmouth Institute for Health Policy and Clinical Practice, DHMC, Hanover, New Hampshire.
Título:Replacing the Affordable Care Act: Lessons From Behavioral Economics.
Fonte:JAMA; 317(19):1951-1952, 2017 May 16.
ISSN:1538-3598
País de publicação:United States
Idioma:eng
Tipo de publicação: JOURNAL ARTICLE


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PMID:28203071
Autor:Bishwakarma R; Zhang W; Kuo YF; Sharma G
Endereço:Department of Internal Medicine, Division of Pulmonary, Critical Care and Sleep Medicine.
Título:Long-acting bronchodilators with or without inhaled corticosteroids and 30-day readmission in patients hospitalized for COPD.
Fonte:Int J Chron Obstruct Pulmon Dis; 12:477-486, 2017.
ISSN:1178-2005
País de publicação:New Zealand
Idioma:eng
Resumo:BACKGROUND: The ability of a long-acting muscarinic antagonist (LAMA) and long-acting beta 2 agonists (LABAs; long-acting bronchodilators, LABDs) with or without inhaled corticosteroids (ICSs) to reduce early readmission in hospitalized patients with COPD is unknown. METHODS: We studied a 5% sample of Medicare beneficiaries enrolled in Medicare parts A, B and D and hospitalized for COPD in 2011. We examined prescriptions filled for LABDs with or without ICSs (LABDs±ICSs) within 90 days prior to and 30 days after hospitalization. Primary outcome was the 30-day readmission rate between "users" and "nonusers" of LABDs±ICSs. Propensity score matching and sensitivity analysis were performed by limiting analysis to patients hospitalized for acute exacerbation of COPD (AECOPD). Among 6,066 patients hospitalized for COPD, 3,747 (61.8%) used LABDs±ICSs during the specified period. The "user" and "nonuser" groups had similar rates of all-cause emergency room (ER) visits and readmissions within 30 days of discharge date (22.4% vs 20.7%, -value 0.11; 18.0% vs 17.8%, -value 0.85, respectively). However, the "users" had higher rates of COPD-related ER visits (5.3% vs 3.4%, -value 0.0006), higher adjusted odds ratio (aOR) 1.47 (95% CI, 1.11-1.93) and readmission (7.8% vs 5.0%, -value <0.0001 and aOR 1.48 [95% CI, 1.18-1.86]) than "nonusers". After propensity score matching, the aOR of COPD-related ER visits was 1.45 (95% CI, 1.07-1.96) and that of readmission was 1.34 (95% CI, 1.04-1.73). The results were similar when restricted to patients hospitalized for AECOPD. CONCLUSION: Use of LABDs±ICSs did not reduce 30-day readmissions in patients hospitalized for COPD.
Tipo de publicação: JOURNAL ARTICLE
Nome de substância:0 (Adrenal Cortex Hormones); 0 (Adrenergic beta-2 Receptor Agonists); 0 (Bronchodilator Agents); 0 (Muscarinic Antagonists)


  4 / 991 MEDLINE  
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PMID:28198561
Autor:Kramer DB; Reynolds MR; Normand SL; Parzynski CS; Spertus JA; Mor V; Mitchell SL
Endereço:Hebrew SeniorLife Institute for Aging Research, Boston, MA.
Título:Nursing Home Use After Implantable Cardioverter-Defibrillator Implantation in Older Adults: Results from the National Cardiovascular Data Registry.
Fonte:J Am Geriatr Soc; 65(2):340-347, 2017 Feb.
ISSN:1532-5415
País de publicação:United States
Idioma:eng
Resumo:OBJECTIVES: To evaluate the incidence and characteristics of nursing home (NH) use after implantable cardioverter-defibrillator (ICD) implantation. DESIGN: Cohort study. SETTING: Medicare beneficiaries in the National Cardiovascular Data Registry-ICD Registry. PARTICIPANTS: Individuals aged 65 and older receiving ICDs between January 1, 2006, and March 31, 2010 (N = 192,483). MEASUREMENTS: Proportion of ICD recipients discharged to NHs directly after device placement, cumulative incidence of long-term NH admission, and factors associated with immediate discharge to a NH and time to long-term NH admission. RESULTS: Over 4 years, 40.6% of the cohort died, and 35,939 (18.7%) experienced at least one NH admission, including 4.0% directly discharged to a NH after ICD implantation and 2.8% admitted to long-term NH care during follow-up. The cumulative incidence of long-term NH admission, accounting for the competing risk of death, was 1.7% at 1 year, 3.8% at 3 years, and 4.6% at 4 years; 20.1% of individuals admitted to a NH died there. Factors most strongly associated with direct NH discharge and time to long-term NH care were older age (adjusted odds ratio (AOR) = 2.09, 95% confidence interval (CI) = 2.01-2.17 per 10-year increment; adjusted hazard ratio (AHR) = 1.88, 95% CI = 1.80-1.97, respectively), dementia (AOR = 2.60, 95% CI = 2.25-3.01; AHR = 2.50, 95% CI = 2.14-2.93, respectively), and Medicare Part A claim for NH stay in prior 6 months (AOR = 3.96, 95% CI = 3.70-4.25; AHR = 2.88, 95% CI = 2.65-3.14, respectively). CONCLUSION: Nearly one in five individuals are admitted to NHs over a median of 1.6 years of follow-up after ICD implantation. Understanding these outcomes may help inform the clinical care of these individuals.
Tipo de publicação: JOURNAL ARTICLE


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PMID:28071874
Autor:; Centers for Medicare & Medicaid Services (CMS), HHS
Título:Medicare Program; Advancing Care Coordination Through Episode Payment Models (EPMs); Cardiac Rehabilitation Incentive Payment Model; and Changes to the Comprehensive Care for Joint Replacement Model (CJR). Final rule.
Fonte:Fed Regist; 82(1):180-651, 2017 01 03.
ISSN:0097-6326
País de publicação:United States
Idioma:eng
Resumo:This final rule implements three new Medicare Parts A and B episode payment models, a Cardiac Rehabilitation (CR) Incentive Payment model and modifications to the existing Comprehensive Care for Joint Replacement model under section 1115A of the Social Security Act. Acute care hospitals in certain selected geographic areas will participate in retrospective episode payment models targeting care for Medicare fee-forservice beneficiaries receiving services during acute myocardial infarction, coronary artery bypass graft, and surgical hip/femur fracture treatment episodes. All related care within 90 days of hospital discharge will be included in the episode of care. We believe these models will further our goals of improving the efficiency and quality of care for Medicare beneficiaries receiving care for these common clinical conditions and procedures.
Tipo de publicação: JOURNAL ARTICLE


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PMID:27546309
Autor:Lammers EJ; McLaughlin CG
Endereço:Mathematica Policy Research, Oakland, CA.
Título:Meaningful Use of Electronic Health Records and Medicare Expenditures: Evidence from a Panel Data Analysis of U.S. Health Care Markets, 2010-2013.
Fonte:Health Serv Res; 52(4):1364-1386, 2017 Aug.
ISSN:1475-6773
País de publicação:United States
Idioma:eng
Resumo:OBJECTIVE: To determine if recent growth in hospital and physician electronic health record (EHR) adoption and use is correlated with decreases in expenditures for elderly Medicare beneficiaries. DATA SOURCES: American Hospital Association (AHA) General Survey and Information Technology Supplement, Health Information Management Systems Society (HIMSS) Analytics survey, SK&A Information Services, and the Centers for Medicare & Medicaid Services (CMS) Chronic Conditions Data Warehouse Geographic Variation Database for 2010 through 2013. STUDY DESIGN: Fixed effects model comparing associations between hospital referral region (HRR) level measures of hospital and physician EHR penetration and annual Medicare expenditures for beneficiaries with one of four chronic conditions. Calculated hospital penetration rates as the percentage of Medicare discharges from hospitals that satisfied criteria analogous to Meaningful Use (MU) Stage 1 requirements and physician rates as the percentage of physicians using ambulatory care EHRs. PRINCIPAL FINDINGS: An increase in the hospital penetration rate was associated with a small but statistically significant decrease in total Medicare and Medicare Part A acute care expenditures per beneficiary. An increase in physician EHR penetration was also associated with a significant decrease in total Medicare and Medicare Part A acute care expenditures per beneficiary as well as a decrease in Medicare Part B expenditures per beneficiary. For the study population, we estimate approximately $3.8 billion in savings related to hospital and physician EHR adoption during 2010-2013. We also found that an increase in physician EHR penetration was associated with an increase in lab test expenses. CONCLUSIONS: Health care markets that had steeper increases in EHR penetration during 2010-2013 also had steeper decreases in total Medicare and acute care expenditures per beneficiary. Markets with greater increases in physician EHR had greater declines in Medicare Part B expenditures per beneficiary.
Tipo de publicação: JOURNAL ARTICLE


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PMID:27060973
Autor:Krinsky S; Ryan AM; Mijanovich T; Blustein J
Endereço:1199SEIU, New York, NY.
Título:Variation in Payment Rates under Medicare's Inpatient Prospective Payment System.
Fonte:Health Serv Res; 52(2):676-696, 2017 Apr.
ISSN:1475-6773
País de publicação:United States
Idioma:eng
Resumo:OBJECTIVE: To measure variation in payment rates under Medicare's Inpatient Prospective Payment System (IPPS) and identify the main payment adjustments that drive variation. DATA SOURCES/STUDY SETTING: Medicare cost reports for all Medicare-certified hospitals, 1987-2013, and Dartmouth Atlas geographic files. STUDY DESIGN: We measure the Medicare payment rate as a hospital's total acute inpatient Medicare Part A payment, divided by the standard IPPS payment for its geographic area. We assess variation using several measures, both within local markets and nationally. We perform a factor decomposition to identify the share of variation attributable to specific adjustments. We also describe the characteristics of hospitals receiving different payment rates and evaluate changes in the magnitude of the main adjustments over time. DATA COLLECTION/EXTRACTION METHODS: Data downloaded from the Centers for Medicare and Medicaid Services, the National Bureau of Economic Research, and the Dartmouth Atlas. PRINCIPAL FINDINGS: In 2013, Medicare paid for acute inpatient discharges at a rate 31 percent above the IPPS base. For the top 10 percent of discharges, the mean rate was double the IPPS base. Variations were driven by adjustments for medical education and care to low-income populations. The magnitude of variation has increased over time. CONCLUSIONS: Adjustments are a large and growing share of Medicare hospital payments, and they create significant variation in payment rates.
Tipo de publicação: JOURNAL ARTICLE


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PMID:28248471
Autor:Berry MD; Thomson Reuters Accelus
Título:Healthcare Reform: Enforcement and Compliance.
Fonte:Issue Brief Health Policy Track Serv; 2016:1-37, 2016 Dec 27.
País de publicação:United States
Idioma:eng
Tipo de publicação: JOURNAL ARTICLE


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PMID:27195936
Autor:Matlock DD; Yamashita TE; Min SJ; Smith AK; Kelley AS; M Fischer S
Endereço:Division of Geriatrics, School of Medicine, University of Colorado, Aurora, Colorado.
Título:How U.S. Doctors Die: A Cohort Study of Healthcare Use at the End of Life.
Fonte:J Am Geriatr Soc; 64(5):1061-7, 2016 May.
ISSN:1532-5415
País de publicação:United States
Idioma:eng
Resumo:OBJECTIVES: To compare healthcare use in the last months of life between physicians and nonphysicians in the United States. DESIGN: A retrospective observational cohort study. SETTING: United States. PARTICIPANTS: Fee-for-service Medicare beneficiaries: decedent physicians (n = 9,947) and a random sample of Medicare decedents (n = 192,006). MEASUREMENTS: Medicare Part A claims data from 2008 to 2010 were used to measure days in the hospital and proportion using hospice in the last 6 months of life as primary outcome measures adjusted for sociodemographic characteristics and regional variations in health care. RESULTS: Inpatient hospital use in the last 6 months of life was no different between physicians and nonphysicians, although more physicians used hospice and for longer (using the hospital: odds ratio (OR) = 0.98, 95% confidence interval (CI) = 0.93-1.04; hospital days: mean difference 0.26, P = .14); dying in the hospital: OR = 0.99, 95% CI = 0.95-1.04; intensive care unit (ICU) or critical care unit (CCU) days: mean difference 0.35 more days for physicians, P < .001); using hospice: OR = 1.23, 95% CI = 1.18-1.29; number of days in hospice: mean difference 2.06, P < .001). CONCLUSION: This retrospective, observational study is subject to unmeasured confounders and variation in coding practices, but it provides preliminary evidence of actual use. U.S. physicians were more likely to use hospice and ICU- or CCU-level care. Hospitalization rates were similar.
Tipo de publicação: COMPARATIVE STUDY; JOURNAL ARTICLE; OBSERVATIONAL STUDY


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PMID:26835814
Autor:Bosler B
Endereço:Barbara Bosler, JD, MHE, RHIA, is Veterans Accredited Attorney at Law, Assistant Clinical Professor, College of Health Professions, University of Detroit Mercy, Detroit, Michigan.
Título:The Legislative Priority of Home Healthcare and Quality.
Fonte:Home Healthc Now; 34(2):110-1, 2016 Feb.
ISSN:2374-4537
País de publicação:United States
Idioma:eng
Tipo de publicação: JOURNAL ARTICLE



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