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Journal of Hospice and Palliative... Aug 2021Integrative hospice and palliative care is a philosophy of treatment framing patients as whole persons composed of interrelated systems. The interdisciplinary treatment...
Integrative hospice and palliative care is a philosophy of treatment framing patients as whole persons composed of interrelated systems. The interdisciplinary treatment team is subsequently challenged to consider ethical and effective provision of holistic services that concomitantly address these systems at the end of life through cotreatment. Nurses and music therapists, as direct care professionals with consistent face-to-face contact with patients and caregivers, are well positioned to collaborate in providing holistic care. This article introduces processes of referral, assessment, and treatment that nurses and music therapists may engage in to address family support, spirituality, bereavement, and telehealth. Clinical vignettes are provided to illustrate how cotreatment may evolve and its potential benefits given diverse circumstances. As part of this framing, music therapy is positioned as a core-rather than alternative or complementary-service in hospice that satisfies the required counseling services detailed in Medicare's Conditions of Participation for hospice providers. The systematic and intentional partnering of nurses and music therapists can provide patients and caregivers access to quality comprehensive care that can cultivate healthy transitions through the dying process.
Topics: Aged; Hospice Care; Hospices; Humans; Medicare; Music Therapy; Palliative Care; United States
PubMed: 33631776
DOI: 10.1097/NJH.0000000000000747 -
The American Journal of Managed Care Mar 2021To examine changes in hospital outpatient surgery trends and case mix for Medicare and privately insured patients needing total knee arthroplasty (TKA) following...
OBJECTIVES
To examine changes in hospital outpatient surgery trends and case mix for Medicare and privately insured patients needing total knee arthroplasty (TKA) following Medicare's removal of TKA from its Inpatient Only list on January 1, 2018.
STUDY DESIGN
A retrospective analysis of all hospital discharge records in Florida from 2012 through 2018.
METHODS
We tracked inpatient vs outpatient performance of TKAs at the state and hospital levels. We also combined our primary data with physician practice organization information to assess variation in the policy response according to physician-hospital ownership status. Supplementary analyses examined policy-induced changes in inpatient TKA case mix.
RESULTS
We observed an immediate shift of roughly 15% of Medicare TKA cases to the outpatient setting. Importantly, there was a simultaneous near doubling of the number of TKAs performed as a hospital outpatient procedure among privately insured patients younger than 60 years. Hospitals allocated a similar proportion of TKA cases to the outpatient setting across the 2 payer groups, and we found evidence of selection against the potentially riskiest Medicare TKA patients for outpatient delivery. Vertically integrated orthopedic physicians retained their Medicare and privately insured TKA cases within the inpatient (higher-cost) setting.
CONCLUSIONS
Market and financial pressures are encouraging more outpatient care delivery; however, the speed of transition is dictated, in part, by regulatory constraints. Our results suggest that Medicare policy may influence surgical treatment approaches for Medicare and privately insured patients. Spillover implications need to be considered when weighing future Medicare regulatory decisions.
Topics: Aged; Arthroplasty, Replacement, Knee; Humans; Inpatients; Medicare; Outpatients; Retrospective Studies; United States
PubMed: 33720667
DOI: 10.37765/ajmc.2021.88598 -
Current Opinion in Urology Jul 2017The Medicare Access and CHIP Reauthorization Act (MACRA) is a historic bill that was recently passed that establishes how quality measurement and practice patterns will... (Review)
Review
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. Both APMs and bundled payments are considered APMs under MACRA. Although most urologists do not currently participate in Accountable Care Organizations (ACOs) and Bundled Payments, both models are considered APMs under MACRA and are likely going to gain increasing attention in the coming years.
SUMMARY
APMs will likely become more relevant to urologists' practices in the future, as both the Centers for Medicare and Medicaid Services and private payers are transitioning away from fee-for-service towards value-based payment.
Topics: Fee-for-Service Plans; Health Expenditures; Health Policy; Humans; Medicare; Reimbursement Mechanisms; United States; Urology
PubMed: 28441271
DOI: 10.1097/MOU.0000000000000403 -
Population Health Management Nov 2016Medicare Advantage: Issues, Insights, and Implications for the Future Paul Cotton, Joseph P. Newhouse, PhD, Kevin G. Volpp, MD, PhD, A. Mark Fendrick, MD, Susan Lynne...
Medicare Advantage: Issues, Insights, and Implications for the Future Paul Cotton, Joseph P. Newhouse, PhD, Kevin G. Volpp, MD, PhD, A. Mark Fendrick, MD, Susan Lynne Oesterle, Pat Oungpasuk, Ruchi Aggarwal, Gail Wilensky, PhD, and Kathleen Sebelius Editorial S-2 D.B. Nash, and A.Y. Schwartz The History, Impact, and Future of the Medicare Advantage Star Ratings System S-3 P. Cotton Medicare Advantage and Traditional Fee-For-Service Medicare S-4 J.P. Newhouse Behavioral Economics: Key to Effective Care Management Programs for Patients, Payers, and Providers S-5 K.G. Volpp Value-Based Insurance Design: A Promising Strategy for Medicare Advantage S-6 A.M. Fendrick, S.L. Oesterle, P. Oungpasuk, and R. Aggarwal Two Perspectives on the Future of Medicare Advantage S-7 G. Wilensky and K. Sebelius.
Topics: Fee-for-Service Plans; Humans; Medicare Part C; Quality Improvement; United States
PubMed: 27834576
DOI: 10.1089/pop.2016.29013.pc -
Health Services Research Feb 2021To determine the relationship between Medicare's site-based outpatient billing policy and hospital-physician integration.
OBJECTIVE
To determine the relationship between Medicare's site-based outpatient billing policy and hospital-physician integration.
DATA SOURCES
National Medicare claims data from 2010 to 2016.
STUDY DESIGN
For each physician-year, we calculated the disparity between Medicare reimbursement under hospital ownership and under physician ownership. Using logistic regression analysis, we estimated the relationship between these payment differences and hospital-physician integration, adjusting for region, market concentration, and time fixed effects. We measured integration status using claims data and legal tax names.
DATA COLLECTION
The study included integrated and non-integrated physicians who billed Medicare between January 1, 2010, and December 31, 2016 (n = 2 137 245 physician-year observations).
PRINCIPAL FINDINGS
Medicare reimbursement for physician services would have been $114 000 higher per physician per year if a physician were integrated compared to being non-integrated. Primary care physicians faced a 78% increase, medical specialists 74%, and surgeons 224%. These payment differences exhibited a modest positive relationship to hospital-physician vertical integration. An increase in this outpatient payment differential equivalent to moving from the 25th to 75th percentile was associated with a 0.20 percentage point increase in the probability of integrating with a hospital (95% CI: 0.0.10-0.30). This effect was slightly larger among primary care physicians (0.27, 95% CI: 0.18 to 0.35) and medical specialists (0.26, 95% CI: 0.05 to 0.48), while not significantly different from zero among surgeons (-0.02; 95% CI: -0.27 to 0.22).
CONCLUSIONS
The payment differences between outpatient settings were large and grew over time. Even routine annual outpatient payment updates from Medicare may prompt some hospital-physician vertical integration, particularly among primary care physicians and medical specialists.
Topics: Ambulatory Care; Efficiency, Organizational; Hospital-Physician Joint Ventures; Humans; Medicare; Pain Management; Practice Patterns, Physicians'; Private Sector; Reimbursement Mechanisms; United States
PubMed: 33616932
DOI: 10.1111/1475-6773.13613 -
American Journal of Kidney Diseases :... Aug 2019In late 2017, the 7 regional contractors responsible for paying dialysis claims in Medicare proposed new payment rules that would restrict payment for hemodialysis...
In late 2017, the 7 regional contractors responsible for paying dialysis claims in Medicare proposed new payment rules that would restrict payment for hemodialysis treatments in excess of 3 weekly to exceptional acute-care circumstances. Frequent hemodialysis is performed more frequently than the traditional thrice-weekly pattern, and many stakeholders-patients, providers, dialysis machine manufacturers, and others-have expressed concern that these payment rules will inhibit the growth of this treatment modality's use among US dialysis patients. In this Perspective, we explain the role of these contractors in the context of Medicare's in-center hemodialysis-centric dialysis payment system and assess how well this system accommodates the higher treatment frequencies of both peritoneal dialysis and frequent hemodialysis. Then, given the available evidence concerning the relative effectiveness of these modalities versus thrice-weekly in-center hemodialysis and trends in their use, we discuss options for modifying Medicare's payment system to support frequent dialysis.
Topics: Humans; Kidney Failure, Chronic; Medicare; Reimbursement Mechanisms; Renal Dialysis; United States
PubMed: 30922595
DOI: 10.1053/j.ajkd.2019.01.027 -
JAMA Oct 2022Prescription drug spending is a topic of increased interest to the public and policymakers. However, prior assessments have been limited by focusing on retail spending...
IMPORTANCE
Prescription drug spending is a topic of increased interest to the public and policymakers. However, prior assessments have been limited by focusing on retail spending (Part D-covered drugs), omitting clinician-administered (Part B-covered) drug spending, or focusing on all fee-for-service Medicare beneficiaries, regardless of their enrollment into prescription drug coverage.
OBJECTIVE
To estimate the proportion of health care spending contributed by prescription drugs and to assess spending for retail and clinician-administered prescriptions.
DESIGN, SETTING, AND PARTICIPANTS
Descriptive, serial, cross-sectional analysis of a 20% random sample of fee-for-service Medicare beneficiaries in the United States from 2008 to 2019 who were continuously enrolled in Parts A (hospital), B (medical), and D (prescription drug) benefits, and not in Medicare Advantage.
EXPOSURE
Calendar year.
MAIN OUTCOMES AND MEASURES
Net spending on retail (Part D-covered) and clinician-administered (Part B-covered) prescription drugs; prescription drug spending (spending on Part B-covered and Part D-covered drugs) as a percentage of total per-capita health care spending. Measures were adjusted for inflation and for postsale rebates (for Part D-covered drugs).
RESULTS
There were 3 201 284 beneficiaries enrolled in Parts A, B, and D in 2008 and 4 502 718 in 2019. In 2019, beneficiaries had a mean (SD) age of 71.7 (12.0) years, documented sex was female for 57.7%, and 69.5% had no low-income subsidies. Total per-capita spending was $16 345 in 2008 and $20 117 in 2019. Comparing 2008 with 2019, per-capita Part A spending was $7106 (95% CI, $7084-$7128) vs $7120 (95% CI, $7098-$7141), Part B drug spending was $720 (95% CI, $713-$728) vs $1641 (95% CI, $1629-$1653), Part B nondrug spending was $5113 (95% CI, $5105-$5122) vs $6702 (95% CI, $6692-$6712), and Part D net spending was $3122 (95% CI, $3117-$3127) vs $3477 (95% CI, $3466-$3489). The proportion of total annual spending attributed to prescription drugs increased from 24.0% in 2008 to 27.2% in 2019, net of estimated rebates and discounts.
CONCLUSIONS AND RELEVANCE
In 2019, spending on prescription drugs represented approximately 27% of total spending among fee-for-service Medicare beneficiaries enrolled in Part D, even after accounting for postsale rebates.
Topics: Aged; Female; Humans; Cross-Sectional Studies; Fee-for-Service Plans; Health Expenditures; Medicare; Medicare Part D; Prescription Drugs; United States; Medicare Part A; Medicare Part B; Male; Middle Aged; Aged, 80 and over
PubMed: 36255428
DOI: 10.1001/jama.2022.17825 -
JAMA Network Open May 2021Oral health care faces ongoing workforce challenges that affect patient access and outcomes. While the Medicare program provides an estimated $14.6 billion annually in...
IMPORTANCE
Oral health care faces ongoing workforce challenges that affect patient access and outcomes. While the Medicare program provides an estimated $14.6 billion annually in graduate medical education (GME) payments to teaching hospitals, including explicit support for dental and podiatry programs, little is known about the level or distribution of this public investment in the oral health and podiatry workforce.
OBJECTIVE
To examine Medicare GME payments to teaching hospitals for dental and podiatry residents from 1998 to 2018, as well as the distribution of federal support among states, territories, and the District of Columbia.
DESIGN, SETTING, AND PARTICIPANTS
This cross-sectional study was conducted using data from 1252 US teaching hospitals. Data were analyzed from May through August 2020.
EXPOSURES
Dental and podiatry residency training.
MAIN OUTCOMES AND MEASURES
Medicare dental and podiatry GME payments were examined.
RESULTS
Among 1252 teaching hospitals, Medicare provided nearly $730 million in dental and podiatry GME payments in 2018. From 1998 to 2018, the number of residents supported more than doubled, increasing from 2340 residents to 4856 residents, for a 2.1-fold increase, while Medicare payments for dental and podiatry GME increased from $279 950 531 to $729 277 090, for a 2.6-fold increase. In 2018, an estimated 3504 of 4856 supported positions (72.2%) were dental. Medicare GME payments varied widely among states, territories, and the District of Columbia, with per capita payments by state, territory, and district population ranging from $0.05 in Puerto Rico to $14.24 in New York, while 6 states received no support for dental or podiatry residency programs.
CONCLUSIONS AND RELEVANCE
These findings suggest that dental and podiatry GME represents a substantial public investment, and deliberate policy decisions are needed to target this nearly $730 million and growing investment to address the nation's priority oral and podiatry health needs.
Topics: Adult; Cross-Sectional Studies; Education, Dental, Graduate; Education, Medical, Graduate; Female; Humans; Male; Medicare; Podiatry; United States; Young Adult
PubMed: 34042989
DOI: 10.1001/jamanetworkopen.2021.11797 -
Annual Review of Public Health Apr 2020Over the past decade, the Centers for Medicare and Medicaid Services (CMS) have led the nationwide shift toward value-based payment. A major strategy for achieving this... (Review)
Review
Over the past decade, the Centers for Medicare and Medicaid Services (CMS) have led the nationwide shift toward value-based payment. A major strategy for achieving this goal has been to implement alternative payment models (APMs) that encourage high-value care by holding providers financially accountable for both the quality and the costs of care. In particular, the CMS has implemented and scaled up two types of APMs: population-based models that emphasize accountability for overall quality and costs for defined patient populations, and episode-based payment models that emphasize accountability for quality and costs for discrete care. Both APM types have been associated with modest reductions in Medicare spending without apparent compromises in quality. However, concerns about the unintended consequences of these APMs remain, and more work is needed in several important areas. Nonetheless, both APM types represent steps to build on along the path toward a higher-value national health care system.
Topics: Aged; Aged, 80 and over; Delivery of Health Care; Female; Humans; Male; Medicare; Reimbursement Mechanisms; United States; Value-Based Health Insurance
PubMed: 32237986
DOI: 10.1146/annurev-publhealth-040119-094327 -
JAMA Health Forum Dec 2022
Topics: United States; Medicare Part C
PubMed: 36580327
DOI: 10.1001/jamahealthforum.2022.4896