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1.
Phys Med Rehabil Clin N Am ; 32(2): 429-436, 2021 05.
Artículo en Inglés | MEDLINE | ID: mdl-33814067

RESUMEN

As a result of the COVID-19 public health emergency, the Centers for Medicare & Medicaid Services expanded its telehealth benefit on a temporary and emergency basis. Effective March 6, 2020, Medicare will pay for Medicare telehealth services at the same rate as regular, in-person visits. Medicare has prescribed specific guidance on the billing and coding of such services, having an impact on reimbursement for qualified providers. Additional guidance also exists on acceptable telehealth communication platforms and patient privacy.


Asunto(s)
Centers for Medicare and Medicaid Services, U.S. , Documentación , Health Insurance Portability and Accountability Act , Reembolso de Seguro de Salud , Telemedicina/economía , Telemedicina/legislación & jurisprudencia , /epidemiología , Healthcare Common Procedure Coding System , Humanos , Pandemias , Estados Unidos/epidemiología
4.
Urol Clin North Am ; 48(2): 215-222, 2021 May.
Artículo en Inglés | MEDLINE | ID: mdl-33795055

RESUMEN

The emergence of the COVID-19 pandemic and subsequent public health emergency (PHE) have propelled telemedicine several years into the future. With the rapid adoption of this technology came socioeconomic inequities as minority communities disproportionately have yet to adopt telemedicine. Telemedicine offers solutions to patient access issues that have plagued urology, helping address physician shortages in rural areas and expanding the reach of urologists. The Centers for Medicare & Medicaid Services have adopted changes to expand coverage for telemedicine services. The expectation is that telemedicine will continue to be a mainstay in the health care system with gradual expansion in utilization.


Asunto(s)
/epidemiología , Telemedicina , Urología , Centers for Medicare and Medicaid Services, U.S. , Difusión de Innovaciones , Humanos , Factores Socioeconómicos , Estados Unidos
5.
Urol Clin North Am ; 48(2): 259-268, 2021 May.
Artículo en Inglés | MEDLINE | ID: mdl-33795060

RESUMEN

The Quality Payment Program was established by the Medicare Access and CHIP Reauthorization Act (MACRA) legislation in response to repeated efforts to create a permanent so-called doc fix in response to the failures of the sustainable growth formula. This article examines the history leading up to MACRA, the current pathways associated with the Quality Payment Program, and future expectation both from the Centers for Medicare and Medicaid Services, stakeholders, and patients.


Asunto(s)
Medicare/economía , Planes de Incentivos para los Médicos/economía , Reembolso de Incentivo/economía , Urólogos/economía , Centers for Medicare and Medicaid Services, U.S. , Predicción , Humanos , Indicadores de Calidad de la Atención de Salud , Estados Unidos
6.
Int J Qual Health Care ; 33(1)2021 Mar 09.
Artículo en Inglés | MEDLINE | ID: mdl-33644795

RESUMEN

OBJECTIVE: To identify how features of the community in which a hospital serves differentially relate to its patients' experiences based on the quality of that hospital. DESIGN: A Finite Mixture Model (FMM) is used to uncover a mix of two latent groups of hospitals that differ in quality. In the FMM, a multinomial logistic equation relates hospital-level factors to the odds of being in either group. And a multiple linear regression relates the characteristics of communities served by hospitals to the patients' expected ratings of their experiences at hospitals in each group. Thus, this association potentially varies with hospital quality. The analysis was conducted via Stata. SETTING: Hospital Ratings are measured by Hospital Compare using the HCAHPS survey, a patient satisfaction survey required by the Centers for Medicare and Medicaid Services (CMS) for hospitals in the United States. Participants: 2,816 Medicare-certified acute care hospitals across all US states.


Asunto(s)
/epidemiología , Centers for Medicare and Medicaid Services, U.S./normas , Indicadores de Calidad de la Atención de Salud/estadística & datos numéricos , Factores Socioeconómicos , Factores de Edad , Femenino , Humanos , Modelos Lineales , Masculino , Satisfacción del Paciente/estadística & datos numéricos , Características de la Residencia/estadística & datos numéricos , Factores Sexuales , Estados Unidos/epidemiología
12.
J Am Geriatr Soc ; 69(4): 850-860, 2021 04.
Artículo en Inglés | MEDLINE | ID: mdl-33577714

RESUMEN

BACKGROUND/OBJECTIVES: Regulatory oversight has been a central strategy to assure nursing home quality of care for decades. In response to COVID-19, traditional elements of oversight that relate to resident care have been curtailed in favor of implementing limited infection control surveys and targeted complaint investigations. We seek to describe the state of nursing home oversight during the pandemic to facilitate a discussion of whether and how these activities should be altered going forward. DESIGN AND SETTING: In a retrospective study, we describe national oversight activities in January-June 2020 and compare these activities to the same time period from 2019. We also examine state-level oversight activities during the peak months of the pandemic. PARTICIPANTS: United States nursing homes. DATA: Publicly available Quality, Certification, and Oversight Reports (QCOR) data from the Centers for Medicare and Medicaid Services (CMS). MEASUREMENTS: Number of standard, complaint, and onsite infection surveys, number of deficiencies from standard and complaint surveys, number of citations by deficiency tag, and number and amount of civil monetary penalties. RESULTS: The number of standard and complaint surveys declined considerably in the second quarter of 2020 relative to the same time frame in 2019. Deficiency citations generally decreased to near zero by April 2020 with the exception of infection prevention and control deficiencies and citations for failure to report COVID-19 data to the national health safety network. Related enforcement actions were down considerably in 2020, relative to 2019. CONCLUSION: In the months since COVID-19 first impacted nursing homes, regulatory oversight efforts have fallen off considerably. While CMS implemented universal infection control surveys and targeted complaint investigations, other routine aspects of oversight dropped in light of justifiable limits on nursing home entry. Going forward, we must develop policies that allow regulators to balance the demands of the pandemic while fulfilling their responsibilities effectively.


Asunto(s)
Centers for Medicare and Medicaid Services, U.S./estadística & datos numéricos , Control de Infecciones , Notificación Obligatoria , Casas de Salud/estadística & datos numéricos , Calidad de la Atención de Salud/normas , Anciano , Certificación/normas , Femenino , Regulación Gubernamental , Humanos , Estudios Retrospectivos , Estados Unidos
13.
JAMA Netw Open ; 4(2): e2037320, 2021 02 01.
Artículo en Inglés | MEDLINE | ID: mdl-33595661

RESUMEN

Importance: The Hospital Readmissions Reduction Program publicly reports and financially penalizes hospitals according to 30-day risk-standardized readmission rates (RSRRs) exclusively among traditional Medicare (TM) beneficiaries but not persons with Medicare Advantage (MA) coverage. Exclusively reporting readmission rates for the TM population may not accurately reflect hospitals' readmission rates for older adults. Objective: To examine how inclusion of MA patients in hospitals' performance is associated with readmission measures and eligibility for financial penalties. Design, Setting, and Participants: This is a retrospective cohort study linking the Medicare Provider Analysis and Review file with the Healthcare Effectiveness Data and Information Set at 4070 US acute care hospitals admitting both TM and MA patients. Participants included patients admitted and discharged alive with a diagnosis of acute myocardial infarction (AMI), congestive heart failure (CHF), or pneumonia between 2011 and 2015. Data analyses were conducted between April 1, 2018, and November 20, 2020. Exposures: Admission to an acute care hospital. Main Outcomes and Measures: The outcome was readmission for any reason occurring within 30 days after discharge. Each hospital's 30-day RSRR was computed on the basis of TM, MA, and all patients and estimated changes in hospitals' performance and eligibility for financial penalties after including MA beneficiaries for calculating 30-day RSRRs. Results: There were 748 033 TM patients (mean [SD] age, 76.8 [83] years; 360 692 [48.2%] women) and 295 928 MA patients (mean [SD] age, 77.5 [7.9] years; 137 422 [46.4%] women) hospitalized and discharged alive for AMI; 1 327 551 TM patients (mean [SD] age, 81 [8.3] years; 735 855 [55.4%] women) and 457 341 MA patients (mean [SD] age, 79.8 [8.1] years; 243 503 [53.2%] women) for CHF; and 2 017 020 TM patients (mean [SD] age, 80.7 [8.5] years; 1 097 151 [54.4%] women) and 610 790 MA patients (mean [SD] age, 79.6 [8.2] years; 321 350 [52.6%] women) for pneumonia. The 30-day RSRRs for TM and MA patients were correlated (correlation coefficients, 0.31 for AMI, 0.40 for CHF, and 0.41 for pneumonia) and the TM-based RSRR systematically underestimated the RSRR for all Medicare patients for each condition. Of the 2820 hospitals with 25 or more admissions for at least 1 of the outcomes of AMI, CHF, and pneumonia, 635 (23%) had a change in their penalty status for at least 1 of these conditions after including MA data. Changes in hospital performance and penalty status with the inclusion of MA patients were greater for hospitals in the highest quartile of MA admissions. Conclusions and Relevance: In this cohort study, the inclusion of data from MA patients changed the penalty status of a substantial fraction of US hospitals for at least 1 of 3 reported conditions. This suggests that policy makers should consider including all hospital patients, regardless of insurance status, when assessing hospital quality measures.


Asunto(s)
Hospitales/normas , Readmisión del Paciente/estadística & datos numéricos , Garantía de la Calidad de Atención de Salud/métodos , Indicadores de Calidad de la Atención de Salud , Anciano , Anciano de 80 o más Años , Centers for Medicare and Medicaid Services, U.S. , Femenino , Insuficiencia Cardíaca/terapia , Hospitalización , Humanos , Seguro de Salud , Masculino , Medicare , Medicare Part C , Infarto del Miocardio/terapia , Neumonía/terapia , Formulación de Políticas , Ajuste de Riesgo , Estados Unidos
16.
Curr Opin Anaesthesiol ; 34(2): 154-160, 2021 Apr 01.
Artículo en Inglés | MEDLINE | ID: mdl-33606399

RESUMEN

PURPOSE OF REVIEW: Episode-based cost measures (EBCM) is a method of combining all services related to a defined episode of care, identified as either a procedure, acute illness or chronic disease, and providing expected cost for that episode or bundle of care. Procedural EBCM has become a major scheme for payment methodology and patient quality of care evaluation. Anesthesiologists need to know how EBCM can impact their clinical practice. RECENT FINDING: Centers for Medicare and Medicaid Services (CMS) pays physicians with fee-for-service payment for Clinical Episodes and, in 2020, the EBCM are increasing and currently, represents 4.5% of the total Medicare Part A and B spending [1]. With the recent changes in CMS, it is important, for anesthesia providers to know how cost attribution identifies the cost for all services and complications under anesthetic management. SUMMARY: EBCM can impact the anesthesiologist's quality performance, efficiencies measures, and payment. To preserve practice viability, anesthesiologists must understand how their compensation is impacted by services ordered. Anesthesiologists will increasingly be expected to improve quality and efficiencies in EBCM.


Asunto(s)
Anestesia , Anestesia/efectos adversos , Centers for Medicare and Medicaid Services, U.S. , Planes de Aranceles por Servicios , Humanos , Medicare , Médicos , Estados Unidos
17.
Tex Med ; 117(1): 32-33, 2021 Jan 01.
Artículo en Inglés | MEDLINE | ID: mdl-33641115

RESUMEN

As the Centers for Medicare & Medicaid Services continues to churn out glowing data annually on its Quality Payment Program (QPP), a full picture of the program's impact eludes the agency's reporting. According to the Texas Medical Association's analysis of state-level data in the 2018 QPP Experience Report, it's clear that small practices continue to feel most of the program's punitive pressures.


Asunto(s)
Centers for Medicare and Medicaid Services, U.S. , Pautas de la Práctica en Medicina/economía , Reembolso de Incentivo/economía , Humanos , Texas , Estados Unidos
19.
J Am Board Fam Med ; 34(Suppl): S13-S15, 2021 02.
Artículo en Inglés | MEDLINE | ID: mdl-33622810

RESUMEN

On June 22, 2020, the Centers for Medicare and Medicaid Services (CMS) unveiled an aggregate data set on the impact of the coronavirus disease 2019 (COVID-19) on its beneficiaries. The CMS brief is especially noteworthy for offering COVID-19-related racial and ethnic health disparity data on a national scale, thereby extending reports heretofore limited to states, cities, or health systems. The CMS COVID-19 brief exposes distressing racial and ethnic health disparities. It is the objective of this commentary to trace the origins of the CMS COVID-19 brief, discuss its salient findings, and consider its implications.


Asunto(s)
/etnología , Centers for Medicare and Medicaid Services, U.S. , Grupos de Población Continentales , Grupos Étnicos , Disparidades en el Estado de Salud , Disparidades en Atención de Salud/etnología , Racismo , /diagnóstico , Accesibilidad a los Servicios de Salud , Humanos , Medicaid , Medicare , Pronóstico , Estados Unidos/epidemiología
20.
J Am Board Fam Med ; 34(Suppl): S29-S32, 2021 02.
Artículo en Inglés | MEDLINE | ID: mdl-33622814

RESUMEN

The SARS-CoV-2 epidemic has led to rapid transformation of health care delivery and access with increased provision of telehealth services despite previously identified barriers and limitations to this care. While telehealth was initially envisioned to increase equitable access to care for under-resourced populations, the way in which telehealth provision is designed and implemented may result in worsening disparities if not thoughtfully done. This commentary seeks to demonstrate the opportunities for telehealth equity based on past research, recent developments, and a recent patient experience case example highlighting benefits of telehealth care in underserved patient populations. Recommendations to improve equity in telehealth provision include improved virtual visit technology with a focus on patient ease of use, strategies to increase access to video visit equipment, universal broadband wireless, and inclusion of telephone visits in CMS reimbursement criteria for telehealth.


Asunto(s)
Accesibilidad a los Servicios de Salud/organización & administración , Disparidades en Atención de Salud , Área sin Atención Médica , Telemedicina/organización & administración , /diagnóstico , /terapia , Centers for Medicare and Medicaid Services, U.S./organización & administración , Política de Salud , Humanos , Pandemias , Estados Unidos/epidemiología
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