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2.
Sr Care Pharm ; 35(5): 237, 2020 May 01.
Artículo en Inglés | MEDLINE | ID: mdl-32340661

RESUMEN

The decision of the Centers for Medicare & Medicaid Services to suspend routine surveys in favor of focused inspections targeted at infection control is the first signal that long-term care will be at the epicenter of federal oversight.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus , Cuidados a Largo Plazo , Medicare , Pandemias , Neumonía Viral , Centers for Medicare and Medicaid Services, U.S. , Humanos , Medicaid , Estados Unidos
3.
Am Surg ; 86(2): 140-145, 2020 Feb 01.
Artículo en Inglés | MEDLINE | ID: mdl-32167057

RESUMEN

Perception of physician reimbursement for surgical procedures is not well studied. The few existing studies illustrate that patients believe compensation to be higher than in reality. These studies focus on patient perceptions and have not assessed health-care workers' views. Our study examined health-care workers' perception of reimbursement for complex surgical oncology procedures. An anonymous online survey was distributed to employees at our cancer center with descriptions and illustrations of three oncology procedures-hepatectomy, gastrectomy, and pancreaticoduodenectomy. Participants estimated the Medicare fee and gave their perceived value of each procedure. Participants recorded their perception of surgeon compensation overall, both before and after revealing the Medicare fee schedule. Most of the 113 participants were physicians (33.6%) and nurses (28.3%). When blinded to the Medicare fee schedules, most felt that reimbursements were too low for all procedures (60-64%) and that surgeons were overall undercompensated (57%). Value predictions for each procedure were discordant from actual Medicare fee schedules, with overestimates up to 374 per cent. After revealing the Medicare fee schedules, 55 per cent of respondents felt that surgeons were undercompensated. Even among health-care workers, a large discrepancy exists between perceived and actual reimbursement. Revealing actual reimbursements did not alter perception on overall surgeon compensation.


Asunto(s)
Gastrectomía/economía , Personal de Salud/psicología , Hepatectomía/economía , Reembolso de Seguro de Salud/economía , Medicare/economía , Pancreaticoduodenectomía/economía , Instituciones Oncológicas , Honorarios y Precios , Femenino , Personal de Salud/estadística & datos numéricos , Humanos , Masculino , Cuerpo Médico/economía , Cuerpo Médico/estadística & datos numéricos , Persona de Mediana Edad , Personal de Enfermería/economía , Personal de Enfermería/estadística & datos numéricos , Estados Unidos
5.
Lancet ; 395(10225): 660, 2020 02 29.
Artículo en Inglés | MEDLINE | ID: mdl-32113489
7.
Am J Surg ; 219(4): 571-577, 2020 04.
Artículo en Inglés | MEDLINE | ID: mdl-32147020

RESUMEN

INTRODUCTION: Bariatric surgery is an effective treatment for obesity resulting in both sustained weight loss and reduction in obesity-related comorbidities. It is uncertain how sociodemographic factors affect postoperative outcomes. METHODS: The National Inpatient Sample was queried for patients undergoing Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG) from 2005 to 2014. Factors associated with selection of SG over RYGB, increased postoperative length of stay (LOS) greater than 3 days, and inpatient mortality were compared by race, insurance status, and other clinical and hospital factors. RESULTS: The database captured 781,413 patients, of which 525,986 had a RYGB and 255,428 had SG. There was an increase in the incidence of SG over RYGB over time. Among the self-pay/uninsured, the increased incidence began several years earlier than other groups. Black patients had greater odds of increased postoperative LOS (OR 1.40) and in-hospital mortality (OR 2.11). CONCLUSION: Sociodemographic factors are associated with differences in temporal trends in the adoption of SG versus RYGB for surgical weight loss.


Asunto(s)
Gastrectomía/tendencias , Derivación Gástrica/tendencias , Mortalidad Hospitalaria , Tiempo de Internación/estadística & datos numéricos , Alta del Paciente/estadística & datos numéricos , Adolescente , Adulto , Factores de Edad , Comorbilidad , Grupos de Población Continentales/estadística & datos numéricos , Conjuntos de Datos como Asunto , Femenino , Financiación Personal/estadística & datos numéricos , Humanos , Renta/estadística & datos numéricos , Cobertura del Seguro/estadística & datos numéricos , Masculino , Medicaid/estadística & datos numéricos , Pacientes no Asegurados/estadística & datos numéricos , Medicare/estadística & datos numéricos , Persona de Mediana Edad , Sector Privado , Factores Raciales , Factores Sexuales , Estados Unidos/epidemiología , Adulto Joven
8.
Sr Care Pharm ; 35(4): 187, 2020 Apr 01.
Artículo en Inglés | MEDLINE | ID: mdl-32192569

RESUMEN

Despite initial worries, the new patient-driven payment model appears to have resulted in increased revenue for nursing facilities.


Asunto(s)
Sistema de Pago Prospectivo , Humanos , Medicare , Instituciones de Cuidados Especializados de Enfermería , Estados Unidos
9.
JAMA ; 323(10): 961-969, 2020 03 10.
Artículo en Inglés | MEDLINE | ID: mdl-32154858

RESUMEN

Importance: Medicare beneficiaries who are also enrolled in Medicaid (dually enrolled beneficiaries) have drawn the attention of policy makers because they comprise the poorest subset of the Medicare population; however, it is unclear how their outcomes have changed over time compared with those only enrolled in Medicare (nondually enrolled beneficiaries). Objective: To evaluate annual changes in all-cause mortality, hospitalization rates, and hospitalization-related mortality among dually enrolled beneficiaries and nondually enrolled beneficiaries. Design, Setting, and Participants: Serial cross-sectional study of Medicare fee-for-service beneficiaries aged 65 years or older between January 2004 and December 2017. The final date of follow-up was September 30, 2018. Exposures: Dual vs nondual enrollment status. Main Outcomes and Measures: Annual all-cause mortality rates; all-cause hospitalization rates; and in-hospital, 30-day, 1-year hospitalization-related mortality rates. Results: There were 71 017 608 unique Medicare beneficiaries aged 65 years or older (mean age, 75.6 [SD, 9.2] years; 54.9% female) enrolled in Medicare for at least 1 month from 2004 through 2017. Of these beneficiaries, 11 697 900 (16.5%) were dually enrolled in Medicare and Medicaid for at least 1 month. After adjusting for age, sex, and race, annual all-cause mortality rates declined from 8.5% (95% CI, 8.45%-8.56%) in 2004 to 8.1% (95% CI, 8.05%-8.13%) in 2017 among dually enrolled beneficiaries and from 4.1% (95% CI, 4.08%-4.13%) in 2004 to 3.8% (95% CI, 3.76%-3.79%) in 2017 among nondually enrolled beneficiaries. The difference in annual all-cause mortality between dually and nondually enrolled beneficiaries increased between 2004 (adjusted odds ratio, 2.09 [95% CI, 2.08-2.10]) and 2017 (adjusted odds ratio, 2.22 [95% CI, 2.21-2.23]) (P < .001 for interaction between dual enrollment status and time). All-cause hospitalizations per 100 000 beneficiary-years declined from 49 888 in 2004 to 41 121 in 2017 among dually enrolled beneficiaries (P < .001) and from 29 000 in 2004 to 22 601 in 2017 among nondually enrolled beneficiaries (P < .001); however, the difference between these groups widened between 2004 (adjusted risk ratio, 1.72 [95% CI, 1.71-1.73]) and 2017 (adjusted risk ratio, 1.83 [95% CI, 1.82-1.83]) (P < .001 for interaction). Among hospitalized beneficiaries, the risk-adjusted 30-day mortality rates declined from 10.3% (95% CI, 10.22%-10.33%) in 2004 to 10.1% (95% CI, 10.02%-10.20%) in 2017 among dually enrolled beneficiaries and from 8.5% (95% CI, 8.50%-8.56%) in 2004 to 8.1% (95% CI, 8.06%-8.13%) in 2017 among nondually enrolled beneficiaries. In contrast, 1-year mortality increased among hospitalized beneficiaries from 23.1% (95% CI, 23.05%-23.20%) in 2004 to 26.7% (95% CI, 26.58%-26.84%) in 2017 among dually enrolled beneficiaries and from 18.1% (95% CI, 18.11%-18.17%) in 2004 to 20.3% (95% CI, 20.21%-20.31%) in 2017 among nondually enrolled beneficiaries. The difference in hospitalization-related outcomes between dually and nondually enrolled beneficiaries persisted during the study period. Conclusions and Relevance: Among Medicare fee-for-service beneficiaries aged 65 years or older, dually enrolled beneficiaries had higher annual all-cause mortality, all-cause hospitalizations, and hospitalization-related mortality compared with nondually enrolled beneficiaries. Between 2004 and 2017, these differences did not decrease.


Asunto(s)
Planes de Aranceles por Servicios , Hospitalización/estadística & datos numéricos , Medicaid , Medicare , Mortalidad , Anciano , Anciano de 80 o más Años , Causas de Muerte , Estudios Transversales , Femenino , Mortalidad Hospitalaria , Humanos , Masculino , Estados Unidos/epidemiología
11.
Lancet ; 395(10223): 524-533, 2020 02 15.
Artículo en Inglés | MEDLINE | ID: mdl-32061298

RESUMEN

Although health care expenditure per capita is higher in the USA than in any other country, more than 37 million Americans do not have health insurance, and 41 million more have inadequate access to care. Efforts are ongoing to repeal the Affordable Care Act which would exacerbate health-care inequities. By contrast, a universal system, such as that proposed in the Medicare for All Act, has the potential to transform the availability and efficiency of American health-care services. Taking into account both the costs of coverage expansion and the savings that would be achieved through the Medicare for All Act, we calculate that a single-payer, universal health-care system is likely to lead to a 13% savings in national health-care expenditure, equivalent to more than US$450 billion annually (based on the value of the US$ in 2017). The entire system could be funded with less financial outlay than is incurred by employers and households paying for health-care premiums combined with existing government allocations. This shift to single-payer health care would provide the greatest relief to lower-income households. Furthermore, we estimate that ensuring health-care access for all Americans would save more than 68 000 lives and 1·73 million life-years every year compared with the status quo.


Asunto(s)
Prestación de Atención de Salud/organización & administración , Ahorro de Costo/métodos , Prestación de Atención de Salud/economía , Costos de los Medicamentos/estadística & datos numéricos , Gastos en Salud/estadística & datos numéricos , Accesibilidad a los Servicios de Salud/economía , Accesibilidad a los Servicios de Salud/organización & administración , Humanos , Medicare/economía , Patient Protection and Affordable Care Act , Pronóstico , Estados Unidos , Atención de Salud Universal
12.
J Am Dent Assoc ; 151(4): 255-264.e3, 2020 04.
Artículo en Inglés | MEDLINE | ID: mdl-32081299

RESUMEN

BACKGROUND: Integrating preventive oral health services (POHS) into medical offices may ease access to care for children with intellectual and developmental disabilities (IDD). The authors examined the impact of state policies allowing delivery of POHS in medical offices on receipt of POHS among Medicaid enrollees with IDD. METHODS: The authors used 2006 through 2014 Medicaid data for children with IDD aged 6 months through 5 years from 38 states. IDD were defined using 14 condition codes from Centers for Medicare & Medicaid Services Chronic Conditions Data Warehouse. The length of the state's medical POHS policy (no policy, < 1 year, 1 year, 2 years, 3 years, or ≥ 4 years) was interacted with an indicator that the child was younger than 3 years. The authors used logistic regression models to estimate the likelihood that a child received POHS in a medical office or in a medical or dental office in a given year. RESULTS: Among 447,918 children with IDD, 1.6% received POHS in medical offices. Children younger than 3 years in states with longer-enacted policies had higher rates of receiving POHS. For example, the predicted probability of receiving POHS was 40.6% (95% confidence interval, 36.3% to 44.9%) for children younger than 3 years in states with a medical POHS policy for more than 4 years compared with 30.6% (95% confidence interval, 27.8% to 33.5%) for children in states without a policy. CONCLUSIONS: State Medicaid policies allowing delivery of POHS in medical offices increased receipt of POHS among Medicaid-enrolled children with IDD who were younger than 3 years. PRACTICAL IMPLICATIONS: Few children with IDD receive POHS in any setting. Efforts are needed to reduce barriers to POHS for publicly insured children with IDD.


Asunto(s)
Discapacidades del Desarrollo , Medicaid , Anciano , Niño , Accesibilidad a los Servicios de Salud , Humanos , Lactante , Medicare , Salud Bucal , Estados Unidos
14.
Sr Care Pharm ; 35(2): 85-92, 2020 Feb 01.
Artículo en Inglés | MEDLINE | ID: mdl-32019643

RESUMEN

OBJECTIVE: To identify characteristics in an ambulatory Medicare population that are significantly more likely to be associated with a high risk of undiagnosed prediabetes.
DESIGN: Cross-sectional study.
SETTING: Fourteen health clinics targeting Medicare beneficiaries were held throughout northern and central California during the fall of 2017.
PATIENTS, PARTICIPANTS: Noninstitutionalized Medicare beneficiaries receiving medication therapy management services without self-reported diabetes.
INTERVENTIONS: Beneficiaries were screened for their risk of type 2 diabetes mellitus (T2DM) through the use of the American Diabetes Association (ADA) risk assessment (score of ≥ 5 indicates increased risk of developing type 2 diabetes) by pharmacy students. For this study, patients with a score of ≥ 5 were considered to be at high risk for undiagnosed prediabetes.
MAIN OUTCOME MEASURE(S): Characteristics significantly more likely to be identified in patients at high risk for undiagnosed prediabetes.
RESULTS: A total of 683 Medicare beneficiaries without self-reported diabetes completed the ADA risk assessment, with 457 (66.9%) receiving a score of 5 or more. In those, the presence of hyperlipidemia, hypertension, obesity, coronary heart disease, and use of aspirin were all characteristics researchers identified as significantly more likely to be found in this group. In contrast, those of Asian race or who took dietary supplements were significantly less likely to score 5 or higher in the questionnaire.
CONCLUSION: Identification of older adults at higher risk for undiagnosed prediabetes through the use of appropriate screening tools allows for targeted preventive interventions, potentially lowering risk of developing T2DM for selected patients.


Asunto(s)
Estado Prediabético , Anciano , California , Estudios Transversales , Diabetes Mellitus Tipo 2 , Humanos , Vida Independiente , Medicare , Estados Unidos
15.
Sr Care Pharm ; 35(2): 93-106, 2020 Feb 01.
Artículo en Inglés | MEDLINE | ID: mdl-32019644

RESUMEN

OBJECTIVE: To identify key beliefs that influence behavior, regarding Medicare's Annual Wellness Visit (AWV) and older patients' willingness to implement personalized prevention plans.
DESIGN: Cross-sectional. In-depth semi-structured focus group sessions with Medicare patients in July 2018.
SETTING: Two primary care physician-based practices.
INTERVENTION: A trained moderator facilitated two focus group sessions, and used open-ended questions based on the theory of planned behavior to elicit behavioral, normative, and control beliefs associated with implementing personalized prevention plans.
MAIN OUTCOME MEASURE: Content analysis of the focus groups' transcribed data was used to identify modal salient beliefs. Transcribed focus group sessions were analyzed utilizing grounded-theory methods for emergent themes.
RESULTS: A total of 13 older patients participated in the focus group sessions. Prevalent behavioral beliefs among participants influenced by patient-centered care outcomes included improvement in physical activity, adopting a healthy balanced diet, and weight loss.
Interpersonal and environmental disparities influenced commonly reported control factors such as lack of support at home and affordable fitness facilities. Macro-level influences such as physicians and social marketing by insurance providers, and health partners and spousal support were identified as important normative factors.
CONCLUSION: Identified salient beliefs were congruent to social determinants of health in Medicare patients. Results of the study demonstrate perceived enablers and barriers of elderly patients regarding implementing health-promoting advice. AWV pharmacists should address perceived barriers to improve attitudes and self-efficacy; and incorporate enabling beliefs into adherence strategies to improve adoption of health recommendations.


Asunto(s)
Medicare , Farmacéuticos , Anciano , Estudios Transversales , Ejercicio Físico , Grupos Focales , Humanos , Estados Unidos
16.
Sr Care Pharm ; 35(3): 145, 2020 Mar 01.
Artículo en Inglés | MEDLINE | ID: mdl-32070463

RESUMEN

Those of you who have been around for a while understand that Medicaid is the primary payer for long-term care in the United States. While Medicare pays for the short-term episodes of care associated with rehabilitation following a three-day stay in an acute-care hospital, it?s Medicaid that foots the bill for live-in residents who are unable to afford it themselves.


Asunto(s)
Medicaid , Humanos , Cuidados a Largo Plazo , Medicare , Estados Unidos
18.
Arthroscopy ; 36(2): 353-354, 2020 02.
Artículo en Inglés | MEDLINE | ID: mdl-32014169

RESUMEN

Efforts to maintain normothermia should be a part of every patient's perioperative care. Risks, benefits, and economic implications should be considered when deciding how to use active warming devices for orthopaedic surgery. The Centers for Medicare & Medicaid Services has implemented economic incentives and penalties driving hospitals to invest in active warming devices, including forced-air warmers and resistive heating devices. Even though forced-air warmers and resistive heating blankets are likely to statistically improve patient temperatures, they may not be worth the additional cost for shorter, less invasive, elective arthroscopic surgeries. In addition, recent research demonstrates minimal clinically significant differences between these 2 types of devices. Concern regarding possible increased risk of surgical-site contamination with forced-air warmers warrants further study but, again, is unlikely clinically relevant to arthroscopic cases, and proper staff training and warming equipment routine maintenance could minimize patient risk.


Asunto(s)
Hipotermia , Artroscopía , Humanos , Medicare , Estudios Prospectivos , Hombro , Estados Unidos
19.
BMC Health Serv Res ; 20(1): 77, 2020 Feb 03.
Artículo en Inglés | MEDLINE | ID: mdl-32013969

RESUMEN

BACKGROUND: The Affordable Care Act (ACA) was enacted to enhance access to care primarily among nonelderly and low-income populations; however, several provisions addressed key determinants of emergency department (ED) and inpatient visits among Medicare beneficiaries over age 65 years. We take stock of the overall changes in these visits among older Medicare beneficiaries, focusing on those with multiple chronic conditions (MCCs), and provide a nationally representative post-reform update. METHODS: We analyzed a sample of 32,919 older adults (65+) on Medicare from the 2006-2015 Medical Expenditure Panel Survey (MEPS). Using a survey-weighted two-part model, we examined changes in ED visits, inpatient visits, and length of stay (LOS) by MCC status, before (2006-2010), during (2011-2013), and after the ACA (2014-2015). RESULTS: Prior to the ACA, 18.1% of Medicare older adults had ≥1 ED visit, whereas 17.1% had ≥1 inpatient visits, with an average of 5.1 nights/visit. Following ACA reforms, among those with 2+ chronic conditions, the rate of ever having an ED visit increased by 4.3 percentage points [95% confidence intervals [CI]: 2.5, 6.1, p < 0.01], whereas the rate of inpatient visits decreased by 1.4 percentage points [95%CI: - 2.9, 0.2, p < 0.1], after multivariable adjustment. CONCLUSIONS: We found sizable increases in ED visits and nontrivial decreases in inpatient visits among older Medicare beneficiaries with MCCs, underscoring the continuing need for improving access to and quality of care among older adults with MCCs to decrease reliance on the ED and reduce preventable hospitalizations.


Asunto(s)
Enfermedad Crónica/epidemiología , Enfermedad Crónica/terapia , Servicio de Urgencia en Hospital/estadística & datos numéricos , Utilización de Instalaciones y Servicios/estadística & datos numéricos , Hospitalización/estadística & datos numéricos , Medicare/organización & administración , Multimorbilidad , Anciano , Femenino , Reforma de la Atención de Salud , Humanos , Masculino , Patient Protection and Affordable Care Act , Estados Unidos/epidemiología
20.
Am J Surg ; 219(4): 557-562, 2020 04.
Artículo en Inglés | MEDLINE | ID: mdl-32007235

RESUMEN

BACKGROUND: The "white-flight" phenomenon of the mid-20th century contributed to the perpetuation of residential segregation in American society. In light of recent reports of racial segregation in our healthcare system, could a contemporary "white-flight" phenomenon also exist? METHODS: The New York Statewide Planning and Research Cooperative System was used to identify all Manhattan and Bronx residents of New York city who underwent elective cardiothoracic, colorectal, general, and vascular surgeries from 2010 to 2016. Primary outcome was borough of surgical care in relation to patient's home borough. Multivariable analyses were performed. RESULTS: White patients who reside in the Bronx are significantly more likely than racial minorities to travel into Manhattan for elective surgical care, and these differences persist across different insurance types, including Medicare. CONCLUSIONS: Marked race-based differences in choice of location for elective surgical care exist in New York city. If left unchecked, these differences can contribute to furthering racial segregation within our healthcare system.


Asunto(s)
Conducta de Elección , Grupos de Población Continentales/estadística & datos numéricos , Procedimientos Quirúrgicos Electivos/estadística & datos numéricos , Ubicación de la Práctica Profesional/estadística & datos numéricos , Femenino , Disparidades en Atención de Salud , Humanos , Seguro de Salud/estadística & datos numéricos , Masculino , Medicaid/estadística & datos numéricos , Medicare/estadística & datos numéricos , Persona de Mediana Edad , Ciudad de Nueva York/epidemiología , Participación del Paciente , Factores Raciales , Estados Unidos
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