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1.
Oncology (Williston Park) ; 34(9): 377-378, 2020 09 15.
Artigo em Inglês | MEDLINE | ID: mdl-32965670

RESUMO

The telehealth explosion was facilitated by the onset of the coronavirus disease 2019 (COVID-19) pandemic, but what happens when the crisis is over? Will there be lasting changes to the practice of medicine and delivery of care, or will providers and patients alike be eager to go back to the "old way" of doing things? Jeremy Gabrysch, MD, a physician and CEO of Remedy, an on-demand urgent care service that delivers doctors right to your front door, discusses what the future of telehealth may hold.


Assuntos
Assistência à Saúde , Mecanismo de Reembolso , Padrão de Cuidado , Telemedicina/tendências , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Humanos , Pandemias , Pneumonia Viral/epidemiologia , Telemedicina/economia , Telemedicina/métodos , Telemedicina/normas
5.
Value Health ; 23(7): 831-841, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32762984

RESUMO

OBJECTIVE: This study examines European decision makers' consideration and use of quantitative preference data. METHODS: The study reviewed quantitative preference data usage in 31 European countries to support marketing authorization, reimbursement, or pricing decisions. Use was defined as: agency guidance on preference data use, sponsor submission of preference data, or decision-maker collection of preference data. The data could be collected from any stakeholder using any method that generated quantitative estimates of preferences. Data were collected through: (1) documentary evidence identified through a literature and regulatory websites review, and via key opinion leader outreach; and (2) a survey of staff working for agencies that support or make healthcare technology decisions. RESULTS: Preference data utilization was identified in 22 countries and at a European level. The most prevalent use (19 countries) was citizen preferences, collected using time-trade off or standard gamble methods to inform health state utility estimation. Preference data was also used to: (1) value other impact on patients, (2) incorporate non-health factors into reimbursement decisions, and (3) estimate opportunity cost. Pilot projects were identified (6 countries and at a European level), with a focus on multi-criteria decision analysis methods and choice-based methods to elicit patient preferences. CONCLUSION: While quantitative preference data support reimbursement and pricing decisions in most European countries, there was no utilization evidence in European-level marketing authorization decisions. While there are commonalities, a diversity of usage was identified between jurisdictions. Pilots suggest the potential for greater use of preference data, and for alignment between decision makers.


Assuntos
Pesquisa sobre Serviços de Saúde/organização & administração , Preferência do Paciente , Mecanismo de Reembolso , Projetos de Pesquisa , Avaliação da Tecnologia Biomédica/métodos , Tecnologia Biomédica/economia , Comportamento de Escolha , Custos e Análise de Custo , Tomada de Decisões , Técnicas de Apoio para a Decisão , Europa (Continente) , Humanos , Projetos Piloto , Inquéritos e Questionários
7.
Croat Med J ; 61(3): 252-259, 2020 Jul 05.
Artigo em Inglês | MEDLINE | ID: mdl-32643342

RESUMO

AIM: To develop pragmatic recommendations for Central and Eastern European (CEE) policymakers about transferability assessment of integrated care models established in higher income European Union (EU) countries. METHODS: Draft recommendations were developed based on Horizon 2020-funded SELFIE project deliverables related to 17 promising integrated care models for multimorbid patients throughout Europe, as well as on an online survey among CEE stakeholders on the relevance of implementation barriers. Draft recommendations were discussed at the SELFIE transferability workshop and finalized together with 22 experts from 12 CEE countries. RESULTS: Thirteen transferability recommendations are provided in three areas. Feasibility of local implementation covers the identification and prioritization of implementation barriers and proposals for potential solutions. Performance measurement of potentially transferable models focuses on the selection of models with proven benefits and assurance of performance monitoring. Transferability of financing methods for integrated care explores the relevance of financing methodologies and planning of adequate initial and long-term financing. CONCLUSIONS: Implementation of international integrated care models cannot be recommended without evidence on its local feasibility or scientifically sound and locally relevant performance assessment in the country of origin. However, if the original financing method is not transferable to the target region, development of a locally relevant alternative financing method can be considered.


Assuntos
Prestação Integrada de Cuidados de Saúde/normas , Guias de Prática Clínica como Assunto/normas , Garantia da Qualidade dos Cuidados de Saúde , Mecanismo de Reembolso , Alocação de Recursos , Europa (Continente) , Europa Oriental , União Europeia , Medicina Baseada em Evidências , Humanos , Assistência Centrada no Paciente
8.
Arch Clin Neuropsychol ; 35(6): 647-659, 2020 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-32666093

RESUMO

OBJECTIVE: The Inter Organizational Practice Committee convened a workgroup to provide rapid guidance about teleneuropsychology (TeleNP) in response to the COVID-19 pandemic. METHOD: A collaborative panel of experts from major professional organizations developed provisional guidance for neuropsychological practice during the pandemic. The stakeholders included the American Academy of Clinical Neuropsychology/American Board of Clinical Neuropsychology, the National Academy of Neuropsychology, Division 40 of the American Psychological Association, the American Board of Professional Neuropsychology, and the American Psychological Association Services, Inc. The group reviewed literature; collated federal, regional, and state regulations and information from insurers; and surveyed practitioners to identify best practices. RESULTS: Literature indicates that TeleNP may offer reliable and valid assessments, but clinicians need to consider limitations, develop new informed consent procedures, report modifications of standard procedures, and state limitations to diagnostic conclusions and recommendations. Specific limitations affect TeleNP assessments of older adults, younger children, individuals with limited access to technology, and individuals with other individual, cultural, and/or linguistic differences. TeleNP may be contraindicated or infeasible given specific patient characteristics, circumstances, and referral questions. Considerations for billing TeleNP services are offered with reservations that clinicians must verify procedures independently. Guidance about technical issues and "tips" for TeleNP procedures are provided. CONCLUSION: This document provides provisional guidance with links to resources and established guidelines for telepsychology. Specific recommendations extend these practices to TeleNP. These recommendations may be revised as circumstances evolve, with updates posted continuously at IOPC.online.


Assuntos
Neuropsicologia/métodos , Telemedicina/métodos , Comunicação por Videoconferência , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Humanos , Consentimento Livre e Esclarecido , Seguro Saúde , Licenciamento , Medicaid , Medicare , Testes Neuropsicológicos , Pandemias , Pneumonia Viral/epidemiologia , Mecanismo de Reembolso , Sociedades Científicas , Inquéritos e Questionários , Estados Unidos/epidemiologia
9.
Neurology ; 95(7): e930-e935, 2020 08 18.
Artigo em Inglês | MEDLINE | ID: mdl-32680949

RESUMO

OBJECTIVE: To determine whether the 2013 nerve conduction study (NCS) reimbursement reduction changed Medicare use, payments, and patient access to Medicare physicians by performing a retrospective analysis of Medicare data (2012-2016 fee-for-service data from the CMS Physician and Other Supplier Public Use File). METHODS: Individual billable services were identified by Healthcare Common Procedure Coding System Current Procedural Terminology and G codes. Medicare use and payments were stratified by specialty and type of service (electrodiagnostic tests, including NCS and EMG, and other neurologic procedures). We also assessed access to Medicare physicians using the annual number of unique beneficiaries receiving initial Evaluation and Management (E/M) services. RESULTS: We identified 676,113 Medicare providers included in all analysis years from 2012 to 2016 (10,599 neurologists, 5,881 physiatrists, and 659,633 other specialties). Comparing 2016 to 2012 showed that 21.1% fewer neurologists, 28.6% fewer physiatrists, and 69.3% fewer other specialists performed NCS and 3.8% fewer neurologists, 21.7% fewer physiatrists, and 5.6% fewer other specialists performed EMG. For NCS providers in 2012, the mean number of unique Medicare beneficiaries increased for neurologists (1.2%) and physiatrists (4.8%) but decreased for other specialists (-6.5%) by 2016. After the NCS cut, the number of providers performing autonomic and evoked potential testing increased substantially. CONCLUSIONS: The Medicare NCS reimbursement policy resulted in a larger decrease in NCS providers than in EMG providers. Despite fewer neurologists and physiatrists performing NCS, Medicare access to these physicians for E/M services was not affected. Increased autonomic and evoked potential testing may be an unintended consequence of NCS reimbursement change.


Assuntos
Medicare/legislação & jurisprudência , Políticas , Padrões de Prática Médica/legislação & jurisprudência , Mecanismo de Reembolso , Humanos , Medicare/economia , Médicos/legislação & jurisprudência , Estudos Retrospectivos , Estados Unidos
11.
Continuum (Minneap Minn) ; 26(3): 785-798, 2020 06.
Artigo em Inglês | MEDLINE | ID: covidwho-510024

RESUMO

Almost all medical care in the United States is delivered with the provider and patient in immediate proximity; this model is referred to as face-to-face care. Medical services can be apportioned as procedural care (eg, surgery, radiology, or laboratory testing and others) or cognitive care, also known as Evaluation and Management (E/M) services, in which the provider formulates an assessment and plan after obtaining information from the patient's history, examination, and diagnostic tests.Providing a medical opinion and plan using the telephone as the technology that links the provider and the patient is an example of a non-face-to-face E/M service. Common Procedural Terminology (CPT) codes and the details for how to provide telephone services have been available for decades but have not been reimbursed and therefore were rarely used. In recent years, as new technologies have evolved, there has been slow and steady acceptance that non-face-to-face E/M care can be an adjunct to or replacement for some face-to-face E/M services. These technologies and the descriptors for associated CPT and Healthcare Common Procedure Coding System (HCPCS) codes were introduced over the past few years and have become known by the generic term telehealth. They have been slowly incorporated into medical practice. Most of these services were introduced in the consumer retail market, in which the cost was borne directly by the patient, or as private contract services, in which the cost was borne by the consulting hospital, such as with telestroke services. In both the consumer retail model and private contract model, the care delivered usually did not involve CPT or HCPCS coding. The adoption of telehealth has been slow, in part because of the initial costs and several regulatory constraints, as well as the reluctance of patients, providers, and the insurance industry to change the concept that medical care could only be delivered when the patient and their provider were in physical proximity.After the COVID-19 pandemic reached the United States, the US Department of Health & Human Services issued a public health emergency and declared a Section 1135 Waiver that lifted many of the administrative constraints. With the need for near-absolute social distancing, this perfect storm has resulted in the immediate adoption of telemedicine, at least for the duration of the pandemic, for cognitive care to be delivered using communication technologies that are already in place. This article discusses the most common forms of non-face-to-face E/M care and the proper coding elements necessary to provide these services.


Assuntos
Codificação Clínica/métodos , Infecções por Coronavirus , Current Procedural Terminology , Healthcare Common Procedure Coding System , Neurologia , Pandemias , Pneumonia Viral , Telemedicina , Centers for Medicare and Medicaid Services, U.S. , Humanos , Mecanismo de Reembolso , Telefone , Estados Unidos , Comunicação por Videoconferência
12.
Continuum (Minneap Minn) ; 26(3): 785-798, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32487907

RESUMO

Almost all medical care in the United States is delivered with the provider and patient in immediate proximity; this model is referred to as face-to-face care. Medical services can be apportioned as procedural care (eg, surgery, radiology, or laboratory testing and others) or cognitive care, also known as Evaluation and Management (E/M) services, in which the provider formulates an assessment and plan after obtaining information from the patient's history, examination, and diagnostic tests.Providing a medical opinion and plan using the telephone as the technology that links the provider and the patient is an example of a non-face-to-face E/M service. Common Procedural Terminology (CPT) codes and the details for how to provide telephone services have been available for decades but have not been reimbursed and therefore were rarely used. In recent years, as new technologies have evolved, there has been slow and steady acceptance that non-face-to-face E/M care can be an adjunct to or replacement for some face-to-face E/M services. These technologies and the descriptors for associated CPT and Healthcare Common Procedure Coding System (HCPCS) codes were introduced over the past few years and have become known by the generic term telehealth. They have been slowly incorporated into medical practice. Most of these services were introduced in the consumer retail market, in which the cost was borne directly by the patient, or as private contract services, in which the cost was borne by the consulting hospital, such as with telestroke services. In both the consumer retail model and private contract model, the care delivered usually did not involve CPT or HCPCS coding. The adoption of telehealth has been slow, in part because of the initial costs and several regulatory constraints, as well as the reluctance of patients, providers, and the insurance industry to change the concept that medical care could only be delivered when the patient and their provider were in physical proximity.After the COVID-19 pandemic reached the United States, the US Department of Health & Human Services issued a public health emergency and declared a Section 1135 Waiver that lifted many of the administrative constraints. With the need for near-absolute social distancing, this perfect storm has resulted in the immediate adoption of telemedicine, at least for the duration of the pandemic, for cognitive care to be delivered using communication technologies that are already in place. This article discusses the most common forms of non-face-to-face E/M care and the proper coding elements necessary to provide these services.


Assuntos
Codificação Clínica/métodos , Infecções por Coronavirus , Current Procedural Terminology , Healthcare Common Procedure Coding System , Neurologia , Pandemias , Pneumonia Viral , Telemedicina , Centers for Medicare and Medicaid Services, U.S. , Humanos , Mecanismo de Reembolso , Telefone , Estados Unidos , Comunicação por Videoconferência
13.
Bone Joint J ; 102-B(6_Supple_A): 19-23, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32475276

RESUMO

AIMS: The purpose of this study was to determine the impact of the removal of total knee arthroplasty (TKA) from the Medicare Inpatient Only (IPO) list on our Bundled Payments for Care Improvement (BPCI) Initiative in 2018. METHODS: We examined our institutional database to identify all Medicare patients who underwent primary TKA from 2017 to 2018. Hospital inpatient or outpatient status was cross-referenced with Centers for Medicare & Medicaid Services (CMS) claims data. Demographics, comorbidities, and outcomes were compared between patients classified as 'outpatient' and 'inpatient' TKA. Episode-of-care BPCI costs were then compared from 2017 to 2018. RESULTS: Of the 2,135 primary TKA patients in 2018, 908 (43%) were classified as an outpatient and were excluded from BPCI. Inpatient classified patients had longer mean length of stay (1.9 (SD 1.4) vs 1.4 (SD 1.7) days, p < 0.001) and higher rates of discharge to rehabilitation (17% vs 3%, p < 0.001). Post-acute care costs increased when comparing the BPCI patients from 2017 to 2018, ($5,037 (SD $7,792) vs $5793 (SD $8,311), p = 0.010). The removal of TKA from the IPO list turned a net savings of $53,805 in 2017 into a loss of $219,747 in 2018 for our BPCI programme. CONCLUSIONS: Following the removal of TKA from the IPO list, nearly half of the patients at our institution were inappropriately classified as an outpatient. Our target price was increased and our institution realized a substantial loss in 2018 BPCI despite strong quality metrics. CMS should address its negative implications on bundled payment programmes. Cite this article: Bone Joint J 2020;102-B(6 Supple A):19-23.


Assuntos
Artroplastia do Joelho/economia , Remoção de Dispositivo/economia , Mecanismo de Reembolso , Adulto , Idoso , Feminino , Hospitalização , Humanos , Masculino , Medicare , Estudos Retrospectivos , Estados Unidos
14.
Bone Joint J ; 102-B(6_Supple_A): 79-84, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32475282

RESUMO

AIMS: The aim of this study was to analyze the true costs associated with preoperative CT scans performed for robotic-assisted total knee arthroplasty (RATKA) planning and to determine the value of a formal radiologist's report of these studies. METHODS: We reviewed 194 CT reports of 176 sequential patients who underwent primary RATKA by a single surgeon at a suburban teaching hospital. CT radiology reports were reviewed for the presence of incidental findings that might change the management of the patient. Payments for the scans, including the technical and professional components, for 330 patients at two hospitals were also recorded and compared. RESULTS: There were 82 incidental findings in 61 CT studies, one of which led to a recommendation for additional testing. Across both institutions, the mean total payment for a preoperative scan was $446 ($8 to $3,870). The mean patient payment was $71 ($0 to $2,690). There was wide variation in payments between the institutions. In Institution A, the mean total payment was $258 ($168 to $264), with a mean patient payment of $57 ($0 to $100). The mean technical payment in this institution was $211 ($8 to $856), while the mean professional payment was $48 ($0 to $66). In Institution B, the mean total payment was $636 ($37 to $3,870), with a mean patient payment of $85 ($0 to $2,690). CONCLUSION: The total cost of a CT scan is low and a minimal part of the overall cost of the RATKA. No incidental findings identified on imaging led to a change in management, suggesting that the professional component could be eliminated to reduce costs. Further studies need to take into account the patient perspective and the wide variation in total costs and patient payments across institutions and insurances. Cite this article: Bone Joint J 2020;102-B(6 Supple A):79-84.


Assuntos
Artroplastia do Joelho/economia , Artroplastia do Joelho/métodos , Custos de Cuidados de Saúde , Planejamento de Assistência ao Paciente/economia , Procedimentos Cirúrgicos Robóticos/economia , Tomografia Computadorizada por Raios X/economia , Humanos , Mecanismo de Reembolso , Estudos Retrospectivos
16.
J Am Acad Dermatol ; 83(3): 958-959, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32531304
18.
Neurology ; 94(24): 1077-1087, 2020 06 16.
Artigo em Inglês | MEDLINE | ID: covidwho-155215

RESUMO

The COVID-19 pandemic is causing world-wide social dislocation, operational and economic dysfunction, and high rates of morbidity and mortality. Medical practices are responding by developing, disseminating, and implementing unprecedented changes in health care delivery. Telemedicine has rapidly moved to the frontline of clinical practice due to the need for prevention and mitigation strategies; these have been encouraged, facilitated, and enabled by changes in government rules and regulations and payer-driven reimbursement policies. We describe our neurology department's situational transformation from in-person outpatient visits to a largely virtual neurology practice in response to the COVID-19 pandemic. Two key factors enabled our rapid deployment of virtual encounters in neurology and its subspecialties. The first was a well-established robust information technology infrastructure supporting virtual urgent care services at our institution; this connected physicians directly to patients using both the physician's and the patient's own mobile devices. The second is the concept of one patient, one chart, facilitated by a suite of interconnected electronic medical record (EMR) applications on several different device types. We present our experience with conducting general teleneurology encounters using secure synchronous audio and video connections integrated with an EMR. This report also details how we perform virtual neurologic examinations that are clinically meaningful and how we document, code, and bill for these virtual services. Many of these processes can be used by other neurology providers, regardless of their specific practice model. We then discuss potential roles for teleneurology after the COVID-19 global pandemic has been contained.


Assuntos
Infecções por Coronavirus , Exame Neurológico/métodos , Neurologia/métodos , Pandemias , Pneumonia Viral , Telemedicina/métodos , Comunicação por Videoconferência , Centros Médicos Acadêmicos , Betacoronavirus , Centers for Medicare and Medicaid Services, U.S. , Codificação Clínica , Documentação , Registros Eletrônicos de Saúde , Humanos , Cidade de Nova Iorque , Mecanismo de Reembolso , Estados Unidos
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