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1.
Fed Regist ; 82(9): 4504-91, 2017 Jan 13.
Artigo em Inglês | MEDLINE | ID: mdl-28102984

RESUMO

This final rule revises the conditions of participation (CoPs) that home health agencies (HHAs) must meet in order to participate in the Medicare and Medicaid programs. The requirements focus on the care delivered to patients by HHAs, reflect an interdisciplinary view of patient care, allow HHAs greater flexibility in meeting quality care standards, and eliminate unnecessary procedural requirements. These changes are an integral part of our overall effort to achieve broad- based, measurable improvements in the quality of care furnished through the Medicare and Medicaid programs, while at the same time eliminating unnecessary procedural burdens on providers.


Assuntos
Serviços de Assistência Domiciliar/legislação & jurisprudência , Medicaid/legislação & jurisprudência , Medicare Assignment/legislação & jurisprudência , Medicare/legislação & jurisprudência , Qualidade da Assistência à Saúde/legislação & jurisprudência , Competência Clínica/legislação & jurisprudência , Competência Clínica/normas , Serviços de Assistência Domiciliar/normas , Humanos , Controle de Infecções/legislação & jurisprudência , Controle de Infecções/normas , Competência Mental , Planejamento de Assistência ao Paciente/legislação & jurisprudência , Planejamento de Assistência ao Paciente/normas , Direitos do Paciente/legislação & jurisprudência , Melhoria de Qualidade , Estados Unidos
2.
Undersea Hyperb Med ; 42(3): 197-204, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26152104

RESUMO

Some Medicaid and Medicare fiscal intermediaries are denying hyperbaric oxygen (HBO2) therapy for diabetic foot ulcer (DFU) patients if the glycosylated hemoglobin (HbA1c) > 7.0%. We performed multiple PubMed searches for any diabetic wound healing clinical trial that documented HbA1c and had a wound healing endpoint. We scrutinized 30 peer-reviewed clinical trials, representing more than 4,400 patients. The average HbA1c from the intervention side of the studies was 8.6% (7.2% - 9.9%) and the control/sham side was 8.3% (6.0% - 10.6%). Twelve studies made a direct attempt to link HbA1c and wound healing. Four retrospective studies and one prospective cohort study assert that lower HbA1c favors wound healing, but review of the studies reveal design flaws that invalidate these conclusions. In total, 25 studies showed no direct correlation between HbA1c levels and wound healing. There was no randomized controlled trial (RCT) data demonstrating that HbA1c < 7.0% improves diabetic wound healing. In every study reviewed, wounds healed with high HbA1c levels that would be considered poorly controlled by the American Diabetes Association (ADA). Frequently, patients lack optimal blood glucose control when they have a limb-threatening DFU. The evidence supports that denying hyperbaric oxygen to those with HbA1c > 7.0% is unfounded.


Assuntos
Pé Diabético/sangue , Pé Diabético/terapia , Hemoglobina A Glicada/análise , Oxigenoterapia Hiperbárica , Mecanismo de Reembolso , Cicatrização , Biomarcadores/sangue , Estudos de Casos e Controles , Pé Diabético/fisiopatologia , Humanos , Revisão da Utilização de Seguros , Medicaid , Medicare Assignment , Estudos Prospectivos , Ensaios Clínicos Controlados Aleatórios como Assunto , Valores de Referência , Estudos Retrospectivos , Estados Unidos
5.
Med Care ; 52(6): 469-78, 2014 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-24699236

RESUMO

BACKGROUND: Most catheter-associated urinary tract infections (CAUTIs) are considered preventable and thus a potential target for health care quality improvement and cost savings. OBJECTIVES: We sought to estimate excess Medicare reimbursement, length of stay, and inpatient death associated with CAUTI among hospitalized beneficiaries. RESEARCH DESIGN: Using a retrospective cohort design with linked Medicare inpatient claims and National Healthcare Safety Network data from 2009, we compared Medicare reimbursement between Medicare beneficiaries with and without CAUTIs. SUBJECTS: Fee-for-service Medicare beneficiaries aged 65 years or older with continuous coverage of parts A (hospital insurance) and B (supplementary medical insurance). RESULTS: We found that beneficiaries with CAUTI had higher median Medicare reimbursement [intensive care unit (ICU): $8548, non-ICU: $1479) and length of stay (ICU: 8.1 d, non-ICU: 3.6 d) compared with those without CAUTI controlling for potential confounding factors. Odds of inpatient death were higher among beneficiaries with versus without CAUTI only among those with an ICU stay (ICU: odds ratio 1.37). CONCLUSIONS: Beneficiaries with CAUTI had increased Medicare reimbursement and length of stay compared with those without CAUTI after adjusting for potential confounders.


Assuntos
Infecções Relacionadas a Cateter/economia , Infecção Hospitalar/economia , Hospitalização/economia , Reembolso de Seguro de Saúde/economia , Medicare Assignment/economia , Medicare Part A/economia , Infecções Urinárias/economia , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Infecção Hospitalar/mortalidade , Infecção Hospitalar/prevenção & controle , Feminino , Mortalidade Hospitalar , Humanos , Unidades de Terapia Intensiva/economia , Tempo de Internação/economia , Masculino , Medicare Part B , Melhoria de Qualidade/economia , Estudos Retrospectivos , Estados Unidos , Infecções Urinárias/mortalidade , Infecções Urinárias/prevenção & controle
7.
Health Aff (Millwood) ; 33(1): 153-60, 2014 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-24334312

RESUMO

Since 1992 Medicare has reimbursed physicians on a fee-for-service basis that weights physician services according to the effort and expense of providing those services and converts the weights to dollars using a conversion factor. In 1997 Congress replaced an existing spending constraint with the Sustainable Growth Rate (SGR) to reduce reimbursements if overall physician spending exceeded the growth in the economy. Congress, however, has routinely overridden the SGR because of concerns that reduced payments to physicians would limit patients' access to care. Under continued pressure to override scheduled fee reductions or eliminate the SGR altogether, Congress is now considering legislation that would reimburse physicians to improve quality and lower costs-two things that the current system does not do. This article reviews several promising models, including patient-centered medical homes, accountable care organizations, and various payment bundling pilots, that could offer lessons for a larger reform of physician payment. Pilot projects that focus exclusively on alternative ways to reimburse physicians apart from payments to hospitals, such as payments for episodes of care, are also needed. Most promising, Congress is now showing bipartisan, bicameral interest in revising how Medicare reimburses physicians.


Assuntos
Tabela de Remuneração de Serviços/economia , Tabela de Remuneração de Serviços/legislação & jurisprudência , Planos de Pagamento por Serviço Prestado/economia , Planos de Pagamento por Serviço Prestado/legislação & jurisprudência , Reforma dos Serviços de Saúde/economia , Reforma dos Serviços de Saúde/legislação & jurisprudência , Medicare Assignment/economia , Medicare Assignment/legislação & jurisprudência , Idoso , Redução de Custos/economia , Redução de Custos/legislação & jurisprudência , Desenvolvimento Econômico , Cuidado Periódico , Acesso aos Serviços de Saúde/economia , Acesso aos Serviços de Saúde/legislação & jurisprudência , Humanos , Modelos Econômicos , Garantia da Qualidade dos Cuidados de Saúde/economia , Garantia da Qualidade dos Cuidados de Saúde/legislação & jurisprudência , Estados Unidos
8.
Mo Med ; 110(5): 376-80, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-24279185

RESUMO

Private practice physicians can increase practice revenue and also save Medicare money. What seems like a paradox is instead a choice. The non-assigned Medicare payment option allows physicians to bill 8% more for their services. This also decreases Medicare payment 5%. Selecting the non-assigned payment method does not require permission from Medicare or any Medicare contractor. This is a physician decision and for 2014 must be made between mid-November and year end 2013.


Assuntos
Tabela de Remuneração de Serviços/economia , Gastos em Saúde/estatística & dados numéricos , Medicare Assignment/economia , Medicare Part B/economia , Médicos/economia , Prática Privada/economia , Humanos , Escalas de Valor Relativo , Estados Unidos
9.
Health Aff (Millwood) ; 32(8): 1426-32, 2013 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-23918487

RESUMO

Accountable care organizations (ACOs) are among the most widely discussed models for encouraging movement away from fee-for-service payment arrangements. Although ACOs have the potential to slow health spending growth and improve quality of care, regulating them poses special challenges. Regulations, particularly those that affect both ACOs and Medicare Advantage plans, could inadvertently favor or disfavor certain kinds of providers or payers. Such favoritism could drive efficient organizations from the market and thus increase costs or reduce quality of and access to care. To avoid this type of outcome, we propose a general principle: Regulation of ACOs should strive to preserve a level playing field among different kinds of organizations seeking the same cost, quality, and access objectives. This is known as regulatory neutrality. We describe the implications of regulatory neutrality in four key areas: antitrust, financial solvency regulation, Medicare governance requirements, and Medicare payment models. We also discuss issues relating to short-term versus long-term perspectives--to promote the goal of regulatory neutrality and allow the most efficient organizations to prevail in the marketplace.


Assuntos
Organizações de Assistência Responsáveis/economia , Organizações de Assistência Responsáveis/legislação & jurisprudência , Acesso aos Serviços de Saúde/economia , Acesso aos Serviços de Saúde/legislação & jurisprudência , Garantia da Qualidade dos Cuidados de Saúde/economia , Garantia da Qualidade dos Cuidados de Saúde/legislação & jurisprudência , Organizações de Assistência Responsáveis/organização & administração , Leis Antitruste/organização & administração , Falência da Empresa/economia , Falência da Empresa/legislação & jurisprudência , Redução de Custos/economia , Redução de Custos/legislação & jurisprudência , Eficiência Organizacional/economia , Eficiência Organizacional/legislação & jurisprudência , Financiamento Governamental/economia , Financiamento Governamental/legislação & jurisprudência , Acesso aos Serviços de Saúde/organização & administração , Humanos , Medicare/economia , Medicare/legislação & jurisprudência , Medicare/organização & administração , Medicare Assignment/economia , Medicare Assignment/legislação & jurisprudência , Medicare Part C/economia , Medicare Part C/legislação & jurisprudência , Garantia da Qualidade dos Cuidados de Saúde/organização & administração , Estados Unidos
10.
Health Aff (Millwood) ; 32(7): 1183-7, 2013 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-23836732

RESUMO

As part of the Affordable Care Act, primary care physicians providing services to patients insured through Medicaid in some states will receive higher payments in 2013 and 2014 than in the past. Payments for some services will increase to match Medicare rates. This change may lead to wider acceptance of new Medicaid patients among primary care providers. Using data from the 2011-12 National Ambulatory Medical Care Survey Electronic Medical Records Supplement, I summarize baseline rates of acceptance of new Medicaid patients among office-based physicians by specialty and practice type. I also report state-level acceptance rates for both primary care and other physicians. About 33 percent of primary care physicians (those in general and family medicine, internal medicine, or pediatrics) did not accept new Medicaid patients in 2011-12, ranging from a low of 8.9 percent in Minnesota to a high of 54.0 percent in New Jersey. Primary care physicians in New Jersey, California, Alabama, and Missouri were less likely than the national average to accept new Medicaid patients in 2011-12. The data presented here provide a baseline for comparison of new Medicaid acceptance rates in 2013-14.


Assuntos
Medicaid/economia , Medicaid/tendências , Medicare Assignment/economia , Medicare Assignment/tendências , Atenção Primária à Saúde/economia , Atenção Primária à Saúde/tendências , Previsões , Humanos , Mecanismo de Reembolso/economia , Mecanismo de Reembolso/tendências , Estados Unidos
12.
Health Serv Res ; 48(4): 1526-38, 2013 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-23350910

RESUMO

OBJECTIVE: To determine how the inclusion of post-acute evaluation and management (E&M) services as primary care affects assignment of Medicare beneficiaries to accountable care organizations (ACOs). DATA SOURCES: Medicare claims for a random 5 percent sample of 2009 Medicare beneficiaries linked to American Medical Association Group Practice data identifying provider groups sufficiently large to be eligible for ACO program participation. STUDY DESIGN: We calculated the fraction of community-dwelling beneficiaries whose assignment shifted, as a consequence of including post-acute E&M services, from the group providing their outpatient primary care to a different group providing their inpatient post-acute care. PRINCIPAL FINDINGS: Assignment shifts occurred for 27.6 percent of 25,992 community-dwelling beneficiaries with at least one post-acute skilled nursing facility stay, and they were more common for those incurring higher Medicare spending. Those whose assignment shifted constituted only 1.3 percent of all community-dwelling beneficiaries cared for by large ACO-eligible organizations (n = 535,138), but they accounted for 8.4 percent of total Medicare spending for this population. CONCLUSIONS: Under current Medicare assignment rules, ACOs may not be accountable for an influential group of post-acute patients, suggesting missed opportunities to improve care coordination and reduce inappropriate readmissions.


Assuntos
Organizações de Assistência Responsáveis/organização & administração , Cuidados Críticos/organização & administração , Organizações de Assistência Responsáveis/economia , Continuidade da Assistência ao Paciente/economia , Continuidade da Assistência ao Paciente/organização & administração , Custos de Cuidados de Saúde/estatística & dados numéricos , Humanos , Medicare/economia , Medicare/organização & administração , Medicare Assignment/economia , Medicare Assignment/organização & administração , Estados Unidos
14.
Pediatrics ; 130(6): 1170-3, 2012 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-23184106

RESUMO

Youth transitioning out of foster care face significant medical and mental health care needs. Unfortunately, these youth rarely receive the services they need because of lack of health insurance. Through many policies and programs, the federal government has taken steps to support older youth in foster care and those aging out. The Fostering Connections to Success and Increasing Adoptions Act of 2008 (Pub L No. 110-354) requires states to work with youth to develop a transition plan that addresses issues such as health insurance. In addition, beginning in 2014, the Patient Protection and Affordable Care Act of 2010 (Pub L No. 111-148) makes youth aging out of foster care eligible for Medicaid coverage until age 26 years, regardless of income. Pediatricians can support youth aging out of foster care by working collaboratively with the child welfare agency in their state to ensure that the ongoing health needs of transitioning youth are met.


Assuntos
Cuidados no Lar de Adoção , Transição para Assistência do Adulto , Adolescente , Adoção , Adulto , Comportamento Cooperativo , Acesso aos Serviços de Saúde , Necessidades e Demandas de Serviços de Saúde , Humanos , Cobertura do Seguro , Comunicação Interdisciplinar , Medicaid , Medicare Assignment , Patient Protection and Affordable Care Act , Papel do Médico , Planos Governamentais de Saúde , Estados Unidos , Adulto Jovem
16.
Health Aff (Millwood) ; 31(9): 1977-83, 2012 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-22949446

RESUMO

Many health policy analysts envision provider payment reforms currently under development as replacements for the traditional fee-for-service payment system. Reforms include per episode bundled payment and elements of capitation, such as global payments or accountable care organizations. But even if these approaches succeed and are widely adopted, the core method of payment to many physicians for the services they provide is likely to remain fee-for-service. It is therefore critical to address the current shortcomings in the Medicare physician fee schedule, because it will affect physician incentives and will continue to play an important role in determining the payment amounts under payment reform. This article reviews how the current payment system developed and is applied, and it highlights areas that require careful review and modification to ensure the success of broader payment reform.


Assuntos
Planos de Pagamento por Serviço Prestado , Medicare , Planos de Incentivos Médicos , Tabela de Remuneração de Serviços , Medicare Assignment , Patient Protection and Affordable Care Act , Estados Unidos
17.
J Med Pract Manage ; 27(4): 219-21, 2012.
Artigo em Inglês | MEDLINE | ID: mdl-22413597

RESUMO

This article offers professional opinions and advice on how physicians should prepare in order to protect themselves and their practices during this turbulent time in healthcare reform. This article presents real-life scenarios to help physicians understand what they may face and what actions they should take in anticipation of the future in healthcare. The article focuses on the concept of "the right patient," defining the characteristics of patients that benefit the financial aspect of a practice and those who do not. Its purpose is not to encourage physicians to deny care to patients who are poorly insured or uninsured, but to guide in the establishment of a smart and safe balance between the two. Strategies are discussed on how to attract the right patient and what these patients mean to the practice. The importance of practice marketing is also highlighted, along with an emphasis on the necessity of change in order to survive in the future healthcare environment.


Assuntos
Reforma dos Serviços de Saúde/organização & administração , Reforma dos Serviços de Saúde/tendências , Seleção de Pacientes , Papel do Médico , Administração da Prática Médica/organização & administração , Administração da Prática Médica/tendências , Análise Custo-Benefício , Grupos Diagnósticos Relacionados , Humanos , Marketing de Serviços de Saúde , Medicare/economia , Medicare/organização & administração , Medicare/tendências , Medicare Assignment/economia , Medicare Assignment/organização & administração , Medicare Assignment/tendências , Crédito e Cobrança de Pacientes/economia , Crédito e Cobrança de Pacientes/organização & administração , Crédito e Cobrança de Pacientes/tendências , Cuidados de Saúde não Remunerados/economia , Cuidados de Saúde não Remunerados/tendências , Estados Unidos
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