The American journal of managed care最新文献_第2页

Prices and complications in hospital-based and freestanding surgery centers. 医院和独立外科中心的价格和并发症。

The American journal of managed care Pub Date : 2024-04-01 DOI: 10.37765/ajmc.2024.89529

James C Robinson, Christopher Whaley, S. Dhruva

{"title":"Prices and complications in hospital-based and freestanding surgery centers.","authors":"James C Robinson, Christopher Whaley, S. Dhruva","doi":"10.37765/ajmc.2024.89529","DOIUrl":"https://doi.org/10.37765/ajmc.2024.89529","url":null,"abstract":"OBJECTIVES\u0000To quantify differences in prices paid and procedural complications incurred in hospital outpatient departments (HOPDs) and freestanding ambulatory surgery centers (ASCs).\u0000\u0000\u0000STUDY DESIGN\u0000Observational study using deidentified 2019-2020 insurance claims from Blue Cross Blue Shield insurance plans nationally, with information on prices paid and complications incurred for colonoscopy, knee or shoulder arthroscopy, and cataract removal surgery.\u0000\u0000\u0000METHODS\u0000The data include 1,662,183 patients who received a colonoscopy, 53.5% of whom were treated in HOPDs; 259,200 patients who underwent arthroscopy, 61.0% of whom were treated in HOPDs; and 173,664 patients who had cataract removal surgery, 34.7% of whom were treated in HOPDs. Multivariable linear regression methods were used to identify the associations between HOPD and ASC site of care, prices, and complications after adjusting for patient demographics, risk, and geographic market location.\u0000\u0000\u0000RESULTS\u0000After adjusting for patient characteristics, risk, and geographic market location, prices paid in HOPDs were 54.9% higher than those charged in ASCs for colonoscopy (95% CI, 53.6%-56.1%), 44.4% higher for arthroscopy (95% CI, 43.0%-45.8%), and 44.0% higher for cataract removal surgery (95% CI, 42.9%-45.5%). Adjusted rates of complications were slightly higher in HOPDs than ASCs for colonoscopy over a 90-day interval but similar over the 7- and 30-day intervals. Rates were statistically and clinically similar between the 2 sites of care for arthroscopy and cataract removal.\u0000\u0000\u0000CONCLUSIONS\u0000The higher prices charged in HOPDs for the 3 ambulatory procedures were not balanced by better quality-as measured by rates of procedural complications-compared with procedures performed in nonhospital ASCs.","PeriodicalId":267832,"journal":{"name":"The American journal of managed care","volume":"416 ","pages":"179-184"},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140776182","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Institutional practices for charitable medication access for uninsured patients. 为未参保患者提供慈善用药的机构做法。

The American journal of managed care Pub Date : 2024-04-01 DOI: 10.37765/ajmc.2024.89535

Akshara Kumar, Caitlin Dowd-Green, Robert Green, Rosalyn Stewart

{"title":"Institutional practices for charitable medication access for uninsured patients.","authors":"Akshara Kumar, Caitlin Dowd-Green, Robert Green, Rosalyn Stewart","doi":"10.37765/ajmc.2024.89535","DOIUrl":"https://doi.org/10.37765/ajmc.2024.89535","url":null,"abstract":"OBJECTIVES\u0000To identify the most frequently prescribed medications, the location where prescriptions were filled, and whether a voucher was utilized among patients enrolled in a charitable care program within an academic medical center.\u0000\u0000\u0000STUDY DESIGN\u0000This was a retrospective cohort study analyzing electronic health record and pharmacy dispensing information at a medical center's outpatient pharmacies.\u0000\u0000\u0000METHODS\u0000Patients included in this analysis were enrolled in a charitable care program and had at least 1 ambulatory encounter in a primary care clinic from March 1, 2019, to June 30, 2021. The study identified frequently prescribed medications, prescription payment methods, the overall cost of prescriptions if available, and the percentage of patients who filled their prescription at a medical center's outpatient pharmacies vs external outpatient pharmacies. Descriptive statistics were used to describe the results.\u0000\u0000\u0000RESULTS\u0000This study included 511 patients, 87% of whom were Spanish speaking. A total of 8453 prescriptions were identified, and more than half of the prescriptions were sent to external outpatient pharmacies. The most common medications prescribed were for cardiovascular disease, diabetes, and pain treatment. Forty-seven percent of all prescriptions were sent to the medical center's outpatient pharmacies. The medical center's charitable care program covered the costs of 44% of the prescriptions sent to internal pharmacies, assisting 148 unique patients and incurring a cost of $111,052 for the medical center.\u0000\u0000\u0000CONCLUSIONS\u0000Overall, this study was able to characterize patient demographics, historical costs related to charitable care coverage, and the utilization of health care services among this population. This information can be used to support the development and implementation of a charitable medication formulary, with the aims of improving quality of care for this population and reducing medical center costs.","PeriodicalId":267832,"journal":{"name":"The American journal of managed care","volume":"532 ","pages":"e135-e139"},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140776134","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Office procedures for older adults by physician associates and nurse practitioners. 助理医师和执业护士为老年人提供的诊疗程序。

The American journal of managed care Pub Date : 2024-04-01 DOI: 10.37765/ajmc.2024.89532

Robert E McKenna, Roderick S. Hooker, Robert L. Christian

{"title":"Office procedures for older adults by physician associates and nurse practitioners.","authors":"Robert E McKenna, Roderick S. Hooker, Robert L. Christian","doi":"10.37765/ajmc.2024.89532","DOIUrl":"https://doi.org/10.37765/ajmc.2024.89532","url":null,"abstract":"OBJECTIVE\u0000We hypothesized that physician associate (PA) and nurse practitioner (NP) procedural roles are expanding. We sought to describe ambulatory procedures these professionals performed in 2021 for older adults.\u0000\u0000\u0000STUDY DESIGN\u0000Retrospective observational cohort study of Medicare Part B data. US Bureau of Labor Statistics data were used to provide overall PA and NP employment context.\u0000\u0000\u0000METHODS\u0000Medicare Part B databases were probed for outpatient events by PAs and NPs using a modified list of the Council of Academic Family Medicine's recommended clinical procedures that focused on 29 procedures organized into 9 categories called procedure clusters. These procedures were linked to Current Procedural Terminology codes and PA and NP National Provider Identifier codes in Medicare Part B and then tabulated and analyzed for 2021. The Bureau of Labor Statistics provided NP and PA employment trends for context. The trend of the procedures and providers spanning 2014-2021 was analyzed.\u0000\u0000\u0000RESULTS\u0000In 2021, 23,581 NPs and PAs filed 9.6 million Medicare Part B enrollee procedure claims. Most procedures (96%) involved skin or the musculoskeletal system. PAs filed more than twice as many claims for skin and musculoskeletal procedures as NPs, and NPs filed 1.25 times as many as PAs for the eye, ear, nose, and throat; pulmonary; genitourinary; gastrointestinal-colorectal; and women's health categories. From 2014 through 2021, the number of PAs and NPs in clinical practice increased by 72%, and the number of those who filed procedure claims increased by 74%.\u0000\u0000\u0000CONCLUSIONS\u0000Overall, PAs performed more skin and musculoskeletal procedures than NPs, and NPs performed more procedures in the other 7 procedure clusters than PAs. PA and NP employment growth does not fully explain these observations. We suggest that outpatient procedural task-shifting activity presents an area for further research.","PeriodicalId":267832,"journal":{"name":"The American journal of managed care","volume":"348 1","pages":"e109-e115"},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140781176","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Impact of care coordination on 30-day readmission, mortality, and costs for heart failure. 护理协调对心力衰竭患者 30 天再入院、死亡率和成本的影响。

The American journal of managed care Pub Date : 2024-04-01 DOI: 10.37765/ajmc.2024.89533

Guann-Ming Chang, Yu-Chi Tung

{"title":"Impact of care coordination on 30-day readmission, mortality, and costs for heart failure.","authors":"Guann-Ming Chang, Yu-Chi Tung","doi":"10.37765/ajmc.2024.89533","DOIUrl":"https://doi.org/10.37765/ajmc.2024.89533","url":null,"abstract":"OBJECTIVES\u0000Although coordination of care has become the main focus of health care reform efforts to improve outcomes and decrease costs, limited information is available concerning the impact of care coordination on 30-day outcomes and costs. We used nationwide, population-based data to examine the influence of care coordination on 30-day readmission, mortality, and costs for heart failure (HF).\u0000\u0000\u0000STUDY DESIGN\u0000We analyzed 20,713 patients with HF 18 years or older discharged from hospitals in 2016 using Taiwan's National Health Insurance Research Database. The coordination of care among a patient's outpatient physicians was measured with care density.\u0000\u0000\u0000METHODS\u0000Multilevel regression models were used after adjustment for patient and hospital characteristics to explore the impact of care density on 30-day readmission, mortality, and costs.\u0000\u0000\u0000RESULTS\u0000Patients with high care coordination had lower odds of 30-day readmission (OR, 0.90; 95% CI, 0.82-0.98) and mortality (OR, 0.83; 95% CI, 0.70-0.99) and lower costs (cost ratio [CR], 0.84; 95% CI, 0.79-0.90) compared with those with low care coordination. Patients with medium care coordination had lower costs (CR, 0.92; 95% CI, 0.86-0.98) than those with low care coordination.\u0000\u0000\u0000CONCLUSIONS\u0000High care coordination is associated with decreased 30-day readmission, mortality, and costs for HF. Enhancing coordination of care has the potential to increase the value of care. It is important to monitor coordination of care and develop strategies to maintain high levels of care coordination for HF.","PeriodicalId":267832,"journal":{"name":"The American journal of managed care","volume":"321 1","pages":"e116-e123"},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140780290","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Development and Validation of the COVID-19 Hospitalized Patient Deterioration Index COVID-19 住院病人病情恶化指数的开发与验证

The American journal of managed care Pub Date : 2023-12-22 DOI: 10.37765/ajmc.2023.89470

引用次数: 0

Understanding the Social Risk Factor Adjustment’s Effect on Star Ratings 了解社会风险因素调整对星级评定的影响

The American journal of managed care Pub Date : 2023-12-20 DOI: 10.37765/ajmc.2023.89471

引用次数: 0

Advanced Care at Home at Scale in an Integrated Health Care System 综合医疗系统中的规模化居家高级护理

The American journal of managed care Pub Date : 2023-12-19 DOI: 10.37765/ajmc.2023.89469

引用次数: 0

Understanding Suboptimal e-Consult Requests: Lessons From the VA 了解次优电子咨询请求：退伍军人事务部的经验教训

The American journal of managed care Pub Date : 2023-12-14 DOI: 10.37765/ajmc.2023.89472

引用次数: 0

Impact of the Patient-Centered Medical Home on Consistently High-Cost Patients 以患者为中心的指定医疗机构对持续高费用患者的影响

The American journal of managed care Pub Date : 2023-12-01 DOI: 10.37765/ajmc.2023.89467

引用次数: 0

Treatment Modification After Initiating Second-Line Medication for Type 2 Diabetes 2 型糖尿病患者开始使用二线药物后的治疗调整

The American journal of managed care Pub Date : 2023-12-01 DOI: 10.37765/ajmc.2023.89466

引用次数: 0