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Commercial and Medicare Advantage Payment for Anesthesiology ServicesMean in-network commercial allowed amounts and charges per anesthesia conversion factor are 314% and 659% of traditional Medicare rates, respectively. Medicare Advantage payments align with traditional Medicare prices.
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Financial Incentives Tied to Medicare Star Ratings: Impact on Influenza Vaccination Uptake in Medicare BeneficiariesInfluenza vaccine uptake improved among Medicare Advantage enrollees when influenza vaccination was introduced as a performance metric in Medicare star ratings and accompanying bonus payments.
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Classifying Clinical Work Settings Using EHR Audit Logs: A Machine Learning ApproachAn automated pipeline of frequency representation and machine learning models on raw electronic health record (EHR) audit logs can classify work settings based on clinical work activities.
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Physicians in ACOs Report Greater Documentation BurdenAn analysis of nationally representative survey data from 2019 and 2021 shows that office-based physicians participating in accountable care organizations (ACOs) reported greater documentation burden across several measures.
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Patient Experience After Modifying Visit Delivery During the COVID-19 PandemicCoronavirus disease 2019 (COVID-19) was associated with immediate weekly visit trend decreases for overall, primary care, and specialty care with long-term recovery trends; transformation to virtual visits; and increasing long-term trends for meeting patient scheduling and visit needs.
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Regulation of Provider Networks in Response to COVID-19The authors describe federal and state provider network adequacy standards and discuss how regulators should adapt these standards and accompanying monitoring processes in response to coronavirus disease 2019 (COVID-19).
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Contributor: Health Systems Will Need a Tech Transformation to Prepare for CMS Glycemia MeasuresWith data collection beginning on January 1, 2023, most health systems are not prepared for CMS’ new glycemia measures, and those that are will likely be floored by the results, according to the chief medical officer at Glytec.
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Clinical and Economic Burden of Uncontrolled Severe Noneosinophilic AsthmaAmong patients with severe asthma with low eosinophils untreated with biologics, there is a high burden of disease among those who have suboptimal disease control.
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A Case-Control Study of Length of Stay OutliersLength of stay outliers are associated with hospital-acquired infections, complications, and discharge to facility, as opposed to nonmodifiable risk factors like age and comorbidities.
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Contributor: Breaking the Cycle—RSAT Program Improving Reentry in ArizonaArizona is well suited to benefit from its 1115 demonstration waiver requested from CMS because it already has a robust justice-involved reentry initiative called the Residential Substance Abuse Treatment (RSAT) Program, which is emerging as an archetype of successful reentry programs that can serve as a template for other states to emulate.
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Tacking Upwind: Reducing Spending Among High-risk Commercially Insured PatientsAlthough commercial accountable care organization populations are healthy on average, some individuals might benefit from programs for high-risk patients to mitigate high levels of health care utilization.
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Patient Perceptions of In-home Urgent Care via Mobile Integrated HealthComparing patients’ experiences with in-home urgent care from community paramedics vs urgent care provided in emergency departments, we found higher satisfaction among patients receiving in-home treatment.
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Changes in Marketplace Competition and Television Advertising by InsurersThis study provides the first evidence on how Marketplace insurers are altering their marketing in response to changes in competitive pressure over time.
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Accountable Care Organization Initiatives to Improve the Cost and Outcomes of Specialty CareEngaging specialty physicians is an emerging area of focus for Medicare accountable care organizations. Enhanced data on specialist costs and outcomes are essential to addressing alignment challenges.
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Food Insecurity, Neighborhood, and Health Care Utilization in Health System AdultsThis retrospective study examined food insecurity and neighborhood disadvantage in health system patients as predictors of acute health care utilization.
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Breaking Barriers: Partnerships to Improve Diabetic Eye Health in AlabamaThis article reviews barriers to diabetic eye health across Alabama and highlights a partnership with Genentech and the American Diabetes Association to address this issue.
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Primary Care Case Conferences to Mitigate Social Determinants of Health: A Case Study From One FQHC SystemThis article describes perceived benefits, facilitators, and challenges of conducting interprofessional team case conferences in primary care settings to address patients’ complex social needs.
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Prevention and Management of COVID-19 in Hemodialysis CentersThis article gives recommendations for individual hemodialysis centers worldwide to ensure the safety and effectiveness of patients receiving maintenance hemodialysis based on the experience of such a patient with coronavirus disease 2019 (COVID-19) in the Sichuan province of China.
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Impact of the Collaborative Care Model on Medical SpendingModest spending on integrated mental health services in primary care, facilitated by use of new collaborative care billing codes, did not increase overall health care costs.
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AHA Telemetry Guidelines Improve Telemetry Utilization in the Inpatient SettingUsing Plan-Do-Study-Act cycles, the studied intervention reduced hospital inpatient telemetry time by 51.25% while increasing American Heart Association (AHA) guideline–based usage.
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Eliminating Defects in Value: Turnaround of an MSSP ACOA health system transformational leadership framework and management system made visible and eliminated defects in value and was associated with reduced annual Medicare expenditures and increased quality between 2017 and 2020.
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A Comparison of Administrative Claims–Based Risk Predictors for Pediatric AsthmaA comparison of claims-based asthma risk predictors in a national sample of children with Medicaid determines accuracy and informs risk predictor choice.
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Decreasing Primary Care Use and Blood Pressure Monitoring During COVID-19Among a group of primary care accountable care organizations, patients with hypertension were 50% less likely to have a blood pressure recorded in April compared with February.
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Economic Burden of Osteoporotic Fractures: The Tip of the Iceberg?The economic burden of osteoporotic fractures may be much higher than estimated: just the tip of the iceberg. In this letter, we suggest that the cost of these fractures might be underestimated by considering only direct medical cost.
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Practice Radiation Patterns Among Oncologists in the Oncology Care ModelDespite the potential incentives for medical oncologists to reduce radiation therapy utilization under the Oncology Care Model, we find no evidence that such reduction occurred.
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An Accelerated Hospital Observation Pathway to Reduce Length of Stay for Patients With COVID-19For select patients hospitalized due to COVID-19, an academic urban hospital implemented an observation pathway that incorporated mobile health technology, reducing hospital length of stay by more than 2 days.
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The Relationship Between the Follow-up to Discharge Ratio and Length of StayThe objective was to evaluate the correlation between the follow-up to discharge ratio and average length of stay.
