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Artigos de revistas sobre o assunto "Bureau of Hospital Reimbursement"
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McFarland, Daniel Curtis, Katherine Ornstein e Randall F. Holcombe. "Hospital size and demographics associated with HCAHPS and implications for hospital value-based purchasing (HVBP)." Journal of Clinical Oncology 32, n.º 30_suppl (20 de outubro de 2014): 38. http://dx.doi.org/10.1200/jco.2014.32.30_suppl.38.
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38 Background: Hospital Consumer Assessments of Healthcare Providers and Systems (HCAHPS) scores appear to be lower in densely populated areas and for urban academic medical centers (AMC). These patient satisfaction scores contribute to CMS reimbursement. We hypothesized that demographics and hospital factors such as size were significant determinants of HCAHPS. Methods: HCAHPS, hospital bed, and county demographics were obtained from the Hospital Compare, American Hospital Directory, and US Census Bureau websites, respectively. An aggregate positive score was created for each hospital. Multivariate regression modeling was performed for the aggregate positive score and all ten dimensions of HCAHPS. Standardized partial regression coefficients were used to assess strengths of postulated predictors (Table). A predictive formula based on the 4 strongest predictors was developed. An adjustment model corrected for demographic and hospital factors. Hospitals were rescored using this model to generate an adjusted score (WIPSAS – weighted individual patient satisfaction score). HCAHPS hospital ranking was compared to WIPSAS ranking for all NY State hospitals. HCAHPS were obtained from 3,192 hospitals and demographic data collected from 3,144 counties. Results: ‘Hospital beds’ and ‘non-English speaking’ were the strongest negative predictors while ‘% Bachelor’s’ and ‘white alone’ were the strongest positive predictors of HCAHPS. The adjusted r2 was.22 for the model and.155 for the predictive formula. WIPSAS altered the ranking in NY State. The adjusted ranking moved 3 AMCs into the top ten (prior #42, #43, #46). Conclusions: Demographic and hospital factors influence HCAHPS. Adjusted scores may be more representative of a hospital’s actual performance. CMS should utilize WIPSAS adjusted scores in order to more fairly calculate HVBP reimbursements. [Table: see text]
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Palomäki, A., J. Paltta, L. Pirilä, H. K. Heikkilä, P. Isomäki, J. Huhtakangas, T. Sokka-Isler, O. Kaipiainen-Seppänen e K. Eklund. "AB1251 VALIDITY OF RHEUMATOID ARTHRITIS DIAGNOSES IN FINNISH BIOBANK PATIENTS". Annals of the Rheumatic Diseases 79, Suppl 1 (junho de 2020): 1917.1–1917. http://dx.doi.org/10.1136/annrheumdis-2020-eular.3890.
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Background:Finnish healthcare registers are used in medical research, but there is little data about the validity of these registers in rheumatology.Objectives:The aim of our study was to determine the validity of rheumatoid arthritis (RA) diagnoses in patients participating in the Finnish Biobanks.Methods:We reviewed the electronic patient charts of 125 patients with at least one visit with a diagnosis of seropositive RA, 125 patients with at least one visit with a diagnosis of seronegative RA and 250 age-and-sex matched controls. Patients were randomly selected from Finnish biobank participants. We evaluated whether the patients’ diagnosis of RA recorded in the hospital discharge registry at the participating hospital was correct according to chart review and expert opinion. In the control group it was investigated whether the diagnosis of RA was written in the patients’ chart, but the diagnosis code was not recorded.Results:The positive predictive value (PPV) of a single hospital registry diagnosis of seropositive RA was 0.74 but rose to 0.98 in patients with a special reimbursement for seropositive RA and 0.98 in anti-citrullinated protein antibody positive patients. For seronegative RA, the PPV of a diagnosis was 0.72 and in patients with a special reimbursement for seronegative RA 0.89. The PPV was higher in patients with more than one visit with the diagnosis: 0.92 if the patients had at least 5 visits with seropositive RA and 0.88 with at least 5 visits with seronegative RA. Negative predictive value for RA diagnosis was 0.99.Conclusion:These results demonstrate that the validity of RA diagnoses in healthcare registers can be markedly improved with data about special reimbursement for medication, number of visits and serological data.Disclosure of Interests:Antti Palomäki Consultant of: Pfizer, Speakers bureau: Pfizer, Sanofi, MSD, Johanna Paltta Consultant of: Lilly, Abbvie, Laura Pirilä Consultant of: Novartis, MSD Finland, Roche, Bristol-Myers-Squibb, Pfizer, Sanofi, Abbvie, Oy Eli LIlly Finland Ab, UCB Pharma Oy Finland, Jansen-Cilag, Mylan, Sandoz, Boehringer-Ingelheim, Paid instructor for: Boehringer -Ingelheim, MSD Finland, Speakers bureau: Boehringer-Ingelheim, Pfizer Finland, Hanna-Kaisa Heikkilä: None declared, Pia Isomäki Consultant of: Abbvie, BMS, Eli Lilly, MSD, Novartis, Pfizer, Roche, Sanofi, Johanna Huhtakangas Consultant of: Boehringer Ingelheim, Tuulikki Sokka-Isler: None declared, Oili Kaipiainen-Seppänen Speakers bureau: Boehringer Ingelheim, Kari Eklund Consultant of: Celgene, Lilly, Speakers bureau: Pfizer, Roche
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Xu, Junfang, Xin Wang, Hongying Hao, Jian Wang e Stephen Nicholas. "Impact of hierarchical hospital reform on patients with diabetes in China: a retrospective observational analysis". BMJ Open 11, n.º 4 (abril de 2021): e041731. http://dx.doi.org/10.1136/bmjopen-2020-041731.
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ObjectivesWe assess whether China’s diabetes pilot hierarchical diagnosis and treatment reforms shifted patient healthcare-seeking behaviour towards primary health institutions (PHIs) and away from secondary and tertiary hospitals. From the patients’ perspective, we evaluate whether the hierarchical system saw the decline of average hospital cost, out-of-pocket (OOP) expenses and the increase of reimbursement rate in PHIs. From the health system’s perspective, we also assessed whether the share of PHIs in total costs, total visits and reimbursement rate increased and the share of secondary and tertiary hospitals decreased.MethodsData were collected from the health insurance bureau of 11 cities in Shandong Province, China between 2015 and 2017, which included 9 118 518 outpatient visits and 622 739 inpatient visits. For both inpatients and outpatients and the health system, we analysed health services-seeking characteristics including hospital costs, hospital visits, OOP expense and reimbursements of hospital costs. Binary logistic regression was conducted to analyse the influencing factors of seeking PHI health services.ResultsPHIs remained the lowest hospital cost provider, but average hospital costs declined across all three healthcare levels of PHIs, secondary hospitals and tertiary hospitals from 2015 to 2017. The hierarchical system aimed to shift patients to PHIs, increasing PHIs’ share of total hospital costs. However, the PHI share of total outpatient costs declined 12.0%, while rising 15.0% in secondary hospitals, the opposite of the goal of the hierarchical medical system. Average outpatient visits rose roughly at the same rate in PHIs (5.1%) as secondary hospitals (6.8%), with no evidence of a shift in patient visits between hospital levels over 2015–2017. Average inpatient visits fell across all levels of hospitals, with no significant difference in the rate of decline between PHIs (9.4%) and secondary (7.5%) and tertiary (7.8%) hospitals. For outpatient and inpatient services, the binary logistic regression showed that over the 2015–2017 period patients with diabetes increasingly used higher level hospitals rather than PHIs (p<0.05). The only success of the hierarchical medical system was the relative fall of OOP outpatient expenses, which fell more rapidly in PHIs (13.7%) than secondary (5.0%) and tertiary (3.5%) hospitals. However, inpatient OOP expenses fell only 2.2% for PHIs, less than half that of secondary (5.5%) and tertiary (7.4%) hospitals, the opposite of the aim of the hierarchical system reform.ConclusionsThe implementation of the hierarchical medical system for patients with diabetes did not achieve its goal of increasing PHI utilisation and decreasing secondary and tertiary hospital utilisation. Enhancing the utilisation of PHIs for diabetes and other patients requires further health reform, including educating patients on PHI use, further reforming the health insurance schemes, improving PHI facilities and encouraging referrals to PHIs from higher level hospitals.
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Deitelzweig, Steven, Stephen Thompson, Jay Lin, Donna McMorrow e Barbara Johnson. "Impact of CMS VTE Hospital Acquired Conditions (HAC) Policy on Hospital Cost and Revenue Associated with Major Surgical Hip and Knee Procedures." Blood 116, n.º 21 (19 de novembro de 2010): 3824. http://dx.doi.org/10.1182/blood.v116.21.3824.3824.
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Abstract Abstract 3824 Background: The Centers for Medicare and Medicaid Services (CMS) recently executed a policy which denies reimbursement for preventable hospital acquired conditions (HAC) (“never events”). Venous thromboembolism (VTE), which encompasses deep vein thrombosis (DVT) and pulmonary embolism (PE), in patients undergoing major surgical hip or knee procedures was a condition selected for implementation as part of this policy in fiscal year 2009 (beginning October 2008). The objective of this analysis was to estimate the financial impact of this policy change on US hospitals. Methods: Discharge-level hospital administrative records were extracted from the Thomson Reuters MarketScan® Hospital Drug Database for patients undergoing CMS-defined surgical hip and knee procedures (total hip/knee replacement, partial hip replacement, and hip resurfacing). Discharged patients meeting the following criteria were included: admission and discharge between October 2007 and September 2008, age ≥ 18 years, Medicare as primary payer, valid CMS hospital ID and no evidence of DVT/PE on admission. The frequency of CMS defined VTE was assessed and the economic impact of the CMS HAC policy was estimated. Revenue impact, the amount of revenue lost per hospital due to CMS policy implementation, was calculated per year and per VTE discharge using the old and new CMS reimbursement rules. The incremental cost impact, the additional cost to hospitals due to VTE among hip/knee surgery patients, was also determined. Results: A total of 107 hospitals were identified to have at least one eligible surgical hip and knee surgery discharge. The total number of such discharges was 26,144. On average, there were 244.34 CMS-defined hip/knee surgery discharges per hospital. The majority of discharged patients were from urban hospitals (83.37%) in the Southern US (73.07%), without teaching status (87.98%) and with a licensed bed size of 300–499 beds (31.90%). VTE occurred in an average (± standard deviation) of 4.25 ± 6.05 hip/knee surgery discharges per hospital; DVT and PE occurred in 2.44 ± 5.11 and 1.81 ± 1.89 discharges per hospital, respectively. The average length of hospital stay was 7.56 ± 2.88 days in hip/knee discharges with VTE, compared to 4.08 ± 0.59 days in discharges without VTE. Anticoagulation was ordered in 94.70% of discharged patients with DVT and in 89.06% of discharged patients with PE. Under the CMS HAC policy for VTE, the mean loss of revenue per hospital per year was estimated to be $8,453 (95% confidence interval [CI] 6,902 – 10,005). Per VTE, the average hospital revenue loss was $2,704 per hospital per year. The mean incremental cost for a hip/knee discharge with VTE, per hospital was $6,581; for DVT and PE, incremental cost impacts were $6,751 and $8,092, respectively. The annual cost impact per hospital for hip/knee discharges with VTE was estimated at $31,609 [95% CI 23,714 – 39,505]. Conclusions: The CMS policy on average caused a loss of hospital revenue (≂f$8,500 per year). Additionally, when a VTE event does occur in patients undergoing surgical hip and knee procedures, it is associated with high incremental hospital costs (≂f$32,000). These significant costs will no longer be reimbursed under the new CMS HAC policy. Subsequently, hospitals will be responsible for covering them. Therefore, now more than ever, reducing VTE rates through appropriate prophylaxis of at-risk patients is vital in order for hospitals to lessen the economic impact associated with treating VTE events. The drive to encourage hospitals to provide more efficient and effective healthcare is becoming particularly relevant now that models of health care reform, such as the “Accountable Care Organization”, are being piloted as part of the Senate's Healthcare Reform Bill. This study was funded by sanofi-aventis U.S., Inc. The authors received editorial/writing support in the preparation of this abstract provided by Katherine Roberts, PhD of Excerpta Medica, funded by sanofi-aventis U.S., Inc. Disclosures: Deitelzweig: sanofi-aventis: Honoraria, Research Funding, Speakers Bureau; Bristol-Myers Squibb: Honoraria, Research Funding, Speakers Bureau; Scios: Honoraria, Research Funding, Speakers Bureau; Pfizer: Speakers Bureau. Thompson:sanofi-aventis US Inc.: Employment. Lin:sanofi-aventis US Inc.: Employment, Research Funding. McMorrow:sanofi-aventis US Inc : Research Funding. Johnson:sanofi-aventis US Inc: Research Funding.
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Álvarez Roman, Teresa, Elena Monzón Manzano, Ihosvany Fernandez-Bello, Mónica Martín, María Isabel Rivas Pollmar, Raul Justo Sanz, Sara García Barcenilla et al. "Real Life Experience in Clinical Practice with Recombinant Coagulation FVIII-Fc Fusion Protein". Blood 134, Supplement_1 (13 de novembro de 2019): 4929. http://dx.doi.org/10.1182/blood-2019-127878.
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Introduction: Efmoroctocog alfa (Elocta®) is a recombinant coagulation FVIII-Fc (rFVIIIFc), a fully recombinant fusion protein produced in human embryonic kidney cells, with an extended half-life used for the treatment and prevention of bleeding in patients with severe hemophilia A. Using rFVIIIFc for the treatment of severe hemophilia A patients received the approval of reimbursement in Spain at the end of 2016. Therefore, there are no many comparative data published about real life use of rFVIIIFc. Objective: This work aims to describe characteristics of the treatment of severe hemophilia A patients with rFVIIIFc and to compare its results with those previously obtained employing other FVIII products. Methods: This was an open-label non-interventional retrospective study reviewing patient characteristics and treatment outcomes before and after the use of rFVIIIFc. The La Paz University Hospital Ethics Committee approved the experimental protocol. Patients with severe hemophilia A without inhibitors being treated with rFVIIIFc since at least six months before study approval by Ethics Committee were included. The following data were collected for patients included in the study: dose (IU/kg) and prophylaxis treatment regimen, number of spontaneous and traumatic bleedings, annual bleeding rate (ABR) and FVIII trough level. The statistical analysis on the variables listed above comparing before and after rFVIIIFc usage was performed by the Biostatistics Unit of La Paz University Hospital with the statistical package SPSS v.18.0 (SPSS Inc., Chicago, IL, USA). Results: Twenty two severe hemophilia A patients (median age: 20 years old, ranging from 6 to 63 years) on prophylaxis with rFVIIIFc were considered to be included in this study, but two were excluded due to lack of data. Median follow-up period was 14 months (ranging from 6 to 28 months). Nineteen severe hemophilia A patients have been previously treated with rFVIII (two of them with other extended half-life product) and one with plasma-derived FVIII. Eight of the ten severe hemophilia A patients who presented an ABR greater than 0 with previous treatments reduced their ABR when treated with rFVIIIFc (Table 1). Among those patients with an ABR=0 with previously used FVIII products, only one increased to an ABR=1 when treated with Elocta® due to a traumatic bleeding. Table 1 shows ABR across all patients before and after rFVIIIFc. There was no difference in dose per injection between other FVIII products and rFVIIIFc (median dose for patients treated with other FVIII products: 46.0 IU/kg, ranging from 26 to 65 IU/kg; median dose for patients treated with rFVIIIFc: 46.5 IU/kg, ranging from 26 to 65 IU/kg). Nevertheless, a reduction was observed in administration frequency. Among the twelve patients who received treatment with other FVIII products every 48 hours, eleven came to receive rFVIIIFc 3 times a week and the one previously receiving a plasma-derived FVIII, to twice a week. Five of the patients receiving treatment 3 times a week reduced its frequency to twice per week. Three patients maintained the same schedule of administration. To note, one of the two patients receiving another prolonged half-life product maintained the schedule of treatment and the other reduced its frequency from every 48 hours to 3 times a week. FVIII trough level in plasma (% of FVIII), expressed as median (25th-75th percentile), was 1.1 (0.1-4.0) for rFVIIIFc treatment and 0.2 (0.0-1.9) for other FVIII products (p=0.06). Conclusions: 85% of the severe hemophilia A patients from our cohort reduced the weekly dose administration after beginning treatment with rFVIIIFc. Most of the patients increased plasma trough level of FVIII with rFVIIIFc. 45% of patients reduced and 40% kept their ABR=0 when they changed rFVIIIFc. These data suggest that treatment with rFVIIIFc gives a higher protection to severe hemophilia A patients. However, further research with larger sample size is required to investigate this. This work was supported by SOBI. NB holds a tenure track grant from FIS-FONDOS FEDER (CP14/00024). Disclosures Álvarez Roman: Takeda: Research Funding; Amgen: Consultancy, Speakers Bureau; NovoNordisk: Consultancy, Speakers Bureau; Novartis: Consultancy, Speakers Bureau; Bayer: Consultancy, Speakers Bureau; Pfizer: Consultancy, Speakers Bureau; Roche: Consultancy, Speakers Bureau; CSL Behring: Consultancy, Speakers Bureau; Sobi: Consultancy, Speakers Bureau. Fernandez-Bello:Novartis, Pfizer, ROCHE, Stago: Speakers Bureau. Martín:SOBI: Research Funding; Novartis, Pfizer, ROCHE, Novo Nordisk: Speakers Bureau. Rivas Pollmar:Novartis, Pfizer, ROCHE, Novo Nordisk: Speakers Bureau; SOBI: Research Funding. García Barcenilla:Bayer, Pfizer, Takeda, Novartis: Speakers Bureau; SOBI: Research Funding. Canales:SOBI: Research Funding; iQone: Honoraria; Karyopharm: Honoraria; Novartis: Honoraria; Takeda: Speakers Bureau; Gilead: Honoraria; Celgene: Honoraria; Janssen: Honoraria, Speakers Bureau; F. Hoffmann-La Roche Ltd: Honoraria, Speakers Bureau; Sandoz: Honoraria. Butta:Roche, Pfizer: Speakers Bureau; Novartis: Consultancy. Jimenez-Yuste:Bayer, CSL Behring, Grifols, Novo Nordisk, Octapharma, Pfizer, Roche, Sobi, Shire: Consultancy, Honoraria, Other: reimbursement for attending symposia/congresses , Research Funding, Speakers Bureau.
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Palomäki, A., T. Laitinen, J. Koskela, A. Palotie e N. Mars. "OP0007 MUC5B PROMOTER VARIANT AND LONG-TERM INCIDENCE OF INTERSTITIAL LUNG DISEASE IN PATIENTS WITH RHEUMATOID ARTHRITIS: A POPULATION BIOBANK STUDY OF 250,000 INDIVIDUALS". Annals of the Rheumatic Diseases 80, Suppl 1 (19 de maio de 2021): 4.2–4. http://dx.doi.org/10.1136/annrheumdis-2021-eular.619.
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Background:The promoter variant rs35705950 in MUC5B is the strongest known genetic risk factor for rheumatoid arthritis-associated interstitial lung disease (RA-ILD) [1]. There is, however, no large-scale data on the impact of MUC5B on the long-term incidence of RA-ILD.Objectives:To describe long term risk of RA-ILD in RA patients carrying MUC5B variant compared to non-carriers with RA.Methods:FinnGen is a collection of epidemiological cohorts and hospital biobank samples, linking genotypes with up to 46 years of follow-up within nationwide registries. Diagnoses of RA and ILD were identified from the Finnish national hospital discharge, medication reimbursement and cause-of-death registries. We estimated lifetime risks of ILD by age 80. MUC5B is a common variant and has an allele frequency of 0.1 in the Finnish population.Results:Out of the 248,400 individuals, 5534 patients have been diagnosed with RA, out of whom 178 (3.2%) developed ILD. MUC5B was a strong predictor of ILD in RA patients (HR 2.14, 95%CI 1.56-2.92). In patients with RA, MUC5B conferred a lifetime risk of 14.5% (95%CI 10.7-18.1%), compared to 5.2% (4.1-6.2%) in MUC5B non-carriers with RA (Figure). In the population, MUC5B carriers and MUC5B non-carriers had lifetime risks of 3.9% and 1.3%, respectively. The risk difference started to emerge at age 65. The risk was highest in men with RA who are MUC5B carriers: 18.5% (11.1-25.2%) developed ILD, compared to 8.5% (6.1-10.9%) of MUC5B non-carriers with RA.Conclusion:We report findings from a large longitudinal study, showing that MUC5B confers a considerable lifetime risk of RA-ILD, and contributes to increased morbidity. These findings have clinical implications for improving identification of RA patients at high risk of developing ILD.References:[1]Juge P-A, Lee JS, Ebstein E, et al. MUC5B Promoter Variant and Rheumatoid Arthritis with Interstitial Lung Disease. N Engl J Med 2018;379:2209–19Disclosure of Interests:Antti Palomäki Speakers bureau: MSD, Pfizer, Sanofi, Consultant of: Pfizer, Abbvie, Tarja Laitinen: None declared, Jukka Koskela Speakers bureau: Pfizer, Aarno Palotie: None declared, Nina Mars: None declared
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Koschmieder, Steffen, Susanne Isfort, Dominik Wolf, Florian H. Heidel, Philippe Schafhausen, Martin Griesshammer, Denise Wolleschak et al. "Ruxolitinib Shows Efficacy in Patients with Newly-Diagnosed Polycythemia Vera: Futility Analysis of the Randomized Ruxo-BEAT Clinical Trial of the German Study Group for Myeloproliferative Neoplasms". Blood 134, Supplement_1 (13 de novembro de 2019): 2944. http://dx.doi.org/10.1182/blood-2019-123985.
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Introduction: Polycythemia vera (PV) is a myeloproliferative neoplasm (MPN) characterized by expansion of the granulocytic, erythrocytic, and megakaryocytic lineages in the bone marrow and peripheral blood, and in most cases, by the presence of a JAK2 mutation. Survival of patients with PV is decreased compared with age-matched controls, and this is mainly due to thromboembolic complications followed by progression to post-PV myelofibrosis and acute leukemia. While no curative treatment exists, cytoreductive treatment with hydroxyurea (HU) or ropeginterferon is approved in EU for first-line therapy, and ruxolitinib (RUX) is approved in EU and US for second-line therapy in patients with HU intolerance or resistance. The current futility analysis assesses the efficacy of ruxolitinib in newly-diagnosed PV treated within the Ruxo-BEAT trial. Methods: This clinical trial entitled "Ruxolitinib versus Best Available Therapy in patients with high-risk Polycythemia Vera or high-risk Essential Thrombocythemia" (Ruxo-BEAT; NCT02577926) is a multicenter, open-label, two-arm phase-IIb trial with a target population of 380 pts with PV and ET. Patients in first-line PV and in first and later lines ET are randomized in a 1:1 manner to receive either RUX or best available therapy (BAT). Crossover from BAT to RUX is possible in eligible patients after 6 months. Patients with PV in the RUX arm receive a starting dose of 10 mg bid and may increase their dose up to 20 mg bid. Primary endpoint is the rate of complete clinicohematologic response rate (CHR) at month 6 as defined by Barosi et al Blood 2009. Secondary endpoints include differences in the absence of phlebotomies, spleen size, patient-reported outcomes, and survival. This is a pre-specified futility analysis of RUX in the PV arm, after 50 PV patients had been enrolled. Of the 50 patients, 28 patients with newly-diagnosed PV were randomized into the RUX arm and were analyzed (a maximum of 6 weeks of HU, anagrelide, or interferon therapy was allowed). The PV arm would have to be closed if no favorable trend were observed for RUX for any of the following variables: (1) improvement (decrease) in the hematocrit level during 6 months of treatment, (2) improvement (decrease) of the JAK2V617F allele burden during 6 months of treatment, or (3) improvement of one of the following three symptom variables assessed by physician´s judgement or via MPN Symptom Assessment Form (MPN-SAF) during 6 months of treatment: pruritus, night sweats, or bone pain. Differences between screening (Hct) or baseline (all other variables) and end of month 6 (all variables) were calculated using Fisher´s exact test (for physician-assessed pruritus and night sweats) or the Wilcoxon matched-pairs signed rank test (all other variables). Results: 28 patients received RUX for at least 6 months. After 6 months, the mean hematocrit level decreased from 45.9+/-5.6% to 41.0+/-5.0% (mean+/-SD) (p=0.0003). The number of phlebotomies calculated per year decreased from 4.2+/-3.9% to 0.96+/-2.1 (p=0.0009). Mean JAK2V617F allele burden decreased from 50.2+/28.4% to 44.0+/-28.5% (p=0.0039). The percentage of patients, as assessed by the physician, with pruritus or night sweats decreased from 41% to 26% (trending with p=0.13), and from 30% to 11% (p=0.02), respectively. The points reported by patients themselves on the MPN-SAF survey for pruritus decreased from 2.7+/-3.0 to 1.3+/-1.5 (p=0.0095) and there was a strong trend for reduction of night sweat points (from 3.1+/-3.6 to 1.6+/-2.4; p=0.0579), while the points for bone pain remained unaltered (2.0+/-2.8 to 1.4+/-2.2; p=0.215). Conclusion: Treatment with ruxolitinib in first line PV is efficient regarding the above-mentioned endpoints. Recruitment of our trial will be ongoing. In order not to weaken the study´s statistical power, comparison of both arms was not performed. Disclosures Koschmieder: Ariad: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; Novartis: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Roche: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; Bristol Myers-Squibb: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Incyte: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; Celgene: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; Shire: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; Novartis Foundation: Research Funding; CTI: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; AOP Pharma: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Janssen: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Bayer: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; Pfizer: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees. Isfort:Mundipharma: Other: Travel reimbursement; Amgen: Other: Travel reimbursement; Hexal: Other: Travel reimbursement; BMS: Honoraria; Ariad: Consultancy, Honoraria; Pfizer: Consultancy, Honoraria, Other: Travel reimbursement; Novartis: Consultancy, Honoraria, Other: Travel reimbursement; Roche: Other: Travel reimbursement; Alexion: Other: Travel reimbursement. Schafhausen:Novartis: Consultancy, Honoraria; Incyte: Consultancy, Equity Ownership, Honoraria. Griesshammer:Novartis: Consultancy, Honoraria, Speakers Bureau. Platzbecker:Abbvie: Consultancy, Honoraria; Celgene: Consultancy, Honoraria, Research Funding; Novartis: Consultancy, Honoraria, Research Funding. Döhner:CTI Biopharma: Consultancy, Honoraria; Daiichi: Honoraria; Jazz: Honoraria; Novartis: Honoraria; Celgene: Honoraria; Janssen: Honoraria. Jost:Abbvie: Consultancy, Patents & Royalties: Royalty payments for the drug compound ABT-199, Research Funding; Bohringer: Consultancy, Research Funding; BMS: Consultancy, Speakers Bureau; Novartis: Consultancy, Speakers Bureau; Pfizer: Consultancy, Speakers Bureau; Celgene: Other: Travel Support; Novartis: Research Funding. von Bubnoff:Novartis: Research Funding. Stegelmann:Novartis: Consultancy, Honoraria; Incyte: Consultancy, Honoraria. Crysandt:Amgem: Other: travel grant; celgene: Other: travel grant; Pfizer: Other: travel grant; Gilead: Other: travel grant; Incyte: Membership on an entity's Board of Directors or advisory committees. Gezer:AMGEM: Membership on an entity's Board of Directors or advisory committees. Brümmendorf:Merck: Consultancy; Pfizer: Consultancy, Research Funding; University Hospital of the RWTH Aachen: Employment; Janssen: Consultancy; Ariad: Consultancy; Novartis: Consultancy, Research Funding. OffLabel Disclosure: Ruxolitinib as first-line treatment in newly-diagnosed PV
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Dunavin, Neil, Lih-Wen Mau, Christa Lea Meyer, Clint Divine, Al-Ola Abdallah, Susan Leppke, Anita D'Souza et al. "Health Care Reimbursement and Service Utilization Among Medicare Beneficiaries with Multiple Myeloma Receiving Autologous Hematopoietic Cell Transplantation in Inpatient and Outpatient Settings". Blood 132, Supplement 1 (29 de novembro de 2018): 832. http://dx.doi.org/10.1182/blood-2018-99-118423.
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Abstract Introduction: Inpatient services are the leading drivers of cost for autologous hematopoietic cell transplantation (HCT), and the number of Medicare beneficiaries who receive autologous HCT is increasing. Using a merged dataset of Center for International Blood and Marrow Transplant Research (CIBMTR) transplant and outcomes data and Centers for Medicare and Medicaid Services (CMS) Medicare administrative claims data, we examined reimbursement and service utilization among Medicare beneficiaries with multiple myeloma (MM) who received IP and OP autologous HCT. Methods: This was a multicenter retrospective cohort study. A total of 11,358 HCT recipients from 2010-2012 were identified in the CMS Medicare database; 9,055 (80%) were linked with CIBMTR data. Selection criteria included first HCT for MM, diagnosis-to-HCT time between 0 and 18 months, and continuous enrollment for 30 days prior to index and 100 days post-HCT or until death. For IP-HCT, the index period for reimbursement and service utilization was day of admission for HCT through discharge date. For OP-HCT, the index period was day -2 through HCT date to capture the conditioning regimen. Total IP and OP service days from 30 days prior to index and 100 days post-HCT, and subsequent admissions post the HCT index period were calculated. Total reimbursement consisted of all payments made to providers (Medicare payments for Part A & B services, secondary payer, and patient responsibility of deductibles, coinsurance, and copayments), which was adjusted by a weighted generalized linear model (GLM). Patient responsibility was assessed separately and adjusted by the same GLM. Kaplan-Meier method was used for overall survival (OS) analysis; potential factors associated with OS were adjusted by Cox regression modeling. Results: The final cohort comprised 1,640 patients; 1,445 (88%) received IP-HCT (126 centers) and 195 (12%) OP-HCT (24 centers). Patient characteristics, functional status, disease status, and HCT year were similar between groups except a higher percentage of IP-HCT recipients were 70 years and older (IP-HCT: 31%, OP-HCT: 19%; P=0.0003), and a lower percentage of IP-HCT recipients received full dose melphalan 200 mg/m2 (IP-HCT: 68%, OP-HCT: 90%; P=0.0036). There was a significant difference between the cohorts in the utilization of IP services (IP-HCT group: median 19 days, OP-HCT group: 4 days; P < 0.0001) and OP services (IP-HCT group: median 16 days, OP-HCT group: 33 days; P < 0.0001) at day 100. Adjusted total mean reimbursement for the IP-HCT group ($83,380 [95% CI: $78,958-$88,051]) was higher than the OP-HCT group ($55,721 [95% CI: $38,595-$80,446]) (P= 0.0301) (Figure). Factors associated with total reimbursement in the GLM were transplant setting, age, sex, comorbidity index, diagnosis-to-HCT time, and melphalan dose. Adjusted total patient responsibility for the IP-HCT group was $4,567 (95% CI: $4,210- $4,955) and $7,372 ($4,218- $12,884) (P=0.0902) for the OP-HCT group. Within 100 days post-HCT, 107/195 (55%) OP-HCT recipients had at least one subsequent admission, compared to 348/1,445 (24%) IP-HCT recipients (P < 0.0001). OS at 100 days was high for both HCT settings and adjusted OS was not significantly different by transplant setting (IP-HCT 98% [95% CI: 97%-99%]; OP-HCT 99% [95% CI: 98%-100%; P=0.1903) Conclusions: Reimbursement and service utilization varied by HCT setting for Medicare beneficiaries with MM. Total reimbursement for 100 days post-HCT was $27,659 higher for IP-HCT than OP-HCT, after adjusting for patient and HCT-related characteristics. After the HCT index period, approximately 1 in 4 IP-HCT recipients required re-hospitalization within 100 days, whereas 1 in 2 OP-HCT recipients required subsequent hospitalization. Many factors influence the decision between IP or OP autologous HCT, including: center experience, severity of disease, patient co-morbidities, access to caregivers, proximity of lodging, cost to the patient, and reimbursement for services to the hospital system. The CIBMTR-CMS merged database is a new resource to support ongoing efforts to inform transplant centers and healthcare systems about provision of care options in the Medicare population. Figure. Figure. Disclosures Ganguly: Janssen: Consultancy; Amgen: Consultancy; Seattle Genetics: Speakers Bureau; Daiichi Sankyo: Research Funding.
9
Meunier, Godelieve, Loïc Ysebaert, Phi Linh Nguyen-Thi, Stephane Lepretre, Anne Quinquenel, Jehan Dupuis, Richard Lemal et al. "First Line Chronic Lymphocytic Leukemia Immunochemotherapy for the Elderly Patients over 79 Years Is Feasible, and Achieves Good Results: A Filo Retrospective Study". Blood 126, n.º 23 (3 de dezembro de 2015): 4170. http://dx.doi.org/10.1182/blood.v126.23.4170.4170.
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Abstract Introduction: Median age of Chronic Lymphocytic Leukemia (CLL) patients is 72 years with 40% older than 75 and 22.8% over 80 years. Important therapeutic progresses have been made, including chemo-immunotherapy as well as the recent use of targeted therapies, leading to progression-free-survival (PFS) and overall survival (OS) improvements. Although the elderly represents the largest subgroup of CLL patients, they are underrepresented in clinical studies and little is known about their clinical characteristics, treatment and outcome. Consequently, results from trials cannot be directly translated into clinical practice for these patients. Bairey et al (Ann Hematol, 2011) reported a series of 214 patients (80 years or older) diagnosed in Israel between 1979 and 2009 with a mean age of 84. However, in this cohort, 56% of the patients had a Rai stage 0 and only 53 received treatment. Median survival was 56 months. Methods: We performed a retrospective study of CLL patients aged 80 or more at initiation of first line therapy. Patients were treated between 2003 and 2013, in 17 hospitals affiliated to the French Innovative Leukemia Organisation (FILO). We report here a cohort of 201 such CLL patients, and describe their clinical and biological characteristics, treatment options and outcome. Results: Patients' median age was 83.4 years (80-92), 29% were older than 85 years, and the sex ratio was 60% male/40% female. Performance status (97%≤ 2) and nutritional status (median Corporal Mass Index of 25.3 kg/m²) were preserved. The median Cumulative Index Rating Scale (CIRS) comorbidity score was 5. More precisely in term of fitness, 57.8% patients were characterized as "go-go" with a CIRS ≤ 6 and organ comorbidities <3. The median creatinine clearance was 48 mL/min (Cockroft formula). Most patients lived at home (89.5%), often with familial or professional help (72%). A complete geriatric assessment was performed for 6.1% of them. Diagnosis relied on a Royal Marsden Hospital (RMH) score > 3, and CD38 was positive in 43,4% of the 129 cases tested (64%). Cytogenetic data were available for 42% of the patients. Isolated abnormalities were deletion 13q (38.1%), trisomy 12 (21.4%), deletion 17q (10.7%) or deletion 11q (7.1%). Besides, associated chromosomic abnormalities were detected, mainly by fluorescence in situ hybridization (FISH) and complex karyotypes (1.2%). At treatment initiation, Binet stage was either A (27.2%), B (28.7%) or C (41.5%). Therapies consisted mainly in Chlorambucil (65.5%), Bendamustine (10.5%) and Rituximab (44.3%). Indeed, therapy regimens were composed of Chlorambucil alone (45.3%) or chemo-immunotherapy (48.3%) including Rituximab+Chlorambucil (22.7%), Rituximab+Bendamustine (10.4%), Rituximab+Cyclophosphamide+Dexamethasone (5.5%) or Rituximab+Fludarabine+Cyclophosphamide (5.5%). In term of tolerance, 20.2% of the patients required hospitalization and 10% of these cases were febrile neutropenia. Finally, 31.8% required a dose reduction of chemotherapy. The Overall Response Rate was 65.9% with 31.4% of clinical complete remission. The median OS and PFS (from treatment initiation) were 48.6 and 18 months, respectively (cf. Survival curves). Afterwards, an important number of patients (41.3%) remained fit enough to receive a second line treatment. In univariate analysis, only comorbidities evaluated by the CIRS had a significant impact on survival (p=0.03). Indeed patients identified as fit by a CIRS score ≤ 6 and no organ comorbidity > 3 had a better outcome. Conclusion: We report a large series of elderly CLL patients, who received first line treatment at a median age of 83. Median OS was about 4 years, which is less than normal population of the same age. Our results suggest that treatment (including immunochemotherapy) is feasible, even in this very old population. Different bias are possible in this retrospective study including the selection of only fit patients, the low percentage of geriatric evaluation, and the possible undertreatment of this population since chlorambucil was the most frequent treatment. In the future, prospective trials should target this population. Oncogeriatric evaluation and new targeted therapies should be part of such future trials. Figure 1. Survival curve 1: Overall Survival Figure 1. Survival curve 1: Overall Survival Figure 2. Survival curve 2: Progression Free Survival Figure 2. Survival curve 2: Progression Free Survival Disclosures Dupuis: ROCHE: Speakers Bureau; ABBVIE: Membership on an entity's Board of Directors or advisory committees. Aurran-Schleinitz:CSLBehring: Honoraria; Janssen: Honoraria. Cymbalista:Karyopharm: Honoraria; Gilead: Honoraria; Roche: Honoraria; Janssen: Honoraria, Research Funding. Dilhuydy:Roche: Honoraria, Other: Travel reimbursement; Janssen: Honoraria, Other: Travel reimbursement; Mundipharma: Honoraria. Cazin:GILEAD,: Honoraria; ROCHE: Consultancy; MUNDIPHARMA: Honoraria, Research Funding; NOVARTIS: Honoraria. Leblond:Roche: Consultancy, Honoraria, Other: Travel, Accommodations, Expenses, Speakers Bureau; GSK: Consultancy, Honoraria, Speakers Bureau; Mundipharma: Honoraria; Gilead: Consultancy, Honoraria, Speakers Bureau; Janssen: Consultancy, Honoraria, Speakers Bureau. Cartron:Sanofi: Honoraria; Gilead: Honoraria; Celgene: Honoraria; GSK: Honoraria; Roche: Consultancy, Honoraria.
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Monzón Manzano, Elena, Ihosvany Fernandez-Bello, Raul Justo Sanz, Larissa Valor, Francisco Javier López-Longo, Angel Robles, Teresa Álvarez Roman, Miguel A. Canales, Victor Jimenez-Yuste e Nora Butta. "Prothrombotic State, Platelet Activation and Netosis in Systemic Lupus Erythematosus". Blood 134, Supplement_1 (13 de novembro de 2019): 1141. http://dx.doi.org/10.1182/blood-2019-127991.
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Introduction: Systemic lupus erythematosus (SLE) is a chronic autoimmune disease of unknown origin characterized by a hypercoagulable state and a high mortality rate. Mechanisms that cause the accelerated deterioration of cardiovascular health in SLE are unknown. Objectives: to characterize the prothrombotic state in SLE patients by global coagulation assays and the contribution of platelets, endothelial damage, microparticles and neutrophil extracellular traps (NETs) in their prothombotic profile. Material and methods: 72 patients and 90 healthy controls were recruited. Patients were classified according to clinical characteristics in: 32 with lupus (SLE group), 29 with SLE and antiphospholipid antibodies (aFL, SLE+aFL group) and 12 who met the criteria for SLE and antiphospholipid syndrome (APS, SLE+APS group). Experimental protocol was approved by La Paz University Hospital Ethics Committee. Venous blood collected in BD sodium citrate tubes (3.2%) was centrifuged at 150 g for 20 min at 23ºC to obtain platelet-rich plasma (PRP). PPP was obtained by centrifugation at 1500 g for 15 min at 23ºC. To obtain neutrophils, whole blood was centrifuged to 1600 rpm 25 min using a Ficoll gradient and red cells were lysed. Rotational thromboelastometry (ROTEM®) was performed in naTEM condition. Clotting time (CT, time from start of measurement until initiation of clotting [in seconds]); alpha angle (tangent to the curve at 2-mm amplitude [in degrees]), Ax (clot firmness at time x, [in mm]) and maximum clot firmness (MCF, [in mm]) were recorded. Procoagulant activity associated to microparticle's content of tissue factor was determined in PPP by Calibrated Automated Thrombogram (CAT) using MP-reagent (4 mM phospholipids, Diagnostica Stago, Spain). We evaluated the endogenous thrombin potential (ETP, the total amount of thrombin generated over time); the lag time (the time to the beginning of the explosive burst of thrombin generation); the peak height of the curve (the maximum thrombin concentration produced) and the time to the peak. Thrombin generation associated to NETs was also measured by CAT. Neutrophils from healthy controls or from LES patients were stimulated with 100 nM PMA in RPMI medium during 45 min at 37º and then cocultivated with PRP adjusted to 105 platelets/µL. NETs formation was verified by fluorescent microscopy performed with DAPI and an anti-myeloperoxidase antibody. Plasma levels of LDL-ox, E-Selectin and PAI-1 were determined by Elisa (R&D Systems, MN, USA and Affymetrix eBioscience, Vienna, Austria, respectively). Platelet activation was analysed by flow cytometry (FCM, FACScan, BD Biosciences). Fibrinogen receptor activation was evaluated through PAC1-FITC binding and release of granule's content was assessed with monoclonal antibodies (mAbs) anti-CD63 and anti P-selectin in quiescent and 100 µM TRAP and 10 µM ADP stimulated platelets. Data were analysed with Graphpad prism and p ≤0.05 was stablished as statistical significance. Results: PAI-1 plasma level was increased in all patient's groups, whereas LDL-ox and E-selectin showed no differences with control cohort (Fig.1). ROTEM demonstrated a procoagulant profile in SLE and SLE+aPL but not in SLE+APS group (Fig. 2). PAI-1 levels correlated with several ROTEM parameters (Table 1). SLE patients and SLE+aFL showed a basal platelet activation. Moreover, SLE group exposed more P-selectin and CD63 than controls (Fig.3). Regarding thrombin generation associated to tissue-factor content of microparticles, no differences were observed between SLE patients and healthy controls. On the other hand, SLE patients had an increased peak of thrombin generation related to NETs formation (control group: 170.3± 58.0, SLE patients: 230.6±39.3, p=0.019). Conclusions: ROTEM® detected a hypercoagulable state in SLE and SLE+aPL patients. The hypercoagulable state might be linked to increased PAI-1 plasma levels and basal platelet activation in SLE and SLE+aPL groups. Moreover, neutrophils from SLE patients seemed to present a basal activation that induced a NETs-related procoagulant state in these patients. SLE+APS patients did not show a hypercoagulable state perhaps because of the presence of lupus anticoagulant and/or to therapeutic treatment of these patients. This work was supported by grants from the FIS-FONDOS FEDER (PI15/01457, NB). NVB holds a Miguel Servet tenure track grant from FIS-FONDOS FEDER (CP14/00024). Disclosures Fernandez-Bello: Novartis, Pfizer, ROCHE, Stago: Speakers Bureau. Robles:ABBVIE, SANDOZ FARMACEUTICA: Speakers Bureau. Álvarez Roman:Sobi: Consultancy, Speakers Bureau; CSL Behring: Consultancy, Speakers Bureau; Roche: Consultancy, Speakers Bureau; Pfizer: Consultancy, Speakers Bureau; Bayer: Consultancy, Speakers Bureau; Novartis: Consultancy, Speakers Bureau; Amgen: Consultancy, Speakers Bureau; Takeda: Research Funding; NovoNordisk: Consultancy, Speakers Bureau. Canales:Celgene: Honoraria; Gilead: Honoraria; Novartis: Honoraria; Janssen: Honoraria, Speakers Bureau; Sandoz: Honoraria; iQone: Honoraria; Takeda: Speakers Bureau; SOBI: Research Funding; Karyopharm: Honoraria; F. Hoffmann-La Roche Ltd: Honoraria, Speakers Bureau. Jimenez-Yuste:Bayer, CSL Behring, Grifols, Novo Nordisk, Octapharma, Pfizer, Roche, Sobi, Shire: Consultancy, Honoraria, Other: reimbursement for attending symposia/congresses , Research Funding, Speakers Bureau. Butta:Novartis: Consultancy; Roche, Pfizer: Speakers Bureau.
Teses / dissertações sobre o assunto "Bureau of Hospital Reimbursement"
1
ALORBI, GENEVIEVE AKU. "ESSAYS ON HOSPITAL REIMBURSEMENT AND QUALITY OF HEALTHCARE PROVISION". OpenSIUC, 2017. https://opensiuc.lib.siu.edu/dissertations/1333.
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This dissertation seeks to investigate how hospital reimbursement policy affects the quality of care provided to patients when providers compete for healthcare labor that is limited in supply. Cost payment systems fully reimburse a provider’s the total cost of healthcare provided, fixed reimbursements are predetermined at a fixed amount and mixed reimbursements have a cost and fixed component. The first chapter investigates how government reimbursement schemes that induce quality competition among health providers affects the choice of quality of care provided to patients and how these choices depend on the labor supply constraints in the healthcare labor market. We build a theoretical model that explicitly incorporates the healthcare labor supply into a framework of a hospital cournot competition, to show how a hospitals' choice of quality of patient care will be directly influenced when there is a shortage of health personnel in a regulated reimbursement system. We find that multiple equilibria can arise in healthcare markets depending on the consumers’ sensitivity to quality and hospitals’ share of cost when investing in quality. Contrary to existing findings, we are able to show that the effects of reimbursement schemes can vary in different equilibria and in different labor market situations. For instance, in high patient quality sensitivity hospital markets under a high hospital quality equilibrium, we can show that a cost payment scheme decreases a provider’s quality of care while a fixed reimbursement scheme increases quality. More importantly we find that the labor market constraint increases or decreases the effect of the reimbursement system on quality of care. Consequently, the labor constraint changes the quality choice of the provider as compared to the quality level that would have been induced by a particular reimbursement’s policy incentive for quality. In the second chapter, we carry out some of the testable implications of the theoretical finding from the first chapter. This paper investigates how higher Medicare payments brought about by geographical reclassification affects a provider’s quality of care as captured by registered nurses (RN) and licensed practical nurses (LPN) staffing, as well as patient outcomes (mortality, urinary tract infections, pneumonia, peptic ulcer deep vein thrombosis) and length of stay when hospitals compete for nurses. In contrast with past literature, we specifically allow for asymmetry in the hospital’s choice of quality, by permitting coefficients to differ across reclassified hospitals in response to the higher Medicare payments. This asymmetry is based on the relativity of the labor cost faced by the hospital due to competition for nurses in the healthcare labor market. Using Healthcare Cost and Utilization Project (HCUP) and the Center for Medicare and Medicaid (CMS) data from the period 2001 to 2011, we find that hospitals who face relatively higher labor costs will post reclassification increase their RN to LPN staffing ratio as compared to hospitals in their post geographical reclassification areas. A higher RN staffing by these hospitals will result in an improvement of quality of care as the incidence of patient complications due to Pneumonia, Peptic Ulcer and Deep Vein Thrombosis reduces for hospitals that were reclassified after allowing for asymmetry in response to the higher Medicare payment due to differences in labor costs (Pneumonia and Peptic Ulcer complications improve as compared to pre re-class area hospitals and DVT in both pre/post re-class area hospitals). Length of stay also increases for hospitals that faced a higher labor cost while mortality and UTI complications remain unchanged post reclassification. Finally, in the third chapter, we examine how the for profit (FP) or not for profit (NFP) status of hospitals impact the choice of nurse staffing and patient outcomes when there is an increase in provider reimbursement due geographical reclassification. Most of the past studies focus on mortality and length of stay in FPs and NFPs, we extend these studies by investigating the impact of geographical reclassification on patient outcomes that have been established as outcomes sensitive to nursing care. From our regression results, with reference to the ratio of RN to LPN staffing, we find evidence that an increase in Medicare payments will have a greater impact in FPs than in NFPs as compared to their pre re-class geographical area control hospitals. We also find that in hospitals that face a relatively higher labor cost as compared to their controls; (1) There is no difference in the impact of reclassification between FPs and NFPs (2) There is a better response from FPs than NFPs to geographical reclassification when the outcome considered is DVT as evidenced by a decreases in cases of DVT (3) NFPs decrease length of stay whiles FPs increase length of stay as compared to their post re-class geographical area hospitals.
2
Talongwa, Catherine. "Racial Differences in Hospital Readmission and Reimbursement Rates for Patients with Congestive Heart Failure". ScholarWorks, 2020. https://scholarworks.waldenu.edu/dissertations/7958.
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Congestive heart failure (CHF) is associated with a significant economic burden that includes frequent emergency department visits, hospitalizations, and readmissions. The purpose of this study was to examine the differences, if any, between hospital readmission rates and insurance reimbursement rates for non-Hispanic Black and White CHF patients in California. The theoretical framework was Bandura's social cognitive theory. Secondary data for this quantitative study were obtained from the Office of Statewide Health Planning and Development and State Inpatient Databases from Healthcare Cost and Utilization for calendar year 2014-2016. A t-test and Levene's test for equality of variance were conducted on a sample of 11,905 patient records from 675 hospitals in California; the readmission discharge data and insurance reimbursement rates were analyzed by ethnicity and payer type. The results indicated that there was not a statistically significant difference between non-Hispanic Blacks as compared to non-Hispanic Whites in relation to readmission rates (M = 49.6, SD = 38.28) or insurance reimbursement rates (M = 50.88, SD = 36.52). Non-Hispanic Blacks had a higher readmission rate (36%) as compared to Whites (29%), and although these results are not significant, they support the need for healthcare professionals to develop programs that meet the needs of the community. The results of this study contribute to positive social change by providing information that healthcare professionals may be able to use to decrease CHF readmissions and improve access to care for non-Hispanic Blacks and other vulnerable patient groups.
3
Liang, Lilin. "Hospital responses to changes in reimbursement methods : an economic analysis of Taiwan’s national health insurance programme". Thesis, London School of Economics and Political Science (University of London), 2011. http://etheses.lse.ac.uk/308/.
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In 1995, the Taiwanese government introduced the Case Payment Scheme (CPS) to initiate a prospective payment method for diagnosis-related groups under the National Health Insurance (NHI) programme. The aim of the CPS was to rectify the supplier induced demand caused by the fee-for-service plan and to improve the efficiency of health services. However, this scheme created a dual reimbursement system for the NHI, under which, some services were reimbursed on the basis of claims for fees, while others were bundled together and paid a fixed rate per discharge. This study examines changes in hospital behaviour in this context based on the assumption that hospitals have incentives to maximise the profits from both payment plans. The aim is to quantify the effects of reimbursement changes on different dimensions of the delivery of health care. This research also evaluates the global budget programme which has changed the budget allocation mechanism within the hospital sector since 2002. Empirical investigations were carried out for all the hospitals contracted into the NHI over the period 1998-2004. To model hospital behaviour, this study employs different econometric methods, including instrumental variables, panel data model, semiparametric estimation, seemingly unrelated regressions and limited dependent variable models. The results suggest that hospitals react to the shift toward the dual payment system by selecting patients, altering treatment patterns, changing the case mix and adjusting treatment intensity. Policymakers do not appear to have anticipated these phenomena. These findings indicate that there could be fundamental problems in the parallel use of retrospective and prospective payments, due to the improper reimbursement incentives embodied within the system. As mixed payment systems have been adopted around the world, this research has implications for existing and future reimbursement reforms.
4
Barrington, James D. "Analysis of Two Strategies for Structuring Medicare Reimbursement to Maximize Profitability in Acute Care General Hospitals". Scholar Commons, 2010. https://scholarcommons.usf.edu/etd/1569.
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The healthcare literature sometimes cites Medicare as a negative determinant of hospital profitability. However, a review of Florida acute care short-term general hospital data revealed a subset of profitable hospitals with high percentages of their revenue structure comprised of Medicare reimbursements. Some investigators might contend that these hospitals are just better managed; that hospital profitability is not related to patient mix or payer source. Although good management enhances financial health, there are perhaps other reasons why certain hospitals can become profitable with Medicare as their primary revenue source.
Research findings indicate there is wide geographic variability shown for per-capita volumes of discretionary procedures reimbursed by Medicare, and broad variations in Medicare spending per enrollee for general acute care short-term hospitalizations. It was also found that many of the hospitals performing higher rates of discretionary procedures and showing the ability to make a profit with Medicare are investor owned.
The focus of this study, covering years 2000-2005, was to examine two strategies using discretionary procedures under Medicare that Florida investor owned hospitals may employ to increase profitability and maintain long-term financial health.
Part 1 of the study examined the association between long-term financial viability, measured by the total assets divided by total liabilities (TATL) ratio (the reciprocal of the debt ratio) and percentages per hospital of two discretionary cardiac and orthopedic procedure variables, reimbursed by conventional Medicare. A positive association was found between the TATL ratio and these variables, as well as significant marginal effects in the association between the TATL ratio and interaction terms for hospital ownership (where investor owned = 1 and not-for-profit = 0) and the discretionary cardiac procedure variable and ownership and the discretionary orthopedic procedure variable.
Part 2 used total charges as the dependent variable for patient discharges reimbursed by Medicare HMO. It was found that investor owned hospitals generally assess significantly higher charges than not-for-profits for discretionary CABG and valve replacement procedures for patients with equivalent levels of medical services and hospitalization. It was also found that charges significantly increase for both investor-owned and not-for-profit hospitals located in the southern region of Florida.
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Mendonça, Maria Angelica Lopes Chaves. "Estimativa de custo direto de lesões traumáticas maxilofaciais em crianças e adolescentes em um hospital público do Município de São Paulo". Universidade de São Paulo, 2010. http://www.teses.usp.br/teses/disponiveis/23/23148/tde-03072010-103139/.
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O presente estudo procurou obter uma estimativa dos custos diretamente ligados ao atendimento de lesões traumáticas maxilofaciais em crianças e adolescentes, comparados com a população adulta acometida do mesmo agravo, bem como o perfil sóciodemográfico da população atendida em um Hospital Público do Município de São Paulo, Brasil,com o intuito de fornecer evidências para avaliação quantitaiva do dano em perícias odontolegais,. Material e Método. Os dados dos prontuários foram colhidos, no período de janeiro de 2002 a dezembro de 2008 dos pacientes atendidos no serviço de Cirurgia Buco-Maxilofacial de um hospital do município de São Paulo. As variáveis classificatórias foram descritivamente apresentadas em tabelas de contingência contendo frequências absolutas (n) e relativas (%). A associação entre elas foi avaliada com o teste Qui-quadrado ou teste da razão de verossimilhança. Para a análise dos custos diretos foram utilizados os valores de referência da Tabela do Sistema de Informações de Tratamento Ambulatorial do Sistema Único de Saúde- SIA-SUS do Ministério da Saúde. Resultados Do1.200 casos analisados, 419preencheram os requisitos da pesquisa. O grupo caso obteve 108 registros (faixa etária até 19 anos), e os demais foram classificados, como grupo controle (acima de 20 anos de idade). O grupo caso apresentou uma incidência de 1,5% ao ano de lesões traumáticas, e a média de idade no grupo caso foi de 14,35 +- 4,76 e no grupo controle foi de 33,65 +- 11,73 anos de idade. Em relação ao sexo predominaram os indivíduos do sexo masculino em ambos os subgrupos O tipo de tratamento cirúrgico prevaleceu em ambos os subgrupos, e o tempo de internação em dias foi cerca de duas vezes maior no grupo controle em relação ao grupo caso, entretanto as complicações foram mais freqüentes no grupo caso em relação ao grupo controle. Os tipos de lesões mais freqüentes no grupo caso foram as fraturas nasais/dentárias, seguidas das fraturas e mandíbula, e que no grupo controle o quadro inverteu-se. A distribuição de custos teve o maior número de casos na faixa de custos até R$500,00 em ambos os subgrupos amostrais A freqüência de ocorrência de complicações foi significativamente maior no grupo caso, em relação ao grupo controle, da mesma forma que os retornos ambulatoriais foram também significativamente maiores neste grupo. Conclusões A distribuição de custos teve o maior número de casos na faixa de custos até R$500,00 em ambos os subgrupos amostrais; esses custos foram calculados com base no repasse de verbas da Tabela de Valores do Sistema Único de Saúde, onde não esta discriminado o custo dos honorários profissionais. A valoração do dano nas atividades periciais deve considerar, além dos custos diretamente envolvidos com o atendimento do traumatizado, as consequências para suas atividades diárias especialmente quando se trata de criança ou adolescentes cuja função social ainda está por se definirThe aim of this study is to provide evidence for the quantitative assessment of injury in forensic dentistry investigation, thorough the estimate of costs directly linked to the care of maxillofacial trauma lesions in children and adolescents, compared to adults who suffered the same injuries, as well as trace a social demographic profile of the patients admitted in a public hospital in Sao Paulo. Material and Method. The hospital chart data were collected from January 2002 to December 2008 and the charts belonged to patients cared for by the Buco-Maxillofacial Surgery Department of a hospital in Sao Paulo. Classification variables were described in contingency tables which comprise absolute (n) and relative (%) frequencies. Their association was assessed using the chi-square test. Reference prices from the Ambulatory Care Price Table, provided by the Unified Health System (SIA-SUS), the government managed Public Health System in Brazil, were used to determine direct costs. Outcome: out of the 1200 cases analyzed, 419 matched the requisites of this survey. The case group comprised 108 cases (up to 19 years old) and the other 311 were classified as the control group (above 20 years old). The incidence rate of trauma lesions was of 1,5% per year in the case group and the average age was of 14,35 +-4,76, while in the control group, the average age was 33,65 +- 11,73. Male individuals prevailed in both groups and so did the surgical treatment. The number of days of hospital stay was about twice as big in the control group in relation to the case group. Complications, however, were more frequent in the case group. The most frequent kinds of lesion in the case group were the dental or nasal fractures, followed by jaw fractures, and this was directly opposite to what happened in the control group. The Unified Health System (SUS) reimbursed treatments of up to 500 reais in both groups. The frequency of complications and returns to the Ambulatory Care facilities were significantly higher in the case group. Conclusion: The reimbursement of expenses happened more frequently when treatment cost up to 500 reais in both sample groups. These costs were calculated taking reference prices from the Ambulatory Care Price Table, provided by Unified Health System (SUS). The prices dont include professional fees. When calculating how much to refund, the Government should take into account not only the direct costs involved in caring for the injured patient, but also the consequences such treatments have on their daily activities, especially when we consider that children and adolescents do not have a their social roles defined yet.
6
Hopes, Scott L. "Healthcare IT in Skilled Nursing and Post-Acute Care Facilities: Reducing Hospital Admissions and Re-Admissions, Improving Reimbursement and Improving Clinical Operations". Scholar Commons, 2017. https://scholarcommons.usf.edu/etd/7409.
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Health information technology (HIT), which includes electronic health record (EHR) systems and clinical data analytics, has become a major component of all health care delivery and care management. The adoption of HIT by physicians, hospitals, post-acute care organizations, pharmacies and other health care providers has been accepted as a necessary (and recently, a government required) step toward improved quality, care coordination and reduced costs: “Better coordination of care provides a path to improving communication, improving quality of care, and reducing unnecessary emergency room use and hospital readmissions. LTPAC providers play a critical role in achieving these goals” (HealthIT.gov, 2013).
Though some of the impacts of evolving HIT and EHRs have been studied in acute care hospitals and physician office settings, a dearth of information exists about the deployment and effectiveness of HIT and EHRs in long-term and post-acute care facilities, places where they are becoming more essential. This dissertation examines how and to what extent health information technology and electronic health record implementation and use affects certain measurable outcomes in long term and post-acute care facilities. Monthly data were obtained for the period beginning January 1, 2016 through June 30, 2017, a total of 18 months. The level of EHR adoption was found to positively impact hospital readmission rates, employee engagement, complaint deficiencies, failed revisit surveys, staff overtime (partial EHR), staff turnover rate (full EHR) and United States Centers for Medicare and Medicaid Services (CMS) Five Star Quality score. The level of EHR adoption was found to negatively impact CMS Five Star Total score, staff retention rate (full EHR) and staff overtime (full EHR group higher than partial EHR).
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Kerns, Elizabeth E. "A Study on the Efficacy of the Medicare Bundled Payments for Care Improvement Initiative at a Large Community Hospital in the Southeast United States". Scholar Commons, 2017. http://scholarcommons.usf.edu/etd/7044.
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In 2013, Medicare launched the Bundled Payments for Care Improvement (BPCI) Initiative which linked payments for multiple services for a complete episode of patient care. With this innovative reimbursement model, hospitals accepted fixed target payments for certain types of clinical diagnoses that were intended to support better care coordination and better outcomes for patients at lower cost to Medicare. This was one of many programs aimed at addressing the serious challenges facing United States healthcare, including costs that are skyrocketing to unsustainable levels and lack of coordination of care across venues.
Preliminary Medicare results showed that bundled payments might lead to lower costs and higher quality of care, however, this idea comes from a relatively small sample size and limited run time of the program. This study examined one large community hospital in the southeast part of the United States participating in the BPCI Initiative. Patient level data was retrospectively analyzed using statistical techniques to determine if financial, operational and clinical outcomes improved as result of the BPCI program compared to similar patient data before the program.
The results were mixed. Financial outcomes did not change significantly, and remained higher than the CMS targets. Length of stay decreased significantly, as anticipated. The 30-day readmissions was statistically unchanged. This study illuminated both challenges and strategies in implementing bundled payments to achieve positive financial, operational, and clinical outcomes.
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Mbi, Feh Marilyn Keng-Nasang. "Physicians' Perceptions and Practice Regarding the Prevention of Catheter-Associated Urinary Tract Infections in the ICU". ScholarWorks, 2015. http://scholarworks.waldenu.edu/dissertations/1699.
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Catheter associated urinary tract infection (CAUTI) incidence continue to rise despite all prevention efforts. The state of Georgia incidence of CAUTI between 2012 and 2013 showed an increase by 350 cases. The challenge is translating CAUTI prevention knowledge into practice by all physicians. The purpose of this correlational study was to improve the epidemiological understanding of CAUTI. Looking at physicians' perception and practice of CAUTI preventions was necessary. A total of 336 physicians from the state of Georgia completed a 26-item survey. Additionally, a pilot study was conducted on a small sample of participants. The result of the Cronbach alpha for the pilot study analysis of the 26-item survey instrument indicated excellent reliability. The analysis revealed that participants' frequency of training on proper catheterization and their perception of CAUTI risk factors and effective implementation of CAUTI prevention bundle elements, varied significantly. It also resulted that many of the participants were not knowledgeable of certain important CAUTI prevention elements. Only a few made changes in their practice despite knowledge of the Center for Medicare and Medicaid Services reimbursement policy. Results of the Pearson's chi-square test for independence indicated a significant correlation (p < .05) between physicians' perception and practice of CAUTI prevention elements and CAUTI incidence. The results of this study suggest that current CAUTI prevention practice may be inefficient without the effective implementation of proven bundled element. Improved understanding of CAUTI and its relation to effective implementation of bundled prevention elements may result in improved prevention efforts, decreased morbidity, mortality, and overall healthcare cost.
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Lucente, Betty C. "Hospitals' Decision to Vertically Integrate Skilled Nursing Units Before and After the Balanced Budget Act". VCU Scholars Compass, 2006. https://scholarscompass.vcu.edu/etd/1495.
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The decision to vertically integrate services and deliver care has both management and policy concerns for healthcare in the United States. The change in reimbursement, which was enacted with the Balanced Budget Act of 1997, influenced the availability of post acute services for acute hospital inpatients. Prior to this change, post acute services were reimbursed based on cost similar to the pre DRG era of Medicare reimbursement. The change in payment had the potential to make discharging patients more difficult resulting in a prolonged length of stay without additional payment and at increased costs for hospitals. As a result of this change hospitals made arrangements to provide care for this population. The choices included vertical integration, contracting or hybrid arrangement and simply relying on the spot market. This makes or buy decision is a focus of this study. Were hospital decisions different after the BBA, than before this legislation?This study utilizes Oliver Williamson's transaction cost economics theory as the framework for the study and is a replication of a prior study by Chiu (1995) hybrid arrangement and simply relying on the spot market. This makes or buy decision is a focus of this study. Were hospital decisions different after the BBA, than before this legislation?This study utilizes Oliver Williamson's transaction cost economics theory as the framework for the study and is a replication of a prior study by Chiu (1995) The Williamsons theory is based on the proposition that three transaction dimensions determine the most efficient method of operation for a firm: uncertainty, frequency, and asset specificity. Depending on the "market", organizations may elect to arrange services through the spot market, contract for services, or vertically integrate the service. The study uses data from the American Hospital Association survey as well as the Area Resources files to determine if individual hospitals have made contract arrangements, vertically integrated, or relied on the spot market to provide skilled nursing services. Data is collected before and after the BBA and analyzed using multiple regression analysis and then subjected to significance testing. Sixteen hypotheses are tested that focus on the three dimensions of transaction cost theory. Findings support the importance of transaction frequency and asset specificity, while only weak support is offered for transaction uncertainty. The results differ from the Chiu study, which found strong support for uncertainty and weak support for frequency. This study is unique in that it examines data from two time periods surrounding a major reimbursement change in Medicare. It makes an important contribution to the empirical testing of transaction cost economics and the decision to vertically integrate in health care.
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Lucas, D. Pulane. "Disruptive Transformations in Health Care: Technological Innovation and the Acute Care General Hospital". VCU Scholars Compass, 2013. http://scholarscompass.vcu.edu/etd/2996.
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Advances in medical technology have altered the need for certain types of surgery to be performed in traditional inpatient hospital settings. Less invasive surgical procedures allow a growing number of medical treatments to take place on an outpatient basis. Hospitals face growing competition from ambulatory surgery centers (ASCs). The competitive threats posed by ASCs are important, given that inpatient surgery has been the cornerstone of hospital services for over a century. Additional research is needed to understand how surgical volume shifts between and within acute care general hospitals (ACGHs) and ASCs. This study investigates how medical technology within the hospital industry is changing medical services delivery. The main purposes of this study are to (1) test Clayton M. Christensen’s theory of disruptive innovation in health care, and (2) examine the effects of disruptive innovation on appendectomy, cholecystectomy, and bariatric surgery (ACBS) utilization. Disruptive innovation theory contends that advanced technology combined with innovative business models—located outside of traditional product markets or delivery systems—will produce simplified, quality products and services at lower costs with broader accessibility. Consequently, new markets will emerge, and conventional industry leaders will experience a loss of market share to “non-traditional” new entrants into the marketplace. The underlying assumption of this work is that ASCs (innovative business models) have adopted laparoscopy (innovative technology) and their unification has initiated disruptive innovation within the hospital industry. The disruptive effects have spawned shifts in surgical volumes from open to laparoscopic procedures, from inpatient to ambulatory settings, and from hospitals to ASCs. The research hypothesizes that: (1) there will be larger increases in the percentage of laparoscopic ACBS performed than open ACBS procedures; (2) ambulatory ACBS will experience larger percent increases than inpatient ACBS procedures; and (3) ASCs will experience larger percent increases than ACGHs. The study tracks the utilization of open, laparoscopic, inpatient and ambulatory ACBS. The research questions that guide the inquiry are: 1. How has ACBS utilization changed over this time? 2. Do ACGHs and ASCs differ in the utilization of ACBS? 3. How do states differ in the utilization of ACBS? 4. Do study findings support disruptive innovation theory in the hospital industry? The quantitative study employs a panel design using hospital discharge data from 2004 and 2009. The unit of analysis is the facility. The sampling frame is comprised of ACGHs and ASCs in Florida and Wisconsin. The study employs exploratory and confirmatory data analysis. This work finds that disruptive innovation theory is an effective model for assessing the hospital industry. The model provides a useful framework for analyzing the interplay between ACGHs and ASCs. While study findings did not support the stated hypotheses, the impact of government interventions into the competitive marketplace supports the claims of disruptive innovation theory. Regulations that intervened in the hospital industry facilitated interactions between ASCs and ACGHs, reducing the number of ASCs performing ACBS and altering the trajectory of ACBS volume by shifting surgeries from ASCs to ACGHs.
Livros sobre o assunto "Bureau of Hospital Reimbursement"
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Mennemeyer, Stephen T. Inpatient hospital reimbursement. [Baltimore, Maryland]: Department of Health and Human Services, Health Care Financing Administration, Office of Research and Demonstrations, 1987.
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1933-, Tully Michael J., ed. Negotiating hospital reimbursement rates: A report. [Albany, N.Y: The Council, 1989.
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Scheier, Thomas E. Hospital guide to maximize medicare reimbursement. 3a ed. Burnsville, Minn: Research Advisors Pub. Co., 1993.
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American Health Information Management Association, ed. Coding and reimbursement for hospital outpatient service. 2a ed. Chicago: American Health Information Management Association, 2009.
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Korda, Holly. State Medicaid inpatient hospital reimbursement: Summary of state programs. Cambridge, MA: Abt Associates, 1985.
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Massachusetts. Executive Office of Human Services., ed. Hospital reimbursement and access to care: Chapter 372 and beyond. Boston, MA: Commonwealth of Massachusetts, Executive Office of Human Services, 1986.
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C, Vertrees James, Bartlett Lawrence e National Governors' Association. Center for Policy Research, eds. Medicaid DRG hospital reimbursement systems: A technical guide for state implementation. Washington, D.C: National Governors' Association Center for Policy Research, 1985.
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Kennedy, James S. Severity DRGs and reimbursement: An MS-DRG primer. Chicago: American Health Information Management Association, 2008.
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New York (State). Dept. of Audit and Control. Department of Health, implementation of hospital diagnosis related group Medicaid reimbursement methodology. [Albany, N.Y: The Office, 1989.
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Midwest Alliance in Nursing. Program Meeting. Prospective payment reimbursement: The costs to nursing. Indianapolis, Ind: Midwest Alliance in Nursing, 1988.
Encontre o texto completo da fonteCapítulos de livros sobre o assunto "Bureau of Hospital Reimbursement"
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Lundbäck, Mattias, e Daniel Staib. "Reimbursement of Hospital Services and Hospital Financing". In Developments in Health Economics and Public Policy, 137–60. Boston, MA: Springer US, 1998. http://dx.doi.org/10.1007/978-1-4615-4052-6_7.
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Haag, Cornelie. "Treatment Coverage and Reimbursement". In The EBMT/EHA CAR-T Cell Handbook, 229–30. Cham: Springer International Publishing, 2022. http://dx.doi.org/10.1007/978-3-030-94353-0_45.
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AbstractThe conditions for reimbursement for CAR-T cell therapy are not uniform in Europe. Most European countries use a DRG system for billing hospital services, but the details vary. Nonetheless, the similarity is that expensive therapies, such as CAR-T cell therapy, are initially not included in the DRG system. Most countries possess instruments to ensure the financing of such expensive therapies outside the DRG system as separate payments. These reimbursement instruments of DRG systems are used in most countries both for short-term financing for innovative and new therapies and as long-term additional fees within the respective DRG system. Individual countries maintain different regulations, and therefore, hospitals have the responsibility to determine the specific requirements of their country before establishing CAR-T cell therapy.
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Rauner, Marion S., e Michaela M. Schaffhauser-Linzatti. "Impact of Inpatient Reimbursement Systems on Hospital Performance: The Austrian Case-Based Payment Strategy". In Operations Research and Health Care Policy, 129–53. New York, NY: Springer New York, 2013. http://dx.doi.org/10.1007/978-1-4614-6507-2_7.
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(Mary) Tai, Hsueh-Yung, Yu-Pin Chang e Shwu-Huey Wu. "High-Value Medical Information and Quality Claims Review". In Digital Health Care in Taiwan, 189–205. Cham: Springer International Publishing, 2022. http://dx.doi.org/10.1007/978-3-031-05160-9_10.
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AbstractThe big data generated by the National Health Insurance (NHI) medical information system is the most important asset that Taiwan possesses in promoting national digital policies. Hence, it is the NHI’s priority to maintain the quality of the dataset and its interoperability with healthcare facilities. This chapter presents the process for claiming medical expenses in detail and gives examples of how the National Health Insurance Administration (NHIA) proactively assists providers to submit accurate claims.Although most medical examination and test results, images, etc., are uploaded in a timely manner to the NHI medical information system, the NHIA plans to bundle the reimbursement to the provider with data upload to further its accuracy. The author explains the strategies applied to strengthen the connection between the hospital information system of contracted institutions and the National Health Insurance MediCloud System (NHI MediCloud System) to improve the accuracy of the data uploaded, such as medical visit identifier, instant upload, and the write-off mechanism.The long-term collaboration among the NHI, contracted institutions, and information system vendors is the key to guaranteeing the quality of the dataset.
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Boutayeb, Saber, e Mohammed Anass Majbar. "General Oncology Care in Morocco". In Cancer in the Arab World, 163–74. Singapore: Springer Singapore, 2022. http://dx.doi.org/10.1007/978-981-16-7945-2_11.
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AbstractThe current population of Morocco is estimated to be 37 million based on the projection of the United Nations data. The median age in the Moroccan population is young. Around 25% of the population is aged under 14 years. Morocco is currently in an epidemiological transition called “double burden,” with the coexistence of infectious and chronic diseases. The most frequent cancers in men are lung, prostate, bladder, colorectum, and lymphoma. Whereas, for women, the most frequent are breast, cervix, colorectum, thyroid, and ovary. The first Moroccan cancer plan (2010–2019) has given the priority to breast and cervix cancers. Concerning treatments, the classical chemotherapies, hormonal therapies, and the first generation of monoclonal antibodies (Trastuzumab, Rituximab, Bevacizumab, Cetuximab, etc.,) are widely available for the entire population. Two immunotherapies are available in Morocco: Pembrolizumab and Atezolizumab. However, their reimbursement is still conflictual. 3D and new irradiation techniques are available in the major cities. Advanced minimally invasive techniques are now routinely performed for colorectal, liver, gynecologic, thoracic, and urologic cancers. The first surgical robot was acquired by the university hospital in Fez in 2019.
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Lee, Po-Chang, Yu-Pin Chang e Yu-Yun Tung. "Comprehensive Policies". In Digital Health Care in Taiwan, 55–83. Cham: Springer International Publishing, 2022. http://dx.doi.org/10.1007/978-3-031-05160-9_4.
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AbstractWith the sharply escalating medical expenses, the National Health Insurance Administration (NHIA) has implemented a number of programs to contain expenditure, deliver patient-centered health care, and meet the medical needs of the super-aged society that Taiwan will face in the future.Taiwan has followed the steps of many advanced countries to separate medicine and pharmacy to promote medication safety. In this chapter, we describe various obstacles and contingent approaches to implementing a policy that is quite against the social norm. The outcome was analyzed to evaluate the effect of this controversial policy. To connect long-term care seamlessly after hospital discharge, discharge planning and follow-up management fees are covered by the National Health Insurance (NHI). The NHIA has also endeavored to encourage two-way referrals in the tiered medical care structure since 2017, hoping to improve the efficiency of the overall healthcare system through the redistribution of workload and the continuity of health care. Therefore, in addition to increasing the reimbursement for hospitalization and emergency treatment, differences in co-payment for referral visits from different levels of hospitals were applied to encourage better healthcare-seeking behavior. We also discuss the decision-making process of the on-going co-payment adjustment at the end of the chapter.
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"Hospital Services". In Hospital Reimbursement, 47–58. Productivity Press, 2012. http://dx.doi.org/10.1201/b12212-5.
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"Statement of Operations (Income Statement)". In Hospital Reimbursement, 155–66. Productivity Press, 2012. http://dx.doi.org/10.1201/b12212-10.
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"Statement of Financial Position (Balance Sheet)". In Hospital Reimbursement, 167–82. Productivity Press, 2012. http://dx.doi.org/10.1201/b12212-11.
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"Coding". In Hospital Reimbursement, 183–92. Productivity Press, 2012. http://dx.doi.org/10.1201/b12212-12.
Texto completo da fonteTrabalhos de conferências sobre o assunto "Bureau of Hospital Reimbursement"
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Ariwardani, Betty Nurizky, Didik Gunawan Tamtomo e Bhisma Murti. "Path Analysis on the Determinants of Hospital Lost Under INA-CBGS Reimbursement for Patient with Dengue Hemorrhagic Fever in Ngawi Regional Public Hospital, East Java". In The 7th International Conference on Public Health 2020. Masters Program in Public Health, Universitas Sebelas Maret, 2020. http://dx.doi.org/10.26911/the7thicph.04.35.
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ABSTRACT Background: Hospitals are demanded to be more efficient and effective in providing medical services to avoid losses in the era of National Health Insurance. The increase in cases of dengue hemorrhagic fever (DHF) is a burden on the cost of medical services in Indonesia. This study aimed to examine the determinants of hospital lost under Indonesia Case-Based Groups (INA-CBGs) reimbursement for patients with dengue hemorrhagic fever (DHF). Subjects and Method: A cross-sectional study was carried out at dr. Soeroto hospital, Ngawi, East Java, from September to October 2019. A sample of 200 in-patients was selected by simple random sampling. The dependent variable was tariff difference between INA-CBGs and hospital cost. The independent variables were class of treatment, length of stay, blood transfusion, co-morbidity, and complication. The data were obtained from DHF in-patients’ medical record. The data were analyzed by path analysis model run on Stata 13. Results: Tariff difference was directly and positively affected by length of stay (b= 2.77; 95% CI= 1.78 to 3.75; p<0.001), blood transfusion (b= 2.95; 95% CI= 0.36 to 5.54; p= 0.025), patients age (b= 0.09; 95% CI= -1.52 to 1.71; p= 0.907), co-morbidity (b= 0.58; 95% CI= -1.07 to 2.22; p= 0.491), and complication (b= 0.34; 95% CI= -1.69 to 2.36; p= 0.743). Tariff difference was directly and negatively affected by type of treatment (b= -0.81; 95% CI= -2.02 to 0.40; p= 0.191). Tariff difference was indirectly affected by co-morbidity, complication, class of treatment, and patient age. Conclusion: Tariff difference is directly and positively affected by length of stay, blood transfusion, patient age, co-morbidity, and complication. Tariff difference is directly and negatively affected by type of treatment. Tariff difference is indirectly affected by co-morbidity, complication, class of treatment, and patient age. Keywords: INA CBGs, hospital tariff, care cost, dengue hemorrhagic fever Correspondence: Betty Nurizky Ariwardani. Masters Program in Public Health, Universitas Sebelas Maret, Jl. Ir. Sutami 36A, Surakarta, Central Java, Indonesia. Email: bettyna175@-gmail.com. Mobile: 082233243164. DOI: https://doi.org/10.26911/the7thicph.04.35
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Merczel, S., A. Zemplényi e A. Fittler. "2SPD-017 Analysis and monitoring of the workload and financial burden of dispensing high-cost medicines with item-based reimbursement in Hungarian hospital pharmacies". In 26th EAHP Congress, Hospital pharmacists – changing roles in a changing world, 23–25 March 2022. British Medical Journal Publishing Group, 2022. http://dx.doi.org/10.1136/ejhpharm-2022-eahp.18.
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Taylor, Ellen, Anjali Joseph, Xiaobo Quan e Upali Nanda. "Designing a Tool to Support Patient Safety: Using Research to Inform a Proactive Approach to Healthcare Facility Design". In Applied Human Factors and Ergonomics Conference. AHFE International, 2022. http://dx.doi.org/10.54941/ahfe1001343.
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Healthcare architecture has become an increasingly specialized field, marked by a complex interaction between people, operations and the physical environment and an ever changing landscape of regulation and reimbursement. Patient safety is often considered in a behavioral context – what can someone do differently to improve outcomes? However, as a complex system of interactions, patient safety is better advanced through a systems-thinking lens of Human Factors/Ergonomics (HFE). Attaianese and Duca commented on the use of HFE principles in design, stating that, “when the system is the built environment, the systemic approach requires that designers move from an attention exclusively reserved for building functions towards the set of actions that users actually perform and that building has to support.” This paper reports the development of a proactive Safety Risk Assessment (SRA) tool which will contribute to the 2014 Facility Guidelines Institute (FGI) Guidelines for the Design and Construction of Hospitals and Outpatient Facilities. Six hazard areas have been considered as underlying conditions to injury or harm in the design of healthcare environments: 1) Hospital Associated Infections, 2) Falls/Immobility, 3) Medication Safety, 4) Patient Handling, 5) Security, and 6) Behavioral Health/Psychiatric Injury. These categories have been developed using iterative cycles of Delphi and nominal group methods to achieve consensus of categories and question sets for inclusion in the SRA.
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Yamaguchi, Hiromi, e Yasunobu Ito. "Changes in the Relationship between Medical Professionals Mediated by an Information Tool: An Ethnography of Team Medicine in Japan". In 13th International Conference on Applied Human Factors and Ergonomics (AHFE 2022). AHFE International, 2022. http://dx.doi.org/10.54941/ahfe1002550.
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Comparing the percentage of the total population aged 65 and over in 2021, Japan (29.1%) is the world's highest super-aged society. It has been predicted for some time that the existing healthcare system would not be able to cope with the increasing demand for healthcare. One of the government's proposals to restructure the healthcare system is to make greater use of team medicine.The purpose of this paper is to clarify what has changed through team medicine mediated by information tools. The study site was a medium-sized hospital in a regional city in Japan. The research method used was ethnography with a focus on participant observation. The study period was eight years, from 2012 to 2020. One of the authors conducted the investigation while working at the hospital as a hospital staff. In the 2012 revision of medical fees, the Ministry of Health, Labor and Welfare (MHLW) added the new item of "guidance and management for prevention of dialysis (through team medicine)" to prevent serious complications in diabetic patients.The new reimbursement system only set out the conditions for calculation and left the operation of the system to the hospitals themselves. Hospitals were initially confused, and medical professionals did not know what to do. However, the introduction of the MAP information tool, which visualizes and lists the patients' treatment status, has made it possible for the health professionals to work proactively. Through the mediation of MAP, inadequate treatment of patients (e.g., lack of necessary tests, inadequate selection of appropriate drugs, etc.) became clear. Under such circumstances, not only nurses and pharmacists but also medical secretaries have been transformed into people who are relied upon by doctors. Such a change was born from their attitude that they did not accept team medicine, which was mainly based on hierarchy and division of labor among medical professionals, and that they were willing to take on the work of other professions. In other words, each specialized profession filled in the gaps in patient care that tended to arise by overlapping their respective duties. In addition, the relationship between doctors and other professionals has changed from a hierarchical relationship to a mutual relationship in which problems are raised.In conclusion, it was found that the mediation of information tools and the overlapping of work with other professions with one's own professional area did not reduce the organizational capacity of the team and promoted positive changes in professional relationships.
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Lee, Yuk Yee Karen, e Kin Yin Li. "THE LANDSCAPE OF ONE BREAST: EMPOWERING BREAST CANCER SURVIVORS THROUGH DEVELOPING A TRANSDISCIPLINARY INTERVENTION FRAMEWORK IN A JIANGMEN BREAST CANCER HOSPITAL IN CHINA". In International Psychological Applications Conference and Trends. inScience Press, 2021. http://dx.doi.org/10.36315/2021inpact003.
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"Breast cancer is a major concern in women’s health in Mainland China. Literatures demonstrates that women with breast cancer (WBC) need to pay much effort into resisting stigma and the impact of treatment side-effects; they suffer from overwhelming consequences due to bodily disfigurement and all these experiences will be unbeneficial for their mental and sexual health. However, related studies in this area are rare in China. The objectives of this study are 1) To understand WBC’s treatment experiences, 2) To understand what kinds of support should be contained in a transdisciplinary intervention framework (TIP) for Chinese WBC through the lens that is sensitive to gender, societal, cultural and practical experience. In this study, the feminist participatory action research (FPAR) approach containing the four cyclical processes of action research was adopted. WBC’s stories were collected through oral history, group materials such as drawings, theme songs, poetry, handicraft, storytelling, and public speech content; research team members and peer counselors were involved in the development of the model. This study revealed that WBC faces difficulties returning to the job market and discrimination, oppression and gender stereotypes are commonly found in the whole treatment process. WBC suffered from structural stigma, public stigma, and self-stigma. The research findings revealed that forming a critical timeline for intervention is essential, including stage 1: Stage of suspected breast cancer (SS), stage 2: Stage of diagnosis (SD), stage 3: Stage of treatment and prognosis (ST), and stage 4: Stage of rehabilitation and integration (SRI). Risk factors for coping with breast cancer are treatment side effects, changes to body image, fear of being stigmatized both in social networks and the job market, and lack of personal care during hospitalization. Protective factors for coping with breast cancer are the support of health professionals, spouses, and peers with the same experience, enhancing coping strategies, and reduction of symptom distress; all these are crucial to enhance resistance when fighting breast cancer. Benefit finding is crucial for WBC to rebuild their self-respect and identity. Collaboration is essential between 1) Health and medical care, 2) Medical social work, 3) Peer counselor network, and 4) self-help organization to form the TIF for quality care. The research findings are crucial for China Health Bureau to develop medical social services through a lens that is sensitive to gender, societal, cultural, and practical experiences of breast cancer survivors and their families."
Relatórios de organizações sobre o assunto "Bureau of Hospital Reimbursement"
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Rosenbaum, Sara. In the Pandemic, Patients Need Health Insurance, Not a Hospital “Claims Reimbursement” Fund. Milbank Quarterly, maio de 2020. http://dx.doi.org/10.1599/mqop.2020.0501.
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Brown, Yolanda, Twonia Goyer e Maragaret Harvey. Heart Failure 30-Day Readmission Frequency, Rates, and HF Classification. University of Tennessee Health Science Center, dezembro de 2020. http://dx.doi.org/10.21007/con.dnp.2020.0002.
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30 Day Hospital Readmission Rates, Frequencies, and Heart Failure Classification for Patients with Heart Failure Background Congestive heart failure (CHF) is the leading cause of mortality, morbidity, and disability worldwide among patients. Both the incidence and the prevalence of heart failure are age dependent and are relatively common in individuals 40 years of age and older. CHF is one of the leading causes of inpatient hospitalization readmission in the United States, with readmission rates remaining above the 20% goal within 30 days. The Center for Medicare and Medicaid Services imposes a 3% reimbursement penalty for excessive readmissions including those who are readmitted within 30 days from prior hospitalization for heart failure. Hospitals risk losing millions of dollars due to poor performance. A reduction in CHF readmission rates not only improves healthcare system expenditures, but also patients’ mortality, morbidity, and quality of life. Purpose The purpose of this DNP project is to determine the 30-day hospital readmission rates, frequencies, and heart failure classification for patients with heart failure. Specific aims include comparing computed annual re-admission rates with national average, determine the number of multiple 30-day re-admissions, provide descriptive data for demographic variables, and correlate age and heart failure classification with the number of multiple re-admissions. Methods A retrospective chart review was used to collect hospital admission and study data. The setting occurred in an urban hospital in Memphis, TN. The study was reviewed by the UTHSC Internal Review Board and deemed exempt. The electronic medical records were queried from July 1, 2019 through December 31, 2019 for heart failure ICD-10 codes beginning with the prefix 150 and a report was generated. Data was cleaned such that each patient admitted had only one heart failure ICD-10 code. The total number of heart failure admissions was computed and compared to national average. Using age ranges 40-80, the number of patients re-admitted withing 30 days was computed and descriptive and inferential statistics were computed using Microsoft Excel and R. Results A total of 3524 patients were admitted for heart failure within the six-month time frame. Of those, 297 were re-admitted within 30 days for heart failure exacerbation (8.39%). An annual estimate was computed (16.86%), well below the national average (21%). Of those re-admitted within 30 days, 50 were re-admitted on multiple occasions sequentially, ranging from 2-8 re-admissions. The median age was 60 and 60% male. Due to the skewed distribution (most re-admitted twice), nonparametric statistics were used for correlation. While graphic display of charts suggested a trend for most multiple re-admissions due to diastolic dysfunction and least number due to systolic heart failure, there was no statistically significant correlation between age and number or multiple re-admissions (Spearman rank, p = 0.6208) or number of multiple re-admissions and heart failure classification (Kruskal Wallis, p =0.2553).