The elimination of urban-rural differences in the Medicare prospective payment system (PPS) standard rates implies a need to re-examine all the PPS payment adjustments. Refinements for case mix, outliers, and the wage index can make a significant contribution to avoiding payment disparities in a single-rate system. However, changes in the adjustments for teaching and disproportionate-share (DSH) hospitals are also needed. The typically urban location of these hospitals makes it difficult to balance PPS payments and costs among major groups of urban and rural hospitals without some form of higher payment for all hospitals located in large urban areas.
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Ann Thorac Surg
January 2025
Division of Thoracic Surgery, Yale School of Medicine, New Haven, CT.
Background: Prospective randomized trials have demonstrated noninferior survival between sublobar resection and lobectomy in healthy non-small cell lung cancer (NSCLC) patients with tumors ≤2cm. However, some patient attributes are not well represented in randomized trials and uncertainty remains in the widespread applicability of randomized trial nodal dissection protocols.
Methods: Patients with ≤2cm, node-negative NSCLC (cT1N0) in the Society of Thoracic Surgeons prospective database were linked to Medicare survival data using a probabilistic matching algorithm.
Clin Lung Cancer
December 2024
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD.
Objective: To determine the association between concurrent statin use with immune checkpoint inhibitors (ICIs) and lung cancer-specific and overall mortality in patients with nonsmall cell lung cancer (NSCLC).
Materials And Methods: SEER-Medicare was used to conduct a retrospective study of Medicare beneficiaries ≥65 years of age diagnosed with NSCLC between 2007 and 2017 treated with an ICI. Patients were followed from date of first ICI claim until death, 1 month from last ICI claim, or 12/31/2018, whichever came first.
J Am Heart Assoc
January 2025
Department of Population Health Sciences Weill Cornell Medicine New York NY.
Background: Transport by mobile stroke units (MSUs), which provide access to computed tomography scanning and intravenous blood pressure medications and thrombolytics, reduces time to treatment and may improve short-term functional outcomes for patients with acute stroke. The longer-term clinical and financial impacts remain incompletely understood. The aim of the study was to determine whether MSU care is associated with better health, utilization, and spending outcomes for patients with suspected acute stroke.
View Article and Find Full Text PDFJ Pharm Policy Pract
January 2025
College of Pharmacy, University of Health Sciences and Pharmacy, St Louis, MO, USA.
Background: The sustainability of community pharmacies in the United States depends, in large part, on policies enacted by the Centers for Medicare and Medicaid Services (CMS). In 2003, CMS policy allowed retrospective direct and indirect remuneration (DIR) fees to manage costs. From 2024, only prospective DIR fees are permitted.
View Article and Find Full Text PDFInt Urogynecol J
January 2025
Division of Urogynecology, Urology Institute, University Hospitals Cleveland, Cleveland, OH, USA.
Introduction And Hypothesis: The objective was to externally validate and recalibrate a previously developed model for predicting postoperative surgical-site infection (SSI) after pelvic organ prolapse (POP) surgery.
Methods: This study utilized a previously validated model for predicting post-POP surgery SSI within 90 days of surgery using a Medicare population. For this study, the model was externally validated and recalibrated using the Premier Healthcare Database (PHD) and the National Surgical Quality Improvement Project (NSQIP) database.
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