Undervaluation of Perioperative Work for ACL Reconstruction by Relative Value Scale Update Committee Methodology in a Single Surgeon's Practice.

Objectives: The purpose of this study was to determine the accuracy of the Relative Value Update Committee (RUC) and Centers for Medicare & Medicaid Services current times and work relative value units (wRVUs) for the perioperative work involved in anterior cruciate ligament (ACL) reconstruction by directly timing perioperative tasks as they occur in real time.

Methods: The RUC was contacted to obtain a list of perioperative tasks and the corresponding times allotted for the tasks involved in arthroscopically aided ACL reconstruction (Current Procedural Terminology code 29888). The tasks that occurred both inside and outside the operating room were timed by the attending physician as the event occurred.

Higher than expected telemedicine use by racial and ethnic minority and cognitively impaired Medicare beneficiaries.

Although pandemic-era telemedicine flexibilities may have preserved access to care, concerns remain that telemedicine may have been inequitably distributed among older adults, especially those with mild cognitive impairment or dementia (MCID). As telemedicine flexibilities are set to fully expire on December 31, 2024, we aimed to examine pandemic-era and future-intended telemedicine use among older Americans to help inform post-pandemic telemedicine policy design. We hypothesized that telemedicine would be disproportionately underutilized among older adults with MCID or with racial and ethnic minority status.

Postoperative Surveillance Adherence in Colorectal Cancer Patients at Urban Medical Centers: Is It Adequate?

Introduction Colorectal cancer (CRC) is among the most frequent cancers in the United States. There are recognized guidelines for monitoring after curative CRC excision. This study looks into the rate of compliance with surveillance guidelines following CRC resection, as well as the impact of demographic characteristics.

Timing and Outcomes of PCI in Conjunction With TAVR With Balloon-Expandable Valves.

Background: The optimal timing for percutaneous coronary intervention (PCI) in patients undergoing transcatheter aortic valve replacement (TAVR) is debatable.

Objectives: The aim of this study was to compare outcomes based on the timing of PCI in stable coronary artery disease patients undergoing TAVR.

Methods: Leveraging the STS/ACC TVT Registry and Medicare Linkage, we analyzed patients with stable coronary artery disease undergoing PCI and TAVR between 2015 and 2023 using the SAPIEN 3 balloon-expandable valve platform.

Changes in Out-of-Pocket Drug Expenditures Among Medicare Beneficiaries with Dementia Under the Inflation Reduction Act: A Simulation Study.

Objectives: We investigated how the Inflation Reduction Act (IRA) Medicare Part D benefit redesign may reduce out-of-pocket (OOP) drug expenditures for Medicare beneficiaries with dementia. Methods Design Utilizing data from the Health and Retirement Study (HRS) linked with Medicare claims, we simulated post-redesign OOP drug spending by applying the 2025 prescription drug cost-sharing rules to each beneficiary's pre-redesign Part D medication utilization data for 2016, adjusting for inflation. Participants Our study population comprised HRS respondents aged 65 and older in 2016, enrolled in Medicare fee-for-service, with at least one Part D drug claim in 2016, and diagnosed with dementia between 2000 and 2016 (n=1,677).

Falling Rates of Public Orthopaedic Surgery Reimbursements and Utilization, 2016 to 2024.

Background: Declining reimbursement rates can lead to decreased access and utilization of common orthopaedic surgeries for patients on Medicare, which is a particularly vulnerable population for musculoskeletal injuries.

Methods: Using the Centers for Medicare & Medicaid Services Physician Fee Schedule Look-Up Tool from 2016 to 2024 and utilization data for Medicare and part B beneficiaries from 2016 to 2022, we analyzed reimbursement and utilization trends. Simple linear regressions were executed to measure the annual trends, and Wilcoxon matched-pairs signed rank test were used to analyze the statistical significance of price and utilization changes.

Improved Risk Adjustment for Comorbid Diagnoses in Administrative Claims Analyses of Orthopaedic Surgery.

Background: The accurate inclusion of patient comorbidities ensures appropriate risk adjustment in clinical or health services research and payment models. Orthopaedic studies often use only the comorbidities included at the index inpatient admission when quantifying patient risk. The goal of this study was to assess improvements in capture rates and in model fit and discriminatory power when using additional data and best practices for comorbidity capture.

Updated Adjustment of the HCAHPS Survey for New Modes of Survey Administration and Patient Mix.

Background: Web-first multimode survey protocols increase HCAHPS survey response rates and representativeness but may result in different HCAHPS scores because of survey mode effects and selective email address availability. A variable absent from many patient-mix adjustment models that may result in more positive patient experiences is whether the hospital admission was planned; adjustment for planned stays may better measure hospital performance.

Objectives: Develop adjustments for new Web-first survey protocols and planned admissions to facilitate comparisons across hospitals.

Medicare telehealth utilization by Rural Health Clinics and Federally Qualified Health Centers prior to and during the COVID-19 pandemic.

Purpose: To address the extent to which Federally Qualified Health Centers (FQHCs) and independent and provider-based Rural Health Clinics (RHCs) were using telehealth prior to and during the COVID-19 pandemic.

Methods: A nationally representative 5% sample of Medicare Fee-for-Service beneficiaries who used outpatient services at FQHCs and RHCs were identified within the 2019-2021 5% Medicare Limited Data Set Outpatient and Carrier files. Rural-Urban Continuum Codes were used to identify rural-urban clinic locations.

Outcomes following intradetrusor onabotulinumtoxinA in a national cohort of nursing home residents.

Objectives: To determine predictors of treatment success and complications following intradetrusor onabotulinumtoxinA injections among a large cohort of nursing home (NH) residents, representing one of the most frail and vulnerable populations in the United States.

Materials And Methods: This is a retrospective cohort study of long-stay NH residents who underwent onabotulinumtoxinA injections between 2014 and 2016. Residents were identified using the Minimum Data Set (MDS) linked to Medicare claims.

Achievement of guideline-based lipid goals among very-high-risk patients with atherosclerotic cardiovascular disease and type 2 diabetes: results in 213,380 individuals from the cvMOBIUS2 registry.

Objective: Lowering lipid to reach guideline-indicated goals significantly reduces cardiovascular outcomes in very-high-risk (VHR) patients with atherosclerotic cardiovascular disease (ASCVD) and type 2 diabetes (DM2). How well VHR patients currently achieve these goals in community practice is unknown.

Methods: VHR patients with ASCVD and DM2 were identified across 14 US healthcare systems using electronic health records between 1/1/2021-12/31/2022.

Linking American Spine Registry (ASR) and Medicare Data:an analysis of 8,755 Lumbar Fusion Cases.

Study Design: Retrospective observational study.

Objective: To evaluate whether the combined American Spine Registry and Medicare (ASR/CMS) data yields substantially different findings versus ASR data alone with regard to key parameters such as risk stratification, complication rates and readmission rates in lumbar surgery investigated through an analysis of 8,755 spondylolisthesis cases.

Summary Of Background Data: Medicare data correlation has been effective for determining revision rates for other procedures such as total hip replacement.

Readmissions and Mortality After "Before Medically Advised" Hospital Discharges Among Medicare Beneficiaries with Opioid Use Disorder.

Background: "Before medically advised" (BMA) discharges are rising among hospitalized people with opioid use disorder (OUD) and associated with worse outcomes. However, little is known about BMA discharge among the growing share of U.S.

Economic impact associated with dronedarone use in patients with atrial fibrillation.

Objective/AimIn 2009, dronedarone was approved by the United States Food and Drug Administration based on results from the ATHENA trial (NCT00174785), which showed significant reduction of cardiovascular (CV) hospitalization and death in patients with atrial fibrillation (AF) randomized to dronedarone versus placebo. In 2020, a retrospective study by Goehring et al. showed CV hospitalizations and deaths were lower in clinical practice following initiation of dronedarone compared to other antiarrhythmic drugs (AADs) in patients with AF and atrial flutter.

Association between governmental spending on social services and health care use among low-income older adults.

Prior research demonstrates that local government spending on social policies, excluding health care, is linked to improved population health. Whether such spending is associated with better access to primary care and reduced acute care utilization remains unclear. In this cross-sectional study, we evaluated the associations between county-level social spending and individual-level health care utilization among low-income Medicare beneficiaries, aged ≥65 years, from 2016 to 2018.

Medicare Resource Use Differs by English Reading Proficiency.

Background And Objectives: Medicare coverage decisions are complex. The Centers for Medicare & Medicaid Services (CMS) provides a hotline, handbook, and website to help Medicare beneficiaries understand their benefits and coverage options, yet it is unclear what factors affect beneficiary use of these resources. We examined limited English speaking and English reading proficiency status as predictors of CMS Medicare informational resource use in a nationally representative sample of Medicare beneficiaries.

Enhancing healthcare cost transparency: assessing implementation challenges, criticisms, and alternative solutions.

The United States healthcare system grapples with a staggering estimated waste of $935 billion, with pricing failure contributing a substantial $240.5 billion. This paper explores an innovative solution to combat rapidly escalating healthcare costs by proposing measures that would complement the mandated disclosure of healthcare prices.

CARDIAC-STAR: prevalence of cardiovascular comorbidities in patients with HR + /HER2 - metastatic breast cancer.

Background: Cardiovascular (CV) comorbidities and concurrent medications with risk of heart rate-corrected QT interval (QTc) prolongation can impact treatment decisions and safety discussions for patients with breast cancer. However, limited data are available regarding their prevalence in patients with HR + /HER2- metastatic breast cancer (mBC). We evaluated the prevalence of CV comorbidities, the use of concurrent medications with risk of QTc prolongation, and treatment patterns in patients with newly diagnosed HR + /HER2 - mBC.

Outpatient chemotherapy drug costs and expensive chemotherapy drug use in 340B and Non-340B hospitals: an observational study.

Background: The 340B Drug Pricing Program has been controversial since its inception in 1992, a major criticism being that 340B hospitals use more outpatient drugs, and more expensive drugs, because of financial incentives to "make money" through the program. The goal of this study was to determine whether characteristics of patients treated at 340B hospitals, and affiliation of hospitals with NCI-designated cancer centers, would explain higher Part B drug costs and use of more expensive chemotherapy drugs.

Methods: This is an observational study using data from SEER-Medicare and 340B entity database.

Competencies of nurses to participate in safe medication management practices for biologics: A scoping review.

Aim: To review the existing literature relating to nurse competence in safe medication management practices for biologics, identify evidence, and develop a competency framework to clarify the role of nurses in these practices.

Background: With the widespread use of biological agents in disease treatment, ensuring the safe and economical use of high-cost medicines is particularly important. Even though nurses are essential in patient care, detailed knowledge regarding their competence and role in the safe administration of biologics is lacking.

The real rotational capacity of the human joints - the muscular and gravitational torques and the foot as a platform.

The purpose was to answer what is the relationship between torques acting on the human body, how does the triceps calf muscle balance the weight of a tilted body and what is the foot's role in the titling body? Two research models were developed. Model 1 - the one-sided lever system consists of a flat bar with, an axis of rotation, used to determine the weight and torque at a given point on it. Model 2 - the two-sided lever system consists of a flat bar imitating a tilted body counteracted by the Achilles tendon, and a platform imitating a foot.

Medication Use Quality and Safety in Older Adults: 2023 Update.

Improving the quality of medication use and medication safety are important priorities for healthcare providers who care for older adults. The objective of this article was to identify four exemplary articles with this focus in 2023. We selected high-quality studies that advanced this field of research.

Assessing the Value of Further Investment in R&D Using Mixed Methods: A Case Study of Biosensor-Integrated Arteriovenous Grafts.

This study illustrates the utility of a mixed-methods approach in assessing the value of an example novel technology-biosensor-integrated self-reporting arteriovenous grafts (smart AVGs). Currently in preclinical development, the device will detect arteriovenous graft stenosis (surveillance-only use case) and treat stenosis (interventional use case). The approach to value assessment adopted in this study was multifaceted, with one stage informing the next and comprised a stakeholder engagement with clinical experts to explore the device's clinical value, a cost-utility analysis (CUA) from a US Medicare perspective to estimate pricing headroom, and an investment model estimating risk-adjusted net present value analysis (rNPVs) to determine commercial viability.

Medicare Payment for Calcium Modification Technologies Among Patients Undergoing Percutaneous Coronary Intervention, 2021-2022.

Background: The Centers for Medicare and Medicaid Services (CMS) New Technology Add-on Payment (NTAP) program supports adoption of new, costly medical technologies demonstrating substantial clinical improvement. In 2021, CMS waived the "substantial clinical improvement" criterion for devices designated under the FDA Breakthrough Devices Program (BDP). This study characterized risk-standardized payments associated with hospitalizations in which Medicare beneficiaries received calcium modification during PCI for acute myocardial infarction (AMI) following the adoption of the Shockwave C Coronary Intravascular Lithotripsy (IVL) Catheter (Shockwave Medical) with BDP designation.