Time-Driven Activity Based Costing Analysis of Panretinal Photocoagulation.

Time-driven activity-based costing analysis of panretinal photocoagulation shows 47.8% of cases have a negative margin relative to maximum Medicare reimbursement, with large financial disincentives for bilateral cases, which may disincentivize high-value care for vulnerable patients.

Gender disparities in industry payments to neurosurgeons: a comprehensive analysis of Centers for Medicare & Medicaid Services Open Payments data (2016-2022).

Objective: This study aimed to investigate the extent of gender disparities in financial interactions between neurosurgeons and the medical device industry, examining the differences in the number, amount, and types of payments made to male and female neurosurgeons.

Methods: Utilizing data from the Centers for Medicare & Medicaid Services Open Payments database covering 2016-2022, the authors conducted a comprehensive analysis of industry payments to neurosurgeons. This methodology included univariate and multivariate analyses to examine the disparities in payments, with a focus on identifying significant differences in compensation across genders.

Economic impact and clinical benefits of clinical pharmacy interventions: A six-year multi-center study using an innovative medication management tool.

Background: Increasing healthcare costs, particularly in Low- and Middle-Income Countries (LMICs) like Egypt, highlight the need for rational economic strategies. Clinical pharmacy interventions offer potential benefits by reducing drug therapy problems and associated costs, thereby supporting healthcare system sustainability.

Objective: This study evaluates the economic impact and clinical benefits of clinical pharmacy interventions in four tertiary hospitals in Egypt by implementing an innovative tool for medication management, focusing on cost avoidance and return on investment (ROI), while accounting for case severity and drug therapy problem (DTP) resolution.

Dementia and Emergency Department Use in Older Adults With Systemic Lupus Erythematosus: An Administrative Claims Data Analysis of Medicare Beneficiaries.

Background/objective: Systemic lupus erythematosus (SLE) is associated with increased dementia risk. Whether this association is present among older adults with SLE is unclear. Further, whether individuals with concomitant SLE and dementia are at increased risk of emergency department (ED) use has not been explored.

Industry affiliation influence on randomized controlled trials for platelet-rich plasma in the treatment of lateral epicondylitis: a systematic review.

Background: Explicit funding and industry affiliation are believed to potentially impact medical research. There have been an increasing number of studies that have evaluated this relationship. The purpose of this study is to determine whether industry affiliation influences the outcomes of randomized controlled trials that investigate the effectiveness of platelet-rich plasma (PRP) in the treatment of lateral epicondylitis.

Hospitalization outcomes among older adults living undiagnosed or unaware of dementia.

Introduction: Many persons with dementia are undiagnosed or unaware of dementia, which may affect hospitalization outcomes.

Methods: We evaluated differences in length of stay, days not at home, discharge destination, and 30-day readmissions over 1 year in 6296 older adults in the National Health and Aging Trends Study with linked Medicare claims. Multivariable-adjusted models compared outcomes across no dementia, undiagnosed dementia, unaware but diagnosed with dementia, and aware and diagnosed with dementia.

Coding intensity variation in Medicare Advantage.

Enrollment in Medicare Advantage (MA) plans rose to over 50% of eligible Medicare patients in 2023. Payments to MA plans incorporate risk scores that are largely based on patient diagnoses from the prior year, which incentivizes MA plans to code diagnoses more intensively. We estimated coding inflation rates for individual MA contracts using a method that allows for differential selection into contracts based on patient health.

Services and payments associated with the medicare new technology add-on payment program.

In 2001, the Centers for Medicare and Medicaid Services established the New Technology Add-On Payment (NTAP) program to incentivize access to costly new technologies for Medicare beneficiaries. These technologies, authorized by the Food and Drug Administration (FDA), must demonstrate "substantial clinical improvement" when compared to existing technologies. However, in FY2021, the FDA introduced two expedited authorization pathways, allowing technologies with either designation to bypass the "substantial clinical improvement" criterion.

Growth of the Program of All-Inclusive Care for the Elderly and the role of for-profit programs.

The Program of All-Inclusive Care for the Elderly (PACE) is a managed care program financed by capitated government payments that primarily serves adults aged 55 or older requiring nursing home level of care who are dual-eligible for Medicare and Medicaid. While PACE programs have historically been nonprofit entities, in 2016, a regulation change allowed for-profit PACE programs to help expand the program. We describe PACE program growth from 2010 to 2022.

Usage patterns of cognitive assessments during Medicare's Annual Wellness Visit: A national survey.

Introduction: Medicare's Annual Wellness Visit (AWV) is a logical opportunity for early detection of cognitive impairment, but recent data for uptake and cognitive assessments during it are lacking.

Methods: We surveyed Medicare beneficiaries of a nationally representative panel about use of AWV and cognitive assessments and analyzed associations between uptake and beneficiaries' characteristics.

Results: Of 1871 participants, 80% had an AWV, among whom 31% underwent formal cognitive testing, 35% were asked about memory problems, including 15% having both.

A Framework for Behavioral Health Integration in the Program of All-Inclusive Care for the Elderly (PACE).

Background: The Program of All-inclusive Care for the Elderly (PACE) is a comprehensive care model that aims to promote aging in the home and community for older adults who are nursing-home eligible needs-wise. Older adults experience age-related barriers to accessing behavioral health (BH) services. PACE programs play an important role in providing all-inclusive health care for individuals over 55 who are dually eligible for Medicaid and Medicare.

Impact of Lookback Duration on the Performance of a Claims-Based Frailty Proxy in Women With Stage I-III Breast Cancer.

Background: Frailty is an important prognostic indicator in older women with breast cancer. The Faurot frailty index, a validated claims-based frailty proxy measure, uses healthcare billing codes during a user-specified ascertainment window to predict frailty. We assessed how the duration of frailty ascertainment affected the ability of the Faurot frailty index to predict one-year mortality in women with stage I-II breast cancer.

Impact of Disability on Postoperative Outcomes After Gastrointestinal Cancer Surgery.

Introduction: Approximately 61 million individuals in the United States have a disability and face unique challenges, resulting in healthcare disparities.

Objective: We aimed to evaluate the impact of disability on postoperative outcomes and number of healthy days at home (HDAH).

Methods: Patients who underwent surgery for gastrointestinal (GI) cancer between 2017 and 2020 were identified using the Medicare database.

Health Care Utilization and Costs for Older Adults Aging Into Medicare After the Affordable Care Act.

Importance: The Affordable Care Act (ACA) expanded Medicaid and Marketplace insurance to nonelderly adults in 2014, but whether these policies improved outcomes later in life is unknown.

Objective: To examine whether exposure to ACA expansions during middle age (50-64 years) was associated with changes in health, utilization, and spending after these adults entered Medicare at 65 years of age.

Design, Setting, And Participants: This serial analysis of the Health and Retirement Study cohort linked to Medicare enrollment and claims data from January 1, 2010, to December 31, 2018.

Utilization of Telemedicine for Patients Receiving In-center Hemodialysis in the United States.

Background: In March 2020, responding to the COVID-19 pandemic, federal emergency waivers in the United States enabled kidney care providers (nephrologists and advanced practice providers) to substitute face-to-face in-center hemodialysis visits with telemedicine encounters. We examined whether the frequency of kidney care provider visits and hospitalizations were associated with telemedicine use in hemodialysis care.

Methods: We used Medicare claims to identify US patients receiving in-center hemodialysis during the first 16 months of the COVID-19 pandemic.

How to Provide Additional Oversight to Ensure That Remote Patient Monitoring for People With Diabetes is Being Used and Billed Appropriately.

An Office of the Inspector General (OIG) report on September 19, 2024, highlighted the need for additional oversight of remote patient monitoring (RPM), which is covered by Medicare. OIG noted that Medicare claims frequently lack crucial information that would facilitate proper oversight. While Medicare has published guidelines for reimbursement according to RPM billing codes, greater clarity is needed to avoid inadvertent improper billing practices.

Hospital Involvement in Screening for and Addressing Patients' Health-Related Social Needs.

The number of hospitals screening patients for health-related social needs (HRSNs) has increased substantially in recent years, yet little is known about the extent to which hospitals invest in programs or strategies aimed at addressing identified needs. Using data from the 2022 American Hospital Association (AHA) Annual Survey for 2,468 non-federal general medical and surgical hospitals, this study explored screening rates and related interventions for eight HRSNs: housing, food insecurity, utilities, interpersonal violence, transportation, employment or income, education, and social isolation. Sample hospitals screened for an average of 6.

Parental Factors Associated With Measles-Mumps-Rubella Vaccination in US Children Younger Than 5 Years.

To determine the association between parental characteristics and MMR (measles-mumps- rubella) vaccination status of children in the United States. We conducted a cross-sectional study from July 2023 to April 2024 using a digital health survey via OutbreaksNearMe, weighted to target national population characteristics. We analyzed the responses of 19 892 parents of children younger than 5 years to examine the association between self-reported parental characteristics (i.

Workforce Attrition Among Emergency Medicine Non-Physician Practitioners.

Study Objective: Non-physician practitioners, including nurse practitioners and physician assistants, increasingly practice in emergency departments, especially in rural areas, where they help mitigate physician shortages. However, little is known about non-physician practitioner durability and demographic trends in emergency departments. Our objective was to examine attrition rates and ages among non-physician practitioners in emergency medicine.

Statin Use With Immune Checkpoint Inhibitors and Survival in Nonsmall Cell Lung Cancer.

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.

Nationwide trends and outcomes of percutaneous coronary intervention for stable ischemic heart disease in end-stage kidney disease: a longitudinal study.

Background: Patients with end-stage kidney disease (ESKD) are at high risk for coronary artery disease. We investigate the trends and outcomes of percutaneous coronary intervention (PCI) for stable ischemic heart disease (SIHD) in patients with ESKD.

Methods: We utilized the United States Renal Data System [2010-2018] to include adult patients with ESKD on dialysis for at least 3 months who underwent PCI for SIHD.