Expanding Surveillance Toward Sharing Data with the Community: Qualitative Insights from a Childcare Center Illness Surveillance Program.

Childcare attendance is a recognized independent risk factor for pediatric infectious diseases due to the pathogen-sharing behaviors of young children and the crowded environments of childcare programs. The Michigan Child Care Related Infections Surveillance Program (MCRISP) is a novel online illness surveillance network used by community childcare centers to track disease incidence. It has been used to warn local public health departments about emerging outbreaks.

Impact Of Medicare Readmissions Penalties On Targeted Surgical Conditions.

The Hospital Readmissions Reduction Program, announced in 2010 to penalize excess readmissions for patients with selected medical diagnoses, was expanded in 2013 to include targeted surgical diagnoses, beginning with hip and knee replacements. Whether these surgical penalties reduced procedure-specific readmissions is not well understood. Using Medicare claims, we evaluated the penalty announcements' effects on risk-adjusted readmission rates, episode payments, lengths-of-stay, and observation status use.

Prostate Cancer Surveillance After Radiation Therapy in a National Delivery System.

Guideline concordance with PSA surveillance among veterans treated with definitive radiation therapy was generally high, but opportunities may exist to improve surveillance among select groups.

Comorbidities and Nonalcoholic Fatty Liver Disease: The Chicken, the Egg, or Both?

Improvement in NAFLD may lead to improvement of metabolic syndrome, cardiovascular disease, and malignancy and vice versa.

Risk Adjustment May Lessen Penalties On Hospitals Treating Complex Cardiac Patients Under Medicare's Bundled Payments.

To reduce variation in spending, Medicare has considered implementing a cardiac bundled payment program for acute myocardial infarction and coronary artery bypass graft. Because the proposed program does not account for patient risk factors when calculating hospital penalties or rewards ("reconciliation payments"), it might unfairly penalize certain hospitals. We estimated the impact of adjusting for patients' medical complexity and social risk on reconciliation payments for Medicare beneficiaries hospitalized for the two conditions in the period 2011-13.

Rising Use Of Observation Care Among The Commercially Insured May Lead to Total And Out-Of-Pocket Cost Savings.

Proponents of hospital-based observation care argue that it has the potential to reduce health care spending and lengths-of-stay, compared to short-stay inpatient hospitalizations. However, critics have raised concerns about the out-of-pocket spending associated with observation care. Recent reports of high out-of-pocket spending among Medicare beneficiaries have received considerable media attention and have prompted direct policy changes.

Outcomes For High-Needs Patients: Practices With A Higher Proportion Of These Patients Have An Edge.

High-value primary care for high-needs patients-those with multiple physical, mental, or behavioral health conditions-is critical to improving health system performance. However, little is known about what types of physician practices perform best for high-needs patients. We examined two scale-related characteristics that could predict how well physician practices delivered care to this population: the proportion of patients in the practice that were high-needs and practice size (number of physicians).

A Sustainable Model For Delivering High-Quality, Efficient Cataract Surgery In Southern India.

Cataracts are a leading cause of reversible blindness in India, where millions of people can be effectively treated for this condition with surgery. The Aravind Eye Care System in southern India developed an efficient system for delivering high-quality and low-cost cataract surgery. We provide a detailed accounting of costs of cataract surgery at the system and a cost-utility analysis.

Sight-Threatening Ocular Diseases Remain Underdiagnosed Among Children Of Less Affluent Families.

Sight-threatening eye diseases such as strabismus (misaligned eyes) and amblyopia (lazy eye) develop during childhood. The earlier in life these diseases are diagnosed and effectively treated, the greater the chance of preventing irreversible long-term sight loss. Using 2001-14 claims data for nearly 900,000 US children with health insurance, we followed a cohort for up to fourteen years from birth, to assess whether household net worth affected rates of visits to ophthalmologists and optometrists or rates of diagnoses of strabismus and amblyopia.

Adding A Spending Metric To Medicare's Value-Based Purchasing Program Rewarded Low-Quality Hospitals.

In fiscal year 2015 the Centers for Medicare and Medicaid Services expanded its Hospital Value-Based Purchasing program by rewarding or penalizing hospitals for their performance on both spending and quality. This represented a sharp departure from the program's original efforts to incentivize hospitals for quality alone. How this change redistributed hospital bonuses and penalties was unknown.

Primary care appointment availability for new Medicaid patients increased after Medicaid expansion in Michigan.

The Affordable Care Act expands health insurance coverage to millions of Americans, but the availability of health care services for the newly insured population remains uncertain. We conducted a simulated patient (or "secret shopper") study to assess primary care appointment availability and wait times for new patients with Medicaid or private insurance before and after implementation of Michigan's Medicaid expansion in 2014. The expansion, which was made possible through a section 1115 waiver, has a unique requirement that new beneficiaries must be seen by a primary care provider within 60-90 days of enrollment.

No evidence found that hospitals are using new electronic health records to increase Medicare reimbursements.

The recent uptick in hospital adoption of electronic health records (EHRs) has been accompanied by growing concerns among some policy makers that hospitals may use these systems to select billing codes that reflect more intensive care or a sicker patient population in order to generate more revenue through higher reimbursements. Such "upcoding" would increase overall health care spending. We used national data to examine whether new adoption of EHRs was associated with increases in coded patient acuity or Medicare payments.