How do you implement value‐based care methodologies in dentistry with existing dental organizational paradigms?

Functional tests used in the catheterization laboratory have emerged as a very important adjunctive tool to coronary angiography that can identify patients with myocardial blood flow impairment. Fractional Flow Reserve (FFR) measurement is highly recommended for detection of ischemia-related coronary lesion(s) when objective evidence of vessel-related ischemia is not available. Recently, the much simpler instantaneous wave free ratio (iFR) was proposed as an alternative to FFR without the requirement for administration of vasodilators. More user-friendly techniques like iFR might further contribute to value-based care in coronary interventions.

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Differences in Hospital Costs among Octogenarians and Nonagenarians Following Primary Total Joint Arthroplasty

Geriatrics ◽

10.3390/geriatrics6010026 ◽

2021 ◽

Vol 6 (1) ◽

pp. 26

Author(s):

Christopher Fang ◽

Andrew Hagar ◽

Matthew Gordon ◽

Carl T. Talmo ◽

David A. Mattingly ◽

...

Keyword(s):

Length Of Stay ◽

Total Joint Arthroplasty ◽

Hospital Costs ◽

Cost Effective ◽

Joint Arthroplasty ◽

Nursing Facilities ◽

Activity Based Costing ◽

Skilled Nursing ◽

Value Based Care ◽

Hospital Expenses

The proportion of patients over the age of 90 years continues to grow, and the anticipated demand for total joint arthroplasty (TJA) in this population is expected to rise concomitantly. As the country shifts to alternative reimbursement models, data regarding hospital expenses is needed for accurate risk-adjusted stratification. The aim of this study was to compare total in-hospital costs following primary TJA in octogenarians and nonagenarians, and to determine the primary drivers of cost. This was a retrospective analysis from a single institution in the U.S. We used time-drive activity-based costing (TDABC) to capture granular total hospital costs for each patient. 889 TJA’s were included in the study, with 841 octogenarians and 48 nonagenarians. Nonagenarians were more likely to undergo total hip arthroplasty (THA) (70.8% vs. 42.4%; p < 0.0001), had higher ASA classification (2.6 vs. 2.4; p = 0.049), and were more often privately insured (35.4% vs. 27.8%; p = 0.0001) as compared to octogenarians. Nonagenarians were more often discharged to skilled nursing facilities (56.2% vs. 37.5%; p = 0.0011), experienced longer operating room (OR) time (142 vs. 133; p = 0.0201) and length of stay (3.7 vs. 3.1; p = 0.0003), and had higher implant and total in-hospital costs (p < 0.0001 and 0.0001). Multivariate linear regression showed implant cost (0.700; p < 0.0001), length of stay (0.546; p < 0.0001), and OR time (0.288; p < 0.0001) to be the strongest associations with overall costs. Primary TJA for nonagenarians was more expensive than octogenarians. Targeting implant costs, length of stay, and OR time can reduce costs for nonagenarians in order to provide cost-effective value-based care.

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Otolaryngologist Performance in the Merit-Based Incentive Payment System in 2018

Otolaryngology ◽

10.1177/01945998211032896 ◽

2021 ◽

pp. 019459982110328

Author(s):

Lauren E. Miller ◽

Neil S. Kondamuri ◽

Roy Xiao ◽

Vinay K. Rathi

Keyword(s):

Pay For Performance ◽

Payment System ◽

Incentive Payment ◽

Cross Sectional ◽

Medicare Data ◽

And Performance ◽

Value Based Care ◽

Sectional Analysis ◽

Median Change ◽

Payment Models

In 2017, the Centers for Medicare and Medicaid Services transitioned clinicians to the Merit-Based Incentive Payment System (MIPS), the largest mandatory pay-for-performance program in health care history. The first full MIPS program year was 2018, during which the Centers for Medicare and Medicaid Services raised participation requirements and performance thresholds. Using publicly available Medicare data, we conducted a retrospective cross-sectional analysis of otolaryngologist participation and performance in the MIPS in 2017 and 2018. In 2018, otolaryngologists reporting as individuals were less likely ( P < .001) to earn positive payment adjustments (n = 1076/1584, 67.9%) than those participating as groups (n = 2802/2804, 99.9%) or in alternative payment models (n = 1705/1705, 100.0%). Approximately one-third (n = 1286/4472, 28.8%) of otolaryngologists changed reporting affiliations between 2017 and 2018. Otolaryngologists who transitioned from reporting as individuals to participating in alternative payment models (n = 137, 3.1%) achieved the greatest performance score improvements (median change, +23.4 points; interquartile range, 12.0-65.5). These findings have important implications for solo and independent otolaryngology practices in the era of value-based care.

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What are the risk factors for avoidable transitions in the last year of life? A qualitative exploration of professionals’ perspectives for improving care in Germany

BMC Health Services Research ◽

10.1186/s12913-021-06138-4 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Alina Kasdorf ◽

◽

Gloria Dust ◽

Vera Vennedey ◽

Christian Rietz ◽

...

Keyword(s):

Healthcare Professional ◽

Healthcare Professionals ◽

Qualitative Content Analysis ◽

Individual Interviews ◽

Information Power ◽

Care Services ◽

Healthcare Settings ◽

Nursing Services ◽

Value Based Care ◽

Qualitative Exploration

Abstract Background Little is known about the nature of patients’ transitions between healthcare settings in the last year of life (LYOL) in Germany. Patients often experience transitions between different healthcare settings, such as hospitals and long-term facilities including nursing homes and hospices. The perspective of healthcare professionals can therefore provide information on transitions in the LYOL that are avoidable from a medical perspective. This study aims to explore factors influencing avoidable transitions across healthcare settings in the LYOL and to disclose how these could be prevented. Methods Two focus groups (n = 11) and five individual interviews were conducted with healthcare professionals working in hospitals, hospices and nursing services from Cologne, Germany. They were asked to share their observations about avoidable transitions in the LYOL. The data collection continued until the point of information power was reached and were audio recorded and analysed using qualitative content analysis. Results Four factors for potentially avoidable transitions between care settings in the LYOL were identified: healthcare system, organization, healthcare professional, patient and relatives. According to the participants, the most relevant aspects that can aid in reducing unnecessary transitions include timely identification and communication of the LYOL; consideration of palliative care options; availability and accessibility of care services; and having a healthcare professional taking main responsibility for care planning. Conclusions Preventing avoidable transitions by considering the multicomponent factors related to them not only immediately before death but also in the LYOL could help to provide more value-based care for patients and improving their quality of life.

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Innovative Partnership Between Primary Care, AAA, and Academia Connects 4Ms and Social Determinants of Health

Innovation in Aging ◽

10.1093/geroni/igaa057.352 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 107-107

Author(s):

Suzanne Leahy ◽

Katie Ehlman ◽

Lisa Maish ◽

Brad Conrad ◽

Jillian Hall ◽

...

Keyword(s):

Older Adults ◽

Primary Care ◽

Health System ◽

Preliminary Evaluation ◽

Language And Literacy ◽

Community Based ◽

Primary Care Clinics ◽

College Of Nursing ◽

Value Based Care ◽

The University

Abstract Nationally, there is a growing focus on addressing geriatric care in primary care settings. HRSA’s Geriatric Workforce Enhancement Program (GWEP) has called for academic and health system partners to develop a reciprocal, innovative, cross-sector partnership that includes primary care sites and community-based agencies serving older adults. Through the University of Southern Indiana’s GWEP, the College of Nursing and Health Professions, the Deaconess Health System, three primary care clinics, and two Area Agencies on Aging (AAA) have joined to transform the healthcare of older adults regionally, including rural residents in the 12-county area. Core to the project is a value-based care model that “embeds” AAA care managers in primary care clinics. Preliminary evaluation indicates early success in improving the healthcare of older adults at one primary clinic, where clinical teams have referred 64 older adult patients to the AAA care manager. Among these 64 patients, 80% were connected to supplemental, community-based health services; 22% to programs addressing housing and transportation; and, nearly 10% to a range of other services (e.g., job training; language and literacy; and technology). In addition to presenting limited data on referred patients and referral outcomes, the presentation will share copies of the AAA referral log, to illustrate how resources were categorized by SDOH and added to support integration of the 4Ms.

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COLUMNS

Asia-Pacific Biotech News ◽

10.1142/s0219030318000484 ◽

2018 ◽

Vol 22 (07) ◽

pp. 16-33

Keyword(s):

Viral Hepatitis ◽

Value Based Care

How to make value-based care a reality? Impactful interventions to maximise healthspan. Viral hepatitis in Arkhangai: How Asia’s first micro-treatment program’s successes can be leveraged to treat a “silent killer”. The long-suffering challenge of vaccination.

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