scholarly journals The Perception and Impact of Relative Value Units (RVUs) and Quality-of-Care Compensation in Neurosurgery: A Literature Review

Healthcare ◽  
2020 ◽  
Vol 8 (4) ◽  
pp. 526
Author(s):  
Praveen Satarasinghe ◽  
Darsh Shah ◽  
Michael T. Koltz
Keyword(s):  
Quality Of Care ◽  
Literature Review ◽  
English Language ◽  
Healthcare Delivery ◽  
Quality Metrics ◽  
Fee For Service ◽  
Payment Model ◽  
Relative Value ◽  
Language Literature

The debate surrounding the integration of value in healthcare delivery and reimbursement reform has centered around integrating quality metrics into the current fee-for-service relative value units (RVU) payment model. Although a great amount of literature has been published on the creation and utilization of the RVU, there remains a dearth of information on how clinicians from various specialties view RVU and the quality-of-care metric in the compensation formula. The aim of this review is to analyze and consolidate existing theories on the RVU payment model in neurosurgery. Google and PubMed were searched for English-language literature describing opinions on the RVU in neurosurgery. Commentary was noted to be primary opinions if it was mentioned at least twice in the eight articles included in this review. Overall, seven primary opinions on the RVU were identified across the analyzed articles. Integration of quality into the RVU is viewed favorably by neurosurgeons with a few caveats and opportunities for further improvement.

scholarly journals Medicare Telehealth Pre and Post-COVID-19

2021 ◽  
Author(s):  
Sophia Albanese ◽  
Amar Gupta ◽  
Ilina Shah ◽  
Joanna Mitri
Keyword(s):  
Health Care ◽  
Quality Of Care ◽  
Literature Review ◽  
Geographic Location ◽  
State Agencies ◽  
Fee For Service ◽  
Medicare Beneficiaries ◽  
Quality Health Care ◽  
Quality Health

ABSTRACT The COVID-19 pandemic led to temporary relaxations for telehealth with respect to physician licensure, geographic location, and eligible sites for reimbursement. Earlier policies had impacted the rate of adoption of telehealth and retarded the ability to derive full benefits related to cost, access to care, and quality of care. This aspect is analyzed using 2018 Medicare fee-for-service codes and rates for 10 telemedicine services. Based on the analysis of these data, additional research, and literature review, this report describes how interstate practices can be better leveraged to achieve maximum potential for direct and indirect savings that can accrue through such pragmatic approaches for certain services. The interstate collaborations proposed in this report provide examples of broader telehealth policies that could foster increasing access to quality health care for Medicare beneficiaries and can potentially be used as insight to assist federal and state agencies as they review the continuation, cessation, or modifications of relaxations granted due to the COVID-19 pandemic.

scholarly journals Quality of Care for Comorbid Conditions During the Transition to Survivorship: Differences Between Cancer Survivors and Noncancer Controls

2013 ◽  
Vol 31 (9) ◽  
pp. 1140-1148 ◽  
Author(s):  
Claire F. Snyder ◽  
Kevin D. Frick ◽  
Robert J. Herbert ◽  
Amanda L. Blackford ◽  
Bridget A. Neville ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Quality Of Care ◽  
Cancer Survivors ◽  
Breast Cancer Survivors ◽  
Care Quality ◽  
Comorbid Condition ◽  
Cancer Type ◽  
Fee For Service ◽  
To Receive

Purpose Building on previous research documenting differences in preventive care quality between cancer survivors and noncancer controls, this study examines comorbid condition care. Methods Using data from the Surveillance, Epidemiology, and End Results (SEER) –Medicare database, we examined comorbid condition quality of care in patients with locoregional breast, prostate, or colorectal cancer diagnosed in 2004 who were age ≥ 66 years at diagnosis, who had survived ≥ 3 years, and who were enrolled in fee-for-service Medicare. Controls were frequency matched to cases on age, sex, race, and region. Quality of care was assessed from day 366 through day 1,095 postdiagnosis using published indicators of chronic (n = 10) and acute (n = 19) condition care. The proportion of eligible cancer survivors and controls who received recommended care was compared by using Fisher's exact tests. The chronic and acute indicators, respectively, were then combined into single logistic regression models for each cancer type to compare survivors' care receipt to that of controls, adjusting for clinical and sociodemographic variables and controlling for within-patient variation. Results The sample matched 8,661 cancer survivors to 17,322 controls (mean age, 75 years; 65% male; 85% white). Colorectal cancer survivors were less likely than controls to receive appropriate care on both the chronic (odds ratio [OR], 0.88; 95% CI, 0.81 to 0.95) and acute (OR, 0.72; 95% CI, 0.61 to 0.85) indicators. Prostate cancer survivors were more likely to receive appropriate chronic care (OR, 1.28; 95% CI, 1.19 to 1.38) but less likely to receive quality acute care (OR, 0.75; 95% CI, 0.65 to 0.87). Breast cancer survivors received care equivalent to controls on both the chronic (OR, 1.06; 95% CI, 0.96 to 1.17) and acute (OR, 0.92; 95% CI, 0.76 to 1.13) indicators. Conclusion Because we found differences by cancer type, research exploring factors associated with these differences in care quality is needed.

scholarly journals The impact of asynchronous e-visits on clinical outcomes and healthcare delivery: A systematic review (Preprint)

2021 ◽  
Author(s):  
Oliver T. Nguyen ◽  
Amir Alishahi Tabriz ◽  
Jinhai Huo ◽  
Karim Hanna ◽  
Christopher M. Shea ◽  
...  
Keyword(s):  
Systematic Review ◽  
Quality Of Care ◽  
Clinical Outcomes ◽  
Healthcare Costs ◽  
Healthcare Delivery ◽  
Healthcare Quality ◽  
Antibiotic Prescribing ◽  
Infection Management ◽  
The Impact

BACKGROUND E-visits involve asynchronous communication between providers and patients through a secure web-based platform, such as a patient portal, to elicit symptoms and determine a diagnosis and treatment plan. E-visits are now reimbursable through Medicare due to the COVID-19 pandemic. The state of the evidence regarding e-visits, such as the impact on clinical outcomes and healthcare delivery, is unclear. OBJECTIVE To address this gap, this systematic review examines how e-visits have impacted clinical outcomes and healthcare quality, access, utilization, and costs. METHODS MEDLINE, Embase, and Web of Science were searched from January 2000 through October 2020 for peer-reviewed studies that assessed e-visits’ impact on clinical and healthcare delivery outcomes. RESULTS Out of 1,858 papers, 19 studies met the inclusion criteria. E-visit usage was associated with improved or comparable clinical outcomes, especially for chronic disease management (e.g., diabetes care, blood pressure management). The impact on quality of care varied across conditions. Quality of care was equivalent or better for chronic conditions but variable quality was observed in infection management (e.g., appropriate antibiotic prescribing). Similarly, the impact on healthcare utilization varied across conditions (e.g., lower utilization for dermatology) but mixed impact in primary care. Healthcare costs were lower for e-visits for a wide-range of conditions (e.g., dermatology and acute visits). No studies examined the impact of e-visits on healthcare access. Available studies are observational in nature and it is difficult to draw firm conclusions about effectiveness or impact on care delivery. CONCLUSIONS Overall, the evidence suggests e-visits may provide comparable clinical outcomes to in-person care and reduce healthcare costs for certain healthcare conditions. At the same time, there is mixed evidence on healthcare quality, especially regarding infection management (e.g., sinusitis, urinary tract infections, conjunctivitis). Further studies are needed to test implementation strategies that might improve delivery (e.g., clinical decision support for antibiotic prescribing) and to assess which conditions are amenable to e-visits and which conditions require in-person or face-to-face care (e.g., virtual visit). CLINICALTRIAL not applicable

Innovating in healthcare delivery: a systematic review and a preference-based framework of patient and provider needs

2019 ◽  
Vol 5 (2-3) ◽  
pp. 92-100
Author(s):  
Joseph S Salama ◽  
Alex Lee ◽  
Ashkan Afshin
Keyword(s):  
Systematic Review ◽  
Quality Of Care ◽  
Conceptual Framework ◽  
Unmet Needs ◽  
Healthcare Delivery ◽  
Process Of Care ◽  
Literature Reviews ◽  
Reducing Costs ◽  
Healthcare Innovation

Healthcare innovation is becoming a popular but poorly defined option for those who are seeking new ways of reducing costs while also improving the quality of care. The process of innovating in healthcare delivery can be improved by identifying and understanding the unmet needs of patients and providers. We conducted two systematic literature reviews to identify the needs of these stakeholders throughout healthcare delivery and developed a conceptual framework for innovating in healthcare. Our results reveal tension between patients’ and providers’ preferences across three major categories—treatment and outcomes, process of care and structure of care. Therefore, innovating in healthcare may be better understood as addressing the unmet needs of each stakeholder by easing or eliminating tensions between stakeholders. This conceptual framework may serve as a useful instrument for health policymakers, payers and innovators to alike make better decisions as they invest in healthcare innovations.

Cost Containment and Mental Health Outcomes: Experiences from US Studies

1995 ◽  
Vol 166 (S27) ◽  
pp. 43-51 ◽  
Author(s):  
Kenneth B. Wells
Keyword(s):  
Mental Health ◽  
Quality Of Care ◽  
Cost Containment ◽  
Cost Savings ◽  
Poor People ◽  
Fee For Service ◽  
Us Studies ◽  
Outcomes Of Care ◽  
The Us

Background. Cost containment mechanisms, such as prepayment, are being considered or implemented in the US and elsewhere, but there have been few studies of the effects of such mechanisms on quality or outcomes of care for individuals with serious psychiatric disorders.Method. Key results from US studies on cost containment and their implications are reviewed.Results. Cost savings in out-patient mental health care can be achieved through increasing the share of costs paid by the covered individual or through prepayment, but individuals with the greatest psychological distress or poor people may achieve worse outcomes under greater cost containment. Quality of care may be poorer under some forms of prepayment than under fee-for-service care, yet a national prospective payment mechanism for depressed elderly in-patients was not associated with a marked drop in quality or outcomes of care among those admitted.Conclusions. Prepayment, relative to fee-for-service is not always associated with lower outcomes or quality of care for affective disorders. Under cost containment, quality and outcomes of care, especially for the sick poor, should be monitored to identify adverse consequences.

scholarly journals Glomus Tumor of the Oral Cavity: Report of a Rare Case and Literature Review

2019 ◽  
Vol 30 (2) ◽  
pp. 185-190 ◽  
Author(s):  
Celeste Sánchez-Romero ◽  
Maria Eduarda Pérez de Oliveira ◽  
Jurema Freire Lisboa de Castro ◽  
Elaine Judite de Amorim Carvalho ◽  
Oslei Paes de Almeida ◽  
...  
Keyword(s):  
Literature Review ◽  
Oral Cavity ◽  
Rare Case ◽  
English Language ◽  
Glomus Tumor ◽  
Benign Neoplasm ◽  
Upper Lip ◽  
Middle Aged Adults ◽  
Glomus Body ◽  
Language Literature

Abstract Glomus tumor is a benign neoplasm composed of a perivascular proliferation of glomic cells that resembles the normal glomus body. Usually, it appears as a solitary, symptomatic small blue-red nodule, located in the deep dermis or subcutis of upper or lower extremities of young to middle-aged adults. Cases affecting the oral cavity are very rare, with only 23 well-documented cases reported in the English-language literature. Herein, we present a rare case of glomus tumor of the upper lip, and review the literature of cases involving the mouth.

scholarly journals Review: Relation Between Quality-of-Care Indicators for Diabetes and Patient Outcomes: A Systematic Literature Review

2011 ◽  
Vol 68 (3) ◽  
pp. 263-289 ◽  
Author(s):  
Grigory Sidorenkov ◽  
Flora M Haaijer-Ruskamp ◽  
Dick de Zeeuw ◽  
Henk Bilo ◽  
Petra Denig
Keyword(s):  
Quality Of Care ◽  
Literature Review ◽  
Patient Outcomes ◽  
Systematic Literature Review
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