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Medical practice leaders, whether their practice is independent or part of a health system, have different motivations for taking the plunge into risk-based contracting. Some are eager to embrace the [...]

Objective: To evaluate whether primary care physicians' participation in the Medicare Shared Savings Program (MSSP) is associated with changes in their preventive services delivery. Data Sources: Medicare Provider Utilization and Payment Physician and Other Supplier Public Use File and MSSP Accountable Care Organizations (ACO) Provider-Level Research Identifiable File from 2012 to 2018. Study Design: The design was a two-way fixed effects model estimating within-provider changes in preventive services delivery over time controlling for provider time-invariant characteristics, national time trends, and characteristics of served patients. The following preventive services were evaluated: influenza vaccination, pneumococcal vaccination, clinical depression screening, colorectal cancer screening, breast cancer screening, Body Mass Index (BMI) screening and follow-up, tobacco use assessment, and annual wellness visits. Both the likelihood of providing services and the volume of services delivered were evaluated. Data Collection/Extraction Methods: Secondary data linked at the provider level. Principal Findings: MSSP participation was associated with an increase in the likelihood of providing influenza vaccination (0.7 percentage-points), pneumococcal vaccination (2.0 percentage-points), clinical depression screening (2.1 percentage-points), tobacco use assessment (0.3 percentage-points), and annual wellness visits (4.1 percentage-points). A similar increase was found for the volume of services delivered per 100 patients for several preventive services: influenza vaccination (0.18), pneumococcal vaccination (0.56), clinical depression screening (0.46), and annual wellness visits (1.52). MSSP participation was associated with a decrease in the likelihood (-0.4 percentage-points) and the volume of colorectal cancer screening (-0.03). Conclusions: Primary care physicians' participation in MSSP was associated with an increase in the likelihood and the volume of several preventive services. KEYWORDS accountable care organizations, health care delivery, Medicare, Medicare shared savings program, preventive care What is known on this topic * The MSSP is the most widespread value-based program through which the Centers for Medicare & Medicaid Services (CMS) contracts with providers to provide care and accept accountability for the overall quality and cost for Medicare beneficiaries. * Financial incentives and quality performance metrics are included in the MSSP to stimulate individual providers and organizations to deliver more preventive services. * Not much is known on the association between providers' participation in MSSP and their preventive care delivery, particularly using provider-level data. What this study adds * This study used provider-level data on MSSP participation and preventive services delivery to provide evidence on whether MSSP participation is associated with changes in preventive care delivery. * Participation in MSSP was associated with an increase in the likelihood and volume of delivering influenza vaccination, pneumococcal vaccination, clinical depression screening, and annual wellness visits. * MSSP participation was associated with a decrease in the likelihood and the volume of delivering colorectal cancer screening., 1 | INTRODUCTION Delivering quality health services to Medicare beneficiaries at a sustainable cost has been a vexing problem, especially with an increasingly aging population and impending Medicare funding solvency. [...]

2023 JUN 10 (NewsRx) -- By a News Reporter-Staff News Editor at Obesity, Fitness & Wellness Week -- Investigators publish new report on acute myocardial infarction. According to news originating [...]

Objective: To assess changes in physicians' provision of care to duals (low-income individuals with Medicare and Medicaid) in response to a policy that required Medicaid to fully pay Medicare's cost sharing for office visits with these patients. This policy-a provision of the Affordable Care Act--effectively increased payments for office visits with duals by 0%-20%, depending on the state, in 2013 and 2014. Data Sources: Fee-for-service claims for a 5% random sample of Medicare beneficiaries in 2010-2016. Study Design: We conducted a difference-in-differences analysis to compare changes in office visits among Qualified Medicare Beneficiaries (QMBs)--the largest subpopulation of duals for whom payment rates were affected by this policy--to changes among other low-income Medicare beneficiaries for whom payment rates were unaffected (pooled across all states). Next, we conducted a triple-differences analysis that compared changes between QMBs and other low-income beneficiaries in 33 states with payment rate increases of approximately 20% to analogous changes in 14 states without payment increases. Data Collection: The study included administrative Medicare enrollment and claims data for QMBs and a comparison group of other low-income Medicare beneficiaries (1 914 073 beneficiary-years from 2010 to 2016). Principal Findings: Nationally, we did not find a differential increase in office visits among QMBs versus other low-income beneficiaries that coincided with this payment change. In the triple-differences analysis, we did not observe a greater increase in visits among QMBs vs other low-income beneficiaries in states where the policy resulted in large (approximately 20%) increases in payment rates vs states where payment rates were unaffected (triple-differences estimate: -0.12 annual visits, 95% CI: -0.28,0.04; P = 0.15). Conclusions: Physicians' provision of care to low-income Medicare beneficiaries may not be responsive to short-run payment changes. KEYWORDS Affordable Care Act, dual eligibles, physician incentives, 1 INTRODUCTION Medicaid serves as a supplemental insurer to approximately 9 million low-income Medicare beneficiaries (duals) who are not responsible for paying cost sharing in Medicare Parts A and B. [...]

2022 DEC 17 (NewsRx) -- By a News Reporter-Staff News Editor at Obesity, Fitness & Wellness Week -- Fresh data on COVID-19 are presented in a new report. According to [...]

BACKGROUND Clinical decision support (CDS) assists clinicians with accessing and processing information to enhance healthcare delivery. Evolving alongside rapid advancements in medicine over the past several decades, the adoption of [...]

Technically efficient surgeons provide shorter active clinical services in a university hospital setting, based on data collected from a leading university hospital in Japan. Output-oriented data models calculated each surgeon's technical efficiency, and six control variables were factored in. The outcome: Efficiency scores had a significantly negative association with length of active clinical services, while experience and surgical volume had a significantly positive association., OPERATING ROOM EFFICIENCY IS AN IMPORTANT concern for physician leaders in most hospitals. (1) This measurement depends upon surgeons' technical efficiency because they usually use the biggest portion of the [...]

Purpose > Research in other medical specialties has shown that the addition of medical scribes to the clinical team enhances physicians' practice experience and increases productivity. To date, literature on the implementation of scribes in primary care is limited. To determine the feasibility and benefits of implementing scribes in family medicine, we undertook a pilot mixed-method quality improvement (QI) study. Methods > In 2014, we incorporated 4 part-time scribes into an academic family medicine practice consisting of 7 physicians. We then measured, via survey and time-tracking data, the impact the scribes had on physician office hours and productivity, time spent on documentation, perceptions of work-life balance, and physician and patient satisfaction. Results > Six of the 7 faculty physicians participated. This study demonstrated that the use of scribes in a busy academic primary care practice substantially reduced the amount of time that family physicians spent on charting, improved work-life balance, and had good patient acceptance. Specifically, the physicians spent an average of 5.1 fewer hours/ week (hrs/wk) on documentation, while various measures of productivity revealed increases ranging from 9.2% to 28.8%. Perhaps most important of all, when the results of the pilot study were annualized, they were projected to generate $168,600 per year--more than twice the $79,500 annual cost of 2 full-time equivalent scribes. Surveys assessing work-life balance demonstrated improvement in the physicians' perception of the administrative burden/paperwork related to practice and a decrease in their perception of the extent to which work encroached on their personal lives. In addition, survey data from 313 patients at the time of their ambulatory visit with a scribe present revealed a high level of comfort. Likewise, surveys completed by physicians after 55 clinical sessions (ie, blocks of consecutive, uninterrupted patient appointments; there are usually 2 sessions per day) revealed good to excellent ratings more than 90% of the time. Conclusion > In an outpatient family medicine clinic, the use of scribes substantially improved physicians' efficiency, job satisfaction, and productivity without negatively impacting the patient experience., Yes, the evidence suggests that they can. This pilot study found that the use of scribes improved both, without negatively affecting the patient experience. While electronic medical records (EMRs) are [...]

Chronic insomnia is often the result of multiple underlying physiologic, psychological, and social factors. A sleep log, sleep hygiene, CBT, and medication can help. Although it is often taken for [...]

Underutilized revenue opportunities may be available to hospital-owned physician practices that focus on Medicare populations. Many practices routinely perform services such as screenings and addiction counseling but may not capture [...]

Many hospital systems, physician groups, and other providers are working hard to transition to value-based care delivery, offering the 'supply side' of care with improved quality, access, and outcomes at [...]

Now that the Medicare Sustainable Growth Rate (SGR) formula has been repealed, physicians and other providers must prepare for the Merit-Based Incentive Payment System (MIPS). We address several important questions [...]

EXECUTIVE SUMMARY The process of creating healthy organization-physician relationships is critical to organizational success. Partnerships in process improvement can nurture these relationships and mitigate burnout by meeting physicians' psychological needs. [...]

Physician burnout has become a high-profile issue in healthcare. Increasingly recognized as a common phenomenon, it has the potential to affect a central point of care delivery by threatening physician [...]

The passage of the Medicare Access and CHIP Reauthorization Act (MACRA, 2015) proposes sweeping changes in physician value-based payment. But until MACRA's Merit-Based Incentive Payment System (MIPS) program is fully [...]

A few years ago I tracked down my medical school interviewer to thank him for giving me the opportunity to do what I felt I was called to do. I [...]

In this article ... Physician records, physician payments and business transactions are all becoming more public. Learn what to expect with the new transparency. AS THE HEALTH CARE TRANSPARENCY MOVEMENT [...]

In this article ... Take an in-depth look at matters of trust, and see how critical trust is to professional relationships. TODAY'S HEALTH CARE LITERATURE IS replete with articles stressing [...]

Dr. Jonathan Letterman's 1862 reorganization of field medical practices for the Army of the Potomac has influenced military medicine ever since. While Mobile Army Surgical Hospital units didn't formally appear [...]

The patient who always seems to be in crisis may actually have a personality disorder. Employing these techniques can benefit the patient and your interaction with him. CASE * Bob [...]

As health care reform takes hold, hospitals are being entrusted with keeping the healthful healthy and carefully managing the chronically ill across all settings, from hospital to home. Population health [...]

An extensive review of the literature, followed by dozens of interviews with health care leaders, confirms that matured physician leadership will be essential for health care to continue moving toward higher quality, consistent safety, streamlined efficiency and becoming value-based., The health care industry has entered an era marked by seismic change and disruption of the status quo, and one area that is experiencing high demand and explosive growth is [...]