Breast cancer survivors with lymphedema face a lifetime of stressful physical and emotional symptoms and challenging self-care demands. An in-depth understanding of the perceptions and feelings surrounding life with lymphedema is critical to developing effective supportive care approaches. The objective of the study was to explore perceptions and feelings related ...

One of the two main goals of the Global Programme to Eliminate Lymphatic Filariasis (LF) is to provide care for those suffering from the devastating clinical manifestations of this filarial infection. Among the 120 million infected people worldwide, up to 16 million have lymphoedema. The WHO strategy for managing lymphoedema ...

Distance delivery systems are being developed to increase access to mental health care. Although development is progressing rapidly, there has been little work delineating the differences between distance and face-to-face interventions from the participants' viewpoint. This article describes scale development and a content validity study of the Treatment Barrier Index ...

The presence in the aquatic environment of xenobiotics such as Pharmaceutical and Personal Care Products (PPCPs) has emerged as an issue of concern. Upgrading sewage treatment quality with modern technologies such as Membrane Bioreactors (MBRs) and/or implementing a further posttreatment might mitigate the release of xenobiotics into surface waters. The ...

William Bohne (1827-1906) was a teacher in Germany before emigrating to the United States in 1852. He worked as an optician (as optometrists were known at that time) in New Orleans in the second half of the nineteenth century. His book, Handbook for Opticians, which went through three editions, appears ...

Prior studies suggest that disease management programs may be effective in improving clinical and economic outcomes in patients with heart failure. Whether these types of programs can lower health care cost and be adapted to the primary care setting is unknown. This study was designed to assess the impact of ...

Heart failure is a common cause of death among Medicare beneficiaries, but little is known about health care resource use at the end of life. In a retrospective cohort study of 229 543 Medicare beneficiaries with heart failure who died between January 1, 2000, and December 31, 2007, we examined resource ...

OBJECTIVE: To examine differences in use of Veterans Health Administration (VA) and Medicare outpatient services by VA primary care patients. DATA SOURCES/STUDY SETTING: VA administrative and Medicare claims data from 2001 to 2004. STUDY DESIGN: Retrospective cohort study of outpatient service use by 8,964 community-based and 6,556 hospital-based VA primary ...

The primary care medical home has been promoted to integrate and improve patient care while reducing healthcare spending, but with little formal study of the model or evidence of its efficacy. ProvenHealth Navigator (PHN), an intensive multidimensional medical home model that addresses care delivery and financing, was introduced into 11 ...

A key consideration in implementing the Patient Protection and Affordable Care Act of 2010 will be changing Medicare payments to providers to slow the growth in costs and spur improvements in health care delivery. In addition to the technical feasibility of new payment models, a crucial issue will be the ...

Colorectal cancer (CRC) screening remains underutilized. The objective of this study was to examine the impact of primary care and economic barriers to health care on CRC testing relative to the 2001 Medicare expansion of screening coverage. Medicare Current Beneficiary Survey data were use to study community-dwelling enrollees aged 65 ...

The Patient Protection and Affordable Care Act establishes a national voluntary program for accountable care organizations (ACOs) by January 2012 under the auspices of the Centers for Medicare and Medicaid Services (CMS). The act also creates a Center for Medicare and Medicaid Innovation in the CMS. We propose that the ...

The purpose of this evaluation was to study the relationship of nurse care coordination (NCC) to the costs of Medicare and Medicaid in a community-based care program called Missouri Care Options (MCO). A retrospective cohort design was used comparing 57 MCO clients with NCC to 80 MCO clients without NCC. ...

Objective. To examine differences in use of Veterans Health Administration (VA) and Medicare outpatient services by VA primary care patients. Data Sources/Study Setting. VA administrative and Medicare claims data from 2001 to 2004. Study Design. Retrospective cohort study of outpatient service use by 8,964 community-based and 6,556 hospital-based VA primary ...

A national survey was used to examine patterns of delivery of dietetic care for patients referred to private practitioners under Medicare Chronic Disease Management (CDM). This asked dietitians about referrals from general practitioners, patient management, fees charged and patient billing. There were 356 (47%) Australian private practice dietitians who responded ...

OBJECTIVES: To validate a predictive model for identifying Medicare beneficiaries who need end-of-life care planning and to determine the impact on cost and hospice care of a telephonic counseling program utilizing this predictive model in 2 Medicare Health Support (MHS) pilots. STUDY DESIGN: Secondary analysis of data from 2 MHS ...

CONTEXT: Clinicians often have negative attitudes toward obesity and express dissatisfaction in caring for obese patients. Moreover, obese patients often feel that clinicians are biased or disrespectful because of their weight. These observations raise the concern that obese patients may receive lower quality of care. OBJECTIVE: To determine whether performance ...

Examine associations between patient experiences with care and service use across markets. Medicare fee-for-service (FFS) and managed care (Medicare Advantage [MA]) beneficiaries in 306 markets from the 2003 Consumer Assessments of Healthcare Providers and Systems (CAHPS) surveys. Resource use intensity is measured by the 2003 end-of-life expenditure index. We estimated ...

OBJECTIVE: To determine how reliance on Veterans Affairs (VA) for medical care among veterans enrolled in Medicare is affected by medical conditions, access, and patient characteristics. DATA SOURCES/STUDY SETTING: Department of Veterans Affairs. STUDY DESIGN: We examined reliance on the VA for inpatient, outpatient, and overall medical care among all ...

Warfarin is prescribed to millions of Americans for the management of thromboembolism and is a common cause of adverse events. Optimizing warfarin therapy has been the focus of national quality improvement initiatives. Anticoagulation clinics have been demonstrated to result in better outcomes than usual care. Nevertheless, Highmark Medicare Services recently ...

This study aimed to examine longitudinal patterns of VA-only use, dual VA and Medicare use, or Medicare-only use among veterans with dementia. Data on VA and Medicare use (1998-2001) were obtained from VA administrative datasets and Medicare claims for 2,137 male veterans with a formal diagnosis of Alzheimer's disease or ...

To determine the rate of prostate-specific antigen (PSA) screening in men aged 80 and older in Medicare and to examine geographic variation in screening rates across the U.S. Retrospective cohort study of variation across hospital referral regions using administrative data. National random sample in fee-for-service Medicare. Medicare beneficiaries aged 80 ...

Objective To determine whether a diabetes case management telemedicine intervention reduced healthcare expenditures, as measured by Medicare claims, and to assess the costs of developing and implementing the telemedicine intervention. Design We studied 1665 participants in the Informatics for Diabetes Education and Telemedicine (IDEATel), a randomized controlled trial comparing telemedicine ...

BACKGROUND: Prior research identified variations in care experiences across Medicare health plans (Medicare Advantage [MA]), but the relative amount of variation in MA and traditional fee-for-service (FFS) Medicare is unknown. OBJECTIVES: Compare variation and correlations of beneficiary reports of care experiences across geographic areas in MA and FFS. METHODS: Using ...

OBJECTIVE: To examine the effect of exclusive and dual use of Department of Veterans Affairs (VA) and Medicare healthcare systems on outpatient predialysis nephrology care. STUDY DESIGN: Retrospective cohort study. METHODS: Receipt, timeliness, and intensity of predialysis nephrology care were evaluated among 8033 veterans who initiated dialysis in 2000 and ...

A provision of the Patient Protection and Affordable Care Act (PPACA) requires the U.S. Department of Health and Human Services (HHS) to create a special modifier within the Medicare physician fee schedule that would adjust physician payments based on a measurement of cost and quality. They're calling it the "value-based ...

The Centers for Medicare and Medicaid Services (CMS) recently revised the requirements that end-stage renal disease (ESRD) dialysis facilities must meet to be certified under Medicare. The CMS ESRD Interpretive Guidance Update states that the dialysis facility must now have an ongoing program of hemodialysis vascular access surveillance. Surveillance usually ...

Ventilator-associated pneumonia (VAP) is a complication of ventilator care that produces excess, avoidable resource use and treatment costs. Control of VAP is an important aspect of quality of care improvement for long-term care hospitals (LTCHs) since they provide post-acute ventilator care for many Medicare beneficiaries. Data for Medicare patients discharged ...

CMS is investigating techniques that might help identify costly physician practice patterns. One method presently under evaluation is to compare resource use for certain episodes of care using commercially available episode grouping software. Although this software has been used by the private sector to classify insured individuals' medical claims into ...

Many Medicare recipients do not understand their health care rights. Lumetra, formerly California's Medicare quality improvement organization, developed a multifaceted outreach program to increase beneficiary awareness of its services and of the right to file quality-of-care complaints and discharge appeals. Layered outreach activities to Medicare members and their caregivers in ...

The maximum amount physicians can charge Medicare patients for Part B services depends on Medicare reimbursement rates and on federal and state restrictions regarding balance billing. This study evaluates whether Part B payment rates, state restrictions on balance billing beyond the federal limit, and physician balance billing influence how beneficiaries ...

Health-care consumers, payers, and regulatory agencies have become increasingly concerned about the rising cost and perceived deficiencies in the quality of health care in the United States. Pay-for-performance initiatives, otherwise known as value-based purchasing, are gathering political and public support as a method to address these problems. The Centers for ...

The Centers for Medicare & Medicaid Services recently started publicly reporting hospital readmission rates. Health care reform proposals include readmission provisions as vehicles to promote care coordination and achieve savings. Current approaches ascribe variability in hospital readmission primarily to differences in patient medical risk and hospital performance. These approaches do ...

BACKGROUND: Alzheimer disease and related dementias (ADRD) have become a major concern for Medicare because of the increasing prevalence rate and the associated high cost of care. OBJECTIVES: This study investigated the extent of concentration and persistence in total health care expenditures and prescription drug expenditures among the elderly with ...

The objectives of this study were to examine longitudinal patterns of Department of Veterans Affairs (VA)-only use, dual VA and Medicare use, and Medicare-only use by veterans with dementia. Data on VA and Medicare use were obtained from VA administrative datasets and Medicare claims (1998-2001) for 2,137 male veterans who, ...

BACKGROUND: The Centers for Medicare & Medicaid Services pays for services provided through traditional fee-for-service (FFS) Medicare and managed care plans (Medicare Advantage [MA]). It is important to understand how financing and organizational arrangements relate to quality of care. OBJECTIVES: To compare care experiences and preventive services receipt in traditional ...

BACKGROUND: Patient activation status (PAS) can be identified using the Medicare Segmentation Screening Tool, a 2-item measure assessing patients' health skills and motivation to participate in their own care. OBJECTIVE: To determine whether PAS is predictive of Medicare beneficiary health care experiences with health providers and insurance plans after case-mix ...

BACKGROUND: Estimates of the costs of medical care vary across patient populations, data sources, and methods. The objective of this study was to compare 3 approaches for estimating the incidence costs of colorectal cancer (CRC) care using similar patient populations, but different data sources and methods. METHODS: We used 2 ...

A San Antonio hospital system is taking part in a Centers for Medicare & Medicaid Services project to find out if cheaper health care equals better health care.

This interim final rule with comment period implements revised Medicare severity long-term care diagnosis-related group (MS-LTC-DRG) relative weights for payment under the long-term care hospital (LTCH) prospective payment system (PPS) for federal fiscal year (FY) 2009. We are revising the MS-LTC-DRG relative weights for FY 2009 due to the misapplication ...

BACKGROUND: Risk selection in the Medicare managed care program ("Medicare Advantage") is an important policy concern. Past research has shown that Medicare managed care plans tend to attract healthier beneficiaries and that market characteristics such as managed care penetration may also affect risk selection. OBJECTIVES: To assess whether patient enrollment ...

A Clinton administration Executive Memorandum authorized Medicare payment for routine costs associated with clinical trials and recognized the role of clinical trials in patient care. However, a loophole in Medicare Advantage regulations has created a disparity in the way clinical trial services are covered for these enrollees.

Medicaid physician fees increased 15.1 percent, on average, between 2003 and 2008. This was below the general rate of inflation, resulting in a reduction in real fees. Only primary care fees grew at the rate of inflation-20 percent between 2003 and 2008. However, because of slow growth in Medicare fees, ...

To test how the implementation of new Medicare post-acute payment systems affected the use of inpatient rehabilitation facilities (IRFs), skilled nursing facilities (SNFs), and home health agencies. Medicare acute hospital, IRF, and SNF claims; provider of services file; enrollment file; and Area Resource File data. We used multinomial logit models ...

Publicly available data provide an excellent resource for benchmarking a hospital's performance around diagnostic groups. The benchmarking analysis should seek to identify any unexpected differences in a hospital's average costs relative to those of similar hospitals. A good starting place for such analysis is the most frequent diagnostic groups for ...

This spring marks the one-year anniversary of an historic change in Medicare policy. This change is positively impacting quality of care for more than a million people with chronic diseases and conditions that are yet still little known. In April 2008, the Centers for Medicare and Medicaid Services (CMS) of ...

CONTEXT: Medicare expenditures of patients with chronic illnesses might be reduced through improvements in care, patient adherence, and communication. OBJECTIVE: To determine whether care coordination programs reduced hospitalizations and Medicare expenditures and improved quality of care for chronically ill Medicare beneficiaries. DESIGN, SETTING, AND PATIENTS: Eligible fee-for-service Medicare patients (primarily ...

Long-Term Care Hospitals (LTCHs) have recently emerged as an important alternative to traditional settings for post-acute care (PAC), including skilled nursing facilities (SNFs) and inpatient rehabilitation hospitals (IRFs). LTCHs are accredited acute care hospitals and primarily serve long-staying patients with complex medical conditions. LTCHs have historically played a fairly minor ...

PURPOSE: To assess the impact of vision loss on healthcare cost for patients with Medicaid and Medicare and whether these costs are adequately captured by Medicare hierarchical condition categories (HCC) risk adjustment methodology. DATA SOURCES: The public use data set of the Program of All-Inclusive Care for the Elderly (PACE) ...

This paper assesses the effect of payment caps for Medicare home health care on the use of informal care by older adults with functional limitations. We find that individuals exposed to more restrictive payment caps offset reductions in Medicare home health care with increased informal care, although we only observe ...