Browsing by Subject "Reimbursement"

Now showing 1 - 4 of 4
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    Building Evidence for Clinical Use of Pharmacogenomics and Reimbursement for Testing
    (Elsevier, 2022) Cavallari, Larisa H.; Pratt, Victoria M.; Medical and Molecular Genetics, School of Medicine
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    High-Quality Nursing Home and Palliative Care-One and the Same
    (Elsevier, 2022) Ersek, Mary; Unroe, Kathleen T.; Carpenter, Joan G.; Cagle, John G.; Stephens, Caroline E.; Stevenson, David G.; Medicine, School of Medicine
    Many individuals receiving post-acute and long-term care services in nursing homes have unmet palliative and end-of-life care needs. Hospice has been the predominant approach to meeting these needs, although hospice services generally are available only to long-term care residents with a limited prognosis who choose to forego disease-modifying or curative therapies. Two additional approaches to meeting these needs are the provision of palliative care consultation through community- or hospital-based programs and facility-based palliative care services. However, access to this specialized care is limited, services are not clearly defined, and the empirical evidence of these approaches’ effectiveness is inadequate. In this paper, we review the existing evidence and challenges with each of these three approaches. We then describe a model for effective delivery of palliative and end-of-life care in nursing homes, one in which palliative and end-of-life care are seen as integral to high quality nursing home care. To achieve this vision, we make four recommendations: 1) Promote internal palliative and end-of-life care capacity through comprehensive training and support; 2) Ensure that state and federal payment policies and regulations do not create barriers to delivering high quality, person-centered palliative and end-of-life care; 3) Align nursing home quality measures to include palliative and end-of-life care-sensitive indicators; and 4) Support access to and integration of external palliative care services. These recommendations will require changes in the organization, delivery, and reimbursement of care. All nursing homes should provide high-quality palliative and end-of-life care, and this paper describes some key strategies to make this goal a reality.
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    Lifestyle Medicine Reimbursement: A Proposal for Policy Priorities Informed by a Cross-Sectional Survey of Lifestyle Medicine Practitioners
    (MDPI, 2021-11-05) Freeman, Kelly J.; Grega, Meagan L.; Friedman, Susan M.; Patel, Padmaja M.; Stout, Ron W.; Campbell, Thomas M.; Tollefson, Michelle L.; Lianov, Liana S.; Pauly, Kaitlyn R.; Pollard, Kathryn J.; Karlsen, Micaela C.; Health Policy and Management, School of Public Health
    Lifestyle medicine (LM) is a rapidly emerging clinical discipline that focuses on intensive therapeutic lifestyle changes to treat chronic disease, often producing dramatic health benefits. In spite of these well-documented benefits of LM approaches to provide evidence-based care that follows current clinical guidelines, LM practitioners have found reimbursement challenging. The objectives of this paper are to present the results of a cross-sectional survey of LM practitioners regarding lifestyle medicine reimbursement and to propose policy priorities related to the ability of practitioners to implement and achieve reimbursement for these necessary services. Results from a closed, online survey in 2019 were analyzed, with a total of n = 857 included in this analysis. Results were descriptively analyzed. This manuscript articulates policy proposals informed by the survey results. The study sample was 58% female, with median age of 51. A minority of the sample (17%) reported that all their practice was LM, while 56% reported that some of their practice was LM. A total of 55% of practitioners reported not being able to receive reimbursement for LM practice. Of those survey respondents who provided an answer to the question of what would make the practice of LM easier (n = 471), the following suggestions were offered: reimbursement overall (18%), reimbursement for more time spent with patients (17%), more support from leadership (16%), policy measures to incentivize health (13%), education in LM for practitioners (11%), LM-specific billing codes and billing knowledge along with better electronic medical record (EMR) capabilities and streamlined reporting/paperwork (11%), and reimbursement for the extended care team (10%). Proposed policy changes focus on three areas of focus: (1) support for the care process using a LM approach, (2) reimbursement emphasizing outcomes of health, patient experience, and delivering person-centered care, and (3) incentivizing treatment that produces disease remission/reversal. Rectifying reimbursement barriers to lifestyle medicine practice will require a sustained effort from health systems and policy makers. The urgency of this transition towards lifestyle medicine interventions to effectively address the epidemic of chronic diseases in a way that can significantly improve outcomes is being hindered by current reimbursement policies and models.
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    Macroeconomic trends and practice models impacting acute care surgery
    (BMJ, 2019-04-11) Bernard, Andrew; Staudenmayer, Kristan; Minei, Joseph P.; Doucet, Jay; Haider, Adil; Scherer, Tres; Davis, Kimberly A.; Surgery, School of Medicine
    Acute care surgery (ACS) diagnoses are responsible for approximately a quarter of the costs of inpatient care in the US government, and individuals will be responsible for a larger share of the costs of this healthcare as the population ages. ACS as a specialty thus has the opportunity to meet a significant healthcare need, and by optimizing care delivery models do so in a way that improves both quality and value. ACS practice models that have maintained or added emergency general surgery (EGS) and even elective surgery have realized more operative case volume and surgeon satisfaction. However, vulnerabilities exist in the ACS model. Payer mix in a practice varies by geography and distribution of EGS, trauma, critical care, and elective surgery. Critical care codes constitute approximately 25% of all billing by acute care surgeons, so even small changes in reimbursement in critical care can have significant impact on professional revenue. Staffing an ACS practice can be challenging depending on reimbursement and due to uneven geographic distribution of available surgeons. Empowered by an understanding of economics, using team-oriented leadership inherent to trauma surgeons, and in partnership with healthcare organizations and regulatory bodies, ACS surgeons are positioned to significantly influence the future of healthcare in the USA.