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Remote Monitoring Approaches to Reduce Readmissions After Infection and Sepsis: A Randomized Clinical Trial.

IMPORTANCE: The Centers for Medicare & Medicaid Services reimburses remote monitoring to reduce hospital readmissions, yet its effectiveness remains uncertain. OBJECTIVE: To evaluate effectiveness of remote monitoring in reducing readmissions following hospitalizations for serious infections overall and across prespecified subgroups. DESIGN, SETTING, AND PARTICIPANTS: This randomized clinical trial was conducted from March 25, 2021, to December 9, 2024, using response adaptive randomization among postdischarge patients with sepsis or lower respiratory tract infection across 19 hospitals. Eli…

Characteristics of older adults who meet the annual prescription drug expenditure threshold for medicare medication therapy management programs.

BACKGROUND: The Medicare Modernization Act of 2003 requires drug plan sponsors to provide medication therapy management programs (MTMPs) to … having TRICARE (military health care services) benefits (OR=0.54; 95% CI, 0.33-0.86), and being on Medicaid (OR=1.36; 95% CI, 1.02-1.81). Other factors that were also predictive of meeting the expenditure threshold included mental health disorders, ulcers, diabetes, dyslipidemia, cardiac disease, chronic obstructive pulmonary disorder, and the number of c …

Ассоциация по борьбе с раком и острыми почечными травмами среди населения, получающего медицинскую плату за услуги.

RATALE & ObJECTive: Острая травма почек (AKI) является частым осложнением рака в силу множественных факторов. Наша цель состояла в том, чтобы оценить современные связи между различными раковыми заболеваниями и инцидентами, связанными с АКИ, среди бенефициаров программы " Медикэр " . ИССЛЕДОВАНИЕ: Ретроспективное исследование наблюдений. УЧАСТНИКИ: Бенефициары медицинской помощи в возрасте ≥66 Годы. Новый диагноз рака. Случай АКИ. АНАЛИТИЧЕСКИЙ ПОДХОД: Последующая деятельность началась с диагностики рака или с декабря 31, 2014, для контроля и до конца на дату AKI, смерть, рак в контро

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… We used the term of sex in accordance with the variable available in the Centers for Medicaer and Medicaid Services administrative data. Study Outcomes The main outcomes were AKI or death among beneficiaries with cancer compared with those without cancer. … Comorbid conditions were defined based on Centers for Medicare & Medicaid Services (CMS), Chronic Condition Data Warehouse (CCW), and ICD-9 codes shown in Table S1 . …

The Impact of Biosimilar Use on Total Cost of Care and Provider Financial Performance in the Medicare Oncology Care Model: A Population-Based Simulation Study.

IntroductionPayment for oncology care is increasingly moving from fee-for-service to value-based payment (VBP). VBPs are agreements in which providers are held accountable for total cost of care (TCOC) through risk-sharing arrangements with payers that tie reimbursement levels to TCOC benchmarks. Oncology biosimilars may play an important role in managing financial risk in the VBPs like Medicare's Oncology Care Model (OCM), but there has been limited research in this area. The objective of this study is to estimate the impact of biosimilar adoption on TCOC and oncology provider financial perfo

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… Centers for Medicare and Medicaid Innovation. Enhancing Oncology Model. https://www.cms.gov/priorities/innovation/innovation-models/enhancing-oncology-model . Accessed 15 Sept 2023. 7. U.S. Food and Drug Administration. … Centers for Medicare and Medicaid Services. Risk adjustment. https://www.cms.gov/Medicare/Health-Plans/MedicareAdvtgSpecRateStats/Risk-Adjustors . Accessed 31 May 2023. 28. Centers for Medicare and Medicaid Services. 2021 ASP drug pricing files. …

Disparities in care of older adults of color with cancer: A narrative review.

This review describes the barriers and challenges faced by older adults of color with cancer and highlights methods to improve their overall care. In the next decade, cancer incidence rates are expected to increase in the United States for people aged ≥65 years. A large proportion will be older adults of color who often have worse outcomes than older White patients. Many issues contribute to racial disparities in older adults, including biological factors and social determinants of health (SDOH) related to healthcare access, socioeconomic concerns, systemic racism, mistrust, and the neighborho

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… Centers for Medicare & Medicaid Services . The Accountable Health Communities Health‐Related Social Needs screening tool. 2017. Accessed February 22, 2022 https://innovation.cms.gov/files/worksheets/ahcm‐screeningtool.pdf 114. Institute for Medicaid Innovation . … Medicaid Access & Coverage to Care in 2018. Results from the Institute for Medicaid Innovation's 2019 Annual Medicaid Managed Care Survey. 2019. Accessed January 30, 2023 https://medicaidinnovation.org/wp‐content/uploads/2022/11/2019_Annual_Medicaid_MCO_Survey_Results_FINAL.pdf 115. …

The role of social, economic, and medical marginalization in cancer clinical trial participation inequities: A systematic review.

Extant literature reveals how patients of marginalized social identities, socioeconomic status (SES), and medical experiences - especially patients of color and older adults - are underrepresented in cancer clinical trials (CCTs). Emerging evidence increasingly indicates CCT underrepresentation among patients of lower SES or rural origin, sexual and gender minorities, and patients with comorbid disability. This review applies an intersectional perspective to characterizing CCT representativeness across race and ethnicity, age, sexual and gender identity, SES, and disability. Four databases wer

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… Participant race (W, B , Asian, Other) Tumor site Age-adjusted incidence rates Chi-square analyses Gross, Filardo, Mayne, and Krumholz 2005 Case-control study Archival database NCI CTEP (1996–2001) SEER-Medicare SES: % below poverty level (zip), % unemployed (county), insurance (private, Medicare, Medicaid … , Medicare + private, Medicare + Medicaid, VA, self-pay, uninsured, other) Age: 65–59, 70–74, 75–79, 80–84, 85+ Race/ethnicity: W, NHB, Hispanic, API Distance between home and site Preliminary chi-square and t-tests Logistic regression Guerrero et al. 2018 Meta-analysis Archival database PubMed Presence …

Precision Reimbursement for Precision Medicine: Using Real-World Evidence to Evolve From Trial-and-Project to Track-and-Pay to Learn-and-Predict.

Basic scientists and drug developers are accelerating innovations toward the goal of precision medicine. Regulators create pathways for timely patient access to precision medicines, including individualized therapies. Healthcare payors acknowledge the need for change but downstream innovation for coverage and reimbursement is only haltingly occurring. Performance uncertainty, high price-tags, payment timing, and actuarial risk issues associated with precision medicines present novel financial challenges for payors. With traditional drug reimbursement frameworks, payment is based on an assumed

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… To date, performance‐based Managed Entry Agreements in Europe and Asia remain rare and experimental. 25 In the United States, only 10 out of 50 State Medicaid Plans even have authorization from the Centers for Medicare and Medicaid Services (CMS) to pursue Value‐Based Purchasing agreements for prescription … Another challenge to PR, specific to the United States, is the legally mandated Medicaid requirement for lowest price. …

Disparities in the enrollment to systemic therapy and survival for patients with multiple myeloma.

BackgroundDisparities driven by socioeconomic factors have been shown to impact outcomes for cancer patients. We sought to explore this relationship among patients with multiple myeloma (MM) who were not considered for hematopoietic stem cell transplant in the first-line setting and how it varied over time.MethodsWe queried the National Cancer Database for patients diagnosed with MM between 2004 and 2016 and included only those who received systemic therapy as the first-line treatment. Enrollment rates for therapy were calculated as receipt of systemic therapy as the incident event of interest

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… Non-Hispanic whites 36,889 (65.8) 33,174 (65.6) Non-Hispanic blacks 11,402 (20.3) 10,228 (20.2) Hispanic 3152 (5.6) 2803 (5.6) Others 4659 (8.3) 4338 (8.6) Insurance Uninsured 2059(3.7) 1941 (3.9) Insured 53,029 (96.3) 47,673 (96.1) Private 16,241 (29.0) 14,761 (29.2) Medicare 3399 (6.1) 3005 (6.0) Medicaid … Advanced age, earlier year of diagnosis, lack of insurance or Medicaid insurance, and higher comorbidity were associated with poor survival outcomes, whereas female sex, NHB race, higher income, and treatment at an academic center were associated with improved survival outcomes. …

Financial challenges of being on long-term, high-cost medications.

The isocitrate dehydrogenase (IDH) inhibitor, vorasidenib, may offer a promising new treatment option for patients with IDH-mutant gliomas. However, the indefinite nature of this targeted therapy raises significant financial concerns. High costs of targeted cancer therapies, often exceeding $150 000 annually, contribute to financial toxicity, characterized by medical debt, income loss, and psychological stress, and place stress on health systems. This review analyzes the drug approval and pricing mechanisms in various countries and their impact on healthcare costs and patient access, focusing

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… An example is the US government insurers, Medicare and Medicaid. … Status of State Medicaid Expansion Decisions: Interactive Map. KFF. May 8, 2024. https://www.kff.org/affordable-care-act/issue-brief/status-of-state-medicaid-expansion-decisions-interactive-map/ . Accessed August 12, 2024. 44. Ostrom QT, Price M, Neff C, et al. …

Implementing the 2009 Institute of Medicine recommendations on resident physician work hours, supervision, and safety.

Long working hours and sleep deprivation have been a facet of physician training in the US since the advent of the modern residency system. … almost a quarter of all physicians who work in hospitals, and that taxpayers, through Medicare and Medicaid, fund graduate medical education, the public has a deep investment in physician training. Patients expect to receive safe, high-quality care in the nation's teaching hospitals. Because it is their safety that is at issue, their voices should be cent …

Assessing Pregnancy, Gestational Complications, and Co-morbidities in Women With Congenital Heart Defects (Data from ICD-9-CM Codes in 3 US Surveillance Sites).

Improved treatment of congenital heart defects (CHDs) has resulted in women with CHDs living to childbearing age. However, no US population-based systems exist to estimate pregnancy frequency or complications among women with CHDs. Cases were identified in multiple data sources from 3 surveillance sites: Emory University (EU) whose catchment area included 5 metropolitan Atlanta counties; Massachusetts Department of Public Health (MA) whose catchment area was statewide; and New York State Department of Health (NY) whose catchment area included 11 counties. Cases were categorized into one of 5 m

Cost-Effectiveness Analysis of Adding Daratumumab to Bortezomib, Melphalan, and Prednisone for Untreated Multiple Myeloma.

Background: To evaluate the cost-effectiveness of adding daratumumab to bortezomib, melphalan, and prednisone for transplant-ineligible newly diagnosed multiple myeloma patients. Methods: A three-state Markov model was developed from the perspective of US payers to simulate the disease development of patient's life time for daratumumab plus bortezomib, melphalan, and prednisone (D-VMP) and bortezomib, melphalan, and prednisone (VMP) regimens. The primary outputs were total costs, expected life-years (LYs), quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratios (ICERs). R

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… The drug unit cost was obtained from Centers for Medicare and Medicaid Services (CMS), costs of AEs were used the data from published literature ( Zhang et al., 2018 ; CMS, 2020b ; REDBOOK, 2020 ). … Center for Medicare and Medicaid Services. Medicare Part B Drug Average Sales Price [Online] . Available at: https://www.cms.gov/medicare/medicare-part-b-drug-average-sales-price/2020-asp-drug-pricing-files ( Accessed August, 2020). CMS ( 2020c ). Center for Medicare and Medicaid Services. …

Facing financial barriers to healthcare: patient-informed adaptation of a conceptual framework for adults with a history of cancer.

BackgroundCancer-related financial hardship is associated with negative clinical outcomes, which may be partially explained by cost-related delayed or forgone care in response to financial barriers. We sought to understand patient experiences facing financial barriers to medical care following a cancer diagnosis.MethodsWe conducted virtual, semi-structured interviews in Fall 2022 with 20 adults with a history of cancer who had experienced cancer-related financial hardship in the prior year. We used template analysis within a pragmatic paradigm, combining constructivist and critical realist the

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… For example, though Medicaid provided comprehensive coverage for those able to qualify, participants expressed frustration over the strict eligibility criteria, particularly in non-expansion states [“ when I tried [to apply for Medicaid] first, my husband and I were not eligible because he was still … Factor | Illustrative quotation Protective Medicaid expansion | “I did not really have any issues with, with Medicaid that, like I said, it was, everything was covered, you know?” …

Access to Chimeric Antigen Receptor T Cell Therapy for Diffuse Large B Cell Lymphoma.

IntroductionGeographic access to novel oncology therapies, and the extent to which it may vary by potential sites of care, regions, and population characteristics, is poorly understood. We examined how expanding access to chimeric antigen receptor (CAR) T cell therapy administration sites impacts patient travel distances and time.MethodsWe used geographic information system techniques to calculate shortest travel distance and time between patients with relapsed/refractory diffuse large B cell lymphoma (DLBCL) and the nearest CAR T cell therapy administration site in three scenarios: academic h

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… Centers for Medicare & Medicaid Services. Glossary and acronyms. 2016. https://www.cms.gov/OpenPayments/About/Glossary-and-Acronyms.html#teachinghospital . Accessed 12 Aug 2019. 17. … Centers for Medicare & Medicaid Services. 2019 reporting cycle: teaching hospital list. 2018. https://www.cms.gov/OpenPayments/Downloads/2019-Reporting-Cycle-Teaching-Hospital-List-pdf.pdf . Accessed 31 July 2019. 18. Kite Pharma. Where can YESCARTA be received? …

Utilization of novel systemic therapies for multiple myeloma: A retrospective study of front-line regimens using the SEER-Medicare data.

The landscape of treatment for multiple myeloma (MM) has significantly changed over the last decade due to novel agents that have shown superiority in efficacy such as proteasome inhibitors (PIs) and immunomodulatory drugs (IMiDs) over traditional therapies. However, the real-world utilization of these new agents has not been studied well. This study evaluated year-to-year changes in treatment choices in a cohort of patients aged 66 or older in the Surveillance, Epidemiology, and End Results (SEER) registry linked with Medicare claims (SEER-Medicare) data who were diagnosed with MM between 200

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… Reference groups for diagnosis year was 2007, 66‐70 for age, non‐Hispanic for race, male for sex, not married for marital status, West for region, no for Medicare and Medicaid dual eligibility, no for poor performance indicators, and 0 for CCI. … Other baseline characteristics, including gender, dual eligibility with Medicaid, and poor performance status, were not associated with treatment receipt (Table 3 ). These results are based on the base model. …

Trends in volumes and survival after hematopoietic cell transplantation in racial/ethnic minorities.

AbstractThere has been an increase in volume as well as an improvement in overall survival (OS) after hematopoietic cell transplantation (HCT) for hematologic disorders. It is unknown if these changes have affected racial/ethnic minorities equally. In this observational study from the Center for International Blood and Marrow Transplant Research of 79 904 autologous (auto) and 65 662 allogeneic (allo) HCTs, we examined the volume and rates of change of autoHCT and alloHCT over time and trends in OS in 4 racial/ethnic groups: non-Hispanic Whites (NHWs), non-Hispanic African Americans (NHAAs), a

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… Building on the Evidence Base: Studies on the Effects of Medicaid Expansion, February 2020 to March 2021. https://www.kff.org/report-section/building-on-the-evidence-base-studies-on-the-effects-of-medicaid-expansion-february-2020-to-march-2021-appendix-a/ KFF. 36. … Association between Medicaid expansion under the Affordable Care Act and survival among newly diagnosed cancer patients. J Natl Cancer Inst. 2022;114(8):1176–1185. doi: 10.1093/jnci/djac077. 37. Waxman AJ, Mink PJ, Devesa SS, et al. …

The burden of metastatic disease of the femur on the Medicare system.

BackgroundIn the United States, over 1,650,000 new cases of cancer are being diagnosed yearly with almost 50 % of them being the top five bone-seeking cancers. Since cancer risk increases with age, this suggests that orthopedic oncology services may be a strain on the Medicare system. The femur is the most common site of long bone metastases. Prophylactic fixation techniques prevent pathologic fractures, reduce morbidities, and enhance the quality of life of patients with femoral metastases. This study aims to assess the rate of metastatic disease to the skeleton and evaluate the use and finan

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… Variables, outcome measures, data sources, and bias Prevalence was calculated using enrollment data from the Centers for Medicare and Medicaid Services 2013 Statistical Supplement (Centers for Medicare and Medicaid Services 2013 ). … Medicaid Services (2016) Signing up for medicare: special conditions. https://www.medicare.gov/sign-up-change-plans/get-parts-a-and-b/special-conditions/special-conditions.html . …

An update of comprehensive evidence-based guidelines for interventional techniques in chronic spinal pain. Part II: guidance and recommendations.

OBJECTIVE: To develop evidence-based clinical practice guidelines for interventional techniques in the diagnosis and treatment of chronic sp … sion, and Dekompressor; and limited to fair for nucleoplasty for which the Centers for Medicare and Medicaid Services (CMS) has issued a noncoverage decision. II. Cervical Spine • The evidence for cervical provocation discography is limited; whereas the evidence for diagnostic cervical facet joint nerve blocks is good with a criterion standard of 75% or gr …

Contemporary treatment patterns of overweight and obesity: insights from the Mass General Brigham health care system.

ObjectiveThe objective of this study was to describe the prevalence of obesity, obesity-related conditions (ORCs), and antiobesity medication (AOM) eligibility and prescribing practice among eligible patients in a large health care system.MethodsIn this cross-sectional analysis of the multicenter Mass General Brigham health care system (Boston, Massachusetts) spanning 2018 to 2022, adults eligible for AOMs (BMI ≥ 30 kg/m2 or BMI 27-29.9 kg/m2 with ≥1 ORC) were identified. Among those AOM-eligible, the prevalence of prescriptions for AOMs approved for long-term weight management was evaluated.R

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… Commercial insurance was more prevalent among patients prescribed AOMs compared with those not prescribed AOMs (95.7% vs. 86.2%), whereas Medicare (12.3% vs. 25.8%) and Medicaid (5.9% vs. 10.3%) insurance was less common. … Massachusetts was also among the states whose Medicaid program did not provide coverage for AOMs over the study interval. However, individuals with the highest BMI values and obesity‐related health burden in this analysis were more likely to have Medicaid and Medicare insurance, respectively. …

Discharge status and post-discharge healthcare costs after skeletal-related event hospitalizations among medicare patients with bone metastatic solid tumors or multiple myeloma.

BACKGROUND: Previous studies have quantified direct inpatient costs of skeletal-related events (SREs); however, costs associated with subsequent post-SRE care have not been examined. METHODS: We identified two study cohorts using 2011-2015 Medicare 20% sample data: patients diagnosed with 1) bone metastases from solid tumors or 2) multiple myeloma (MM), both with SRE-related hospitalization discharge dates January 1, 2011-September 30, 2015. We assessed discharge status and costs from discharge to the earliest of death, end of Medicare enrollment, or December 31, 2015. Discharge status was de

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… During the baseline period, patient demographics, Medicare/Medicaid dual eligible status, pre-index SRE-related hospitalizations (including the index SRE hospitalizations), and Charlson comorbidity index (CCI) were defined. … Methodol 15 2015 65 26286392 10.1186/s12874-015-0047-5 PMC4544826 19 Centers for Medicaid & Medicare Services. Patient Discharge Status Codes Matter. …