Improving the Quality and Lowering the Cost of Health Care: Medicare Reforms from the National Commission on Physician Payment Reform

Patel, Kavita; Nadel, Jeffrey

doi:10.1007/s11606-014-2786-0

Cited by 6 publications

(7 citation statements)

References 1 publication

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“…Data collected prior to and following the mandate demonstrate that disparities in women veterans’ care have been reduced [ 9 ]. However, variability in the implementation of the policy may have resulted in uneven access to needed services and satisfaction in care across facilities [ 10 ]. Furthermore, given that the policy largely focused on primary care, unmet needs may remain elsewhere, e.g., in mental health.…”

Section: Introductionmentioning

confidence: 99%

Experiences with VHA care: a qualitative study of U.S. women veterans with self-reported trauma histories

et al. 2017

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BackgroundWomen veterans in the United States, particularly those with posttraumatic stress disorder (PTSD) or a history of military sexual assault, have unique health care needs, but their minority status in the US Veterans Health Administration (VHA) has led to documented healthcare disparities when compared to men. This study’s objective was to obtain a richer understanding of the challenges and successes encountered by women veterans with self-reported service-related trauma histories (particularly those with a history of military sexual assault and/or posttraumatic stress symptomology) receiving VHA care.MethodsThirty-seven female Vietnam and post-Vietnam (1975–1998) era veterans were randomly selected from a cohort of PTSD disability benefit applicants to complete semi-structured interviews in 2011–2012. Grounded-theory informed procedures were used to identify interview themes; differences between veterans with and without a history of military sexual assault were examined through constant comparison.ResultsAt the time of the interviews, many women believed that VHA was falling short of meeting women veterans’ needs (e.g., lack of women-only mental health programming). Also common, but particularly among those with a military sexual assault history, was the perception that VHA’s environment was unwelcoming; being “surrounded by men” yielded emotions ranging from discomfort and mistrust to severe anxiety. A few veterans reported recent positive changes and offered additional suggestions for improvement.ConclusionsFindings suggest that while at the time of the interviews gains had been made in the delivery of gender-sensitive outpatient medical care, women veterans with a history of military sexual assault and/or posttraumatic stress symptomology perceived that they were not receiving the same quality of care as male veterans.

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Section: Introductionmentioning

confidence: 99%

Experiences with VHA care: a qualitative study of U.S. women veterans with self-reported trauma histories

et al. 2017

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“…Physician services account for approximately 20% of healthcare billing in the US and even then, there is a great divergence of reimbursement between different medical and surgical specialties. [ 16 17 ] Neurosurgeons, in particular, rank as the 37 th billing specialty to Medicare. Neurosurgeons billed Medicare a total of $310 million in 2012; this is less than the $495 million billed by chiropractors and far less than the $839 million billed by pain management and physical medicine specialists.…”

Section: Discussionmentioning

confidence: 99%

“…[ 18 ] According to Merritt Hawkins data, in 2010 a neurosurgeon, on average, generated $2,815,650 in hospital revenue to bundled payment systems; in 2013, this declined to $1,684,523. [ 16 ] Future Medicare research should seek to, at a fundamental level, understand the clinical decision-making (if there is any) that contributes to these changes in revenue.…”

Section: Discussionmentioning

confidence: 99%

Medicare payment data for spine reimbursement; important but flawed data for evaluating utilization of resources

Menger¹,

Wolf²,

Kukreja³

et al. 2015

Surg Neurol Int

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Background:Medicare data showing physician-specific reimbursement for 2012 were recently made public in the mainstream media. Given the ongoing interest in containing healthcare costs, we analyze these data in the context of the delivery of spinal surgery.Methods:Demographics of 206 leading surgeons were extracted including state, geographic area, residency training program, fellowship training, and academic affiliation. Using current procedural terminology (CPT) codes, information was evaluated regarding the number of lumbar laminectomies, lumbar fusions, add-on laminectomy levels, and anterior cervical fusions reimbursed by Medicare in 2012.Results:In 2012 Medicare reimbursed the average neurosurgeon slightly more than an orthopedic surgeon for all procedures ($142,075 vs. $110,920), but this was not found to be statistically significant (P = 0.218). Orthopedic surgeons had a statistical trend illustrating increased reimbursement for lumbar fusions specifically, $1187 versus $1073 (P = 0.07). Fellowship trained spinal surgeons also, on average, received more from Medicare ($125,407 vs. $76,551), but again this was not statistically significant (P = 0.112). A surgeon in private practice, on average, was reimbursed $137,495 while their academic counterparts were reimbursed $103,144 (P = 0.127). Surgeons performing cervical fusions in the Centers for Disease Control West Region did receive statistically significantly less reimbursement for that procedure then those surgeons in other parts of the country (P = 0.015). Surgeons in the West were reimbursed on average $849 for CPT code 22,551 while those in the Midwest received $1475 per procedure.Conclusion:Medicare reimbursement data are fundamentally flawed in determining healthcare expenditure as it shows a bias toward delivery of care in specific patient demographics. However, neurosurgeons, not just policy makers, must take ownership to analyze, investigate, and interpret these data as it will affect healthcare reimbursement and delivery moving forward.

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“…Interestingly, outcomes were favorable for enhanced REP for their primary implementation outcome of uptake (i.e., completed contacts with Veterans with serious mental illness who had been lost to care), but not for increased utilization of services by patients who had dropped out of care [ 19 ]. This prompted us to consider alternate REP enhancements that are (1) more focused on participatory action [ 20 ] within complex adaptive systems [ 21 ] in VA WH clinical settings [ 22 ] and (2) potentially more effective in increasing patient engagement. Accordingly, we draw on complexity theory and multilevel stakeholder engagement (Fig.…”

Section: Methodsmentioning

confidence: 99%

Enhancing Mental and Physical Health of Women through Engagement and Retention (EMPOWER): a protocol for a program of research

et al. 2017

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BackgroundThe Enhancing Mental and Physical health of Women through Engagement and Retention or EMPOWER program represents a partnership with the US Department of Veterans Health Administration (VA) Health Service Research and Development investigators and the VA Office of Women’s Health, National Center for Disease Prevention and Health Promotion, Primary Care-Mental Health Integration Program Office, Women’s Mental Health Services, and the Office of Patient Centered Care and Cultural Transformation. EMPOWER includes three projects designed to improve women Veterans’ engagement and retention in evidence-based care for high-priority health conditions, i.e., prediabetes, cardiovascular, and mental health.Methods/DesignThe three proposed projects will be conducted in VA primary care clinics that serve women Veterans including general primary care and women’s health clinics. The first project is a 1-year quality improvement project targeting diabetes prevention. Two multi-site research implementation studies will focus on cardiovascular risk prevention and collaborative care to address women Veterans’ mental health treatment needs respectively. All projects will use the evidence-based Replicating Effective Programs (REP) implementation strategy, enhanced with multi-stakeholder engagement and complexity theory. Mixed methods implementation evaluations will focus on investigating primary implementation outcomes of adoption, acceptability, feasibility, and reach. Program-wide organizational-, provider-, and patient-level measures and tools will be utilized to enhance synergy, productivity, and impact. Both implementation research studies will use a non-randomized stepped wedge design.DiscussionEMPOWER represents a coherent program of women’s health implementation research and quality improvement that utilizes cross-project implementation strategies and evaluation methodology. The EMPOWER Quality Enhancement Research Initiative (QUERI) will constitute a major milestone for realizing women Veterans’ engagement and empowerment in the VA system. EMPOWER QUERI will be conducted in close partnership with key VA operations partners, such as the VA Office of Women’s Health, to disseminate and spread the programs nationally.Trial registrationThe two implementation research studies described in this protocol have been registered as required:Facilitating Cardiovascular Risk Screening and Risk Reduction in Women Veterans: Trial registration NCT02991534, registered 9 December 2016.Implementation of Tailored Collaborative Care for Women Veterans: Trial registration NCT02950961, registered 21 October 2016.Electronic supplementary materialThe online version of this article (10.1186/s13012-017-0658-9) contains supplementary material, which is available to authorized users.

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Improving the Quality and Lowering the Cost of Health Care: Medicare Reforms from the National Commission on Physician Payment Reform

Cited by 6 publications

References 1 publication

Experiences with VHA care: a qualitative study of U.S. women veterans with self-reported trauma histories

Experiences with VHA care: a qualitative study of U.S. women veterans with self-reported trauma histories

Medicare payment data for spine reimbursement; important but flawed data for evaluating utilization of resources

Enhancing Mental and Physical Health of Women through Engagement and Retention (EMPOWER): a protocol for a program of research

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