Prior authorization must make patient care the priority!
Prior authorization (PA) was designed and promoted as a cost-containment measure to ensure appropriate and cost-effective medical services. Sadly, it has become a tedious and time-consuming bureaucratic process that delays or impedes health care delivery. Although Medicare has relatively few PA requirements, Medicare Advantage (MA) programs and private carriers have their own process, and with more of our patients enrolling into these programs, we must be cognizant of this impact. (Source: Journal of Vascular Surgery)
Source: Journal of Vascular Surgery - April 18, 2024 Category: Surgery Authors: Francesco Aiello Tags: Invited commentary Source Type: research
Clinical and economic outcomes of assigning percutaneous coronary intervention patients to contrast-sparing strategies based on the predicted risk of contrast-induced acute kidney injury
CONCLUSIONS.: Assignment to contrast-sparing regimens at a predicted risk threshold close to the underlying incidence of CI-AKI is projected to result in significant clinical and economic benefits.PMID:38632967 | DOI:10.1080/13696998.2024.2334180 (Source: Journal of Medical Economics)
Source: Journal of Medical Economics - April 18, 2024 Category: Health Management Authors: Robert I Griffiths Aparna Bhave Alysha M McGovern Liesl M Hargens Craig A Solid Amit P Amin Source Type: research
Association of Hospital Market Competition with Outcomes of Complex Cancer Surgery
CONCLUSIONS: Hospital market competition was associated with poor achievement of an optimal postoperative outcome and greater hospitalization costs.PMID:38634960 | DOI:10.1245/s10434-024-15278-w (Source: Ann Oncol)
Source: Ann Oncol - April 18, 2024 Category: Cancer & Oncology Authors: Muhammad Musaab Munir Selamawit Woldesenbet Yutaka Endo Mary Dillhoff Susan Tsai Timothy M Pawlik Source Type: research
Second line therapy in multiple myeloma: A SEER Medicare analysis
Introduction: The therapeutic landscape in relapsed/refractory multiple myeloma (RRMM) has changed rapidly, with twenty-two drug approvals since 2012. We characterized population-level trends in RRMM therapy selection, survival and cost outcomes associated with RRMM treatment over time.Materials and Methods: Our cohort included adults diagnosed with multiple myeloma (MM) in the SEER-Medicare database from 2007 – 2017 who received at least one antimyeloma agent. MM-directed therapies and lines of therapy were identified. (Source: Clinical Lymphoma, Myeloma and Leukemia)
Source: Clinical Lymphoma, Myeloma and Leukemia - April 18, 2024 Category: Hematology Authors: Matthew R LeBlanc, Xi Zhou, Christopher D Baggett, Sascha Tuchman, Christopher E Jensen, Samuel Rubinstein Tags: Original Study Source Type: research
An assessment of the association between patient characteristics and timely lung cancer treatment
ConclusionsWithin a Medicare Advantage population, patient demographics were found to be significantly associated with the decision to pursue surgery, but factors other than stage were not significantly associated with time to non-systemic treatment. (Source: Cancer Causes and Control)
Source: Cancer Causes and Control - April 18, 2024 Category: Cancer & Oncology Source Type: research
A terminal trend model for longitudinal medical cost data and survival
AbstractA joint modeling approach on survival and longitudinal data has proven to be valuable in end of life applications, especially when there is a strong relationship between the longitudinal measurements and survival outcomes in the presence of high mortality rates. We have implemented a novel joint modeling approach, a flexible terminal trend model, to study the trends and factors influencing end of life cost in clinic observational cohorts with significant mortality by comparing the differences in trajectories due to risk and treatment factors. The motivating data consisted of insurance claims for a cohort of patient...
Source: Health Services and Outcomes Research Methodology - April 18, 2024 Category: Statistics Source Type: research
Access to In-Network Mental Health Care Still Lags Far Behind Other Medical Care
Patients are far more likely to go out of network to obtain health care from mental health professionals than from medical or surgical professionals, areport by RTI International has found.In research that was partially funded by APA, Tami L. Mark, Ph.D., M.B.A., and William J. Parish, Ph.D., M.A., analyzed enrollment data and claims from more than 22 million individuals captured annually from 2019 through 2021 to evaluate out-of-network use and reimbursement rates across all 50 states.The researchers found that patients went out of network 3.5 times more often to see a behavioral health professional (physician or nonphysi...
Source: Psychiatr News - April 17, 2024 Category: Psychiatry Tags: billing codes health care insurance out of network parity pay disparities reimbursement RTI International Source Type: research
Comparing PCSK9 Monoclonal Antibody Treatment Strategies Following Myocardial Infarction Using Negative Control Outcomes: A Target Trial Emulation Study
CONCLUSION: A comparative effectiveness study of these treatments using the current approach would likely bias results due to the low number of PCSK9 mAb initiators.PMID:38629975 | DOI:10.1097/EDE.0000000000001730 (Source: Cancer Control)
Source: Cancer Control - April 17, 2024 Category: Cancer & Oncology Authors: Rosa Sloot Alexander Breskin Lisandro D Colantonio Andrew G Allmon Ying Yu Swati Sakhuja Ligong Chen Paul Muntner M Alan Brookhart Nafeesa Dhalwani Source Type: research
Comparative Safety of Long-Acting vs. Short-Acting Erythropoiesis-Stimulating Agents Among Patients Undergoing Hemodialysis
Clin Pharmacol Ther. 2024 Apr 17. doi: 10.1002/cpt.3271. Online ahead of print.ABSTRACTBoth short-acting (epoetin alfa or beta) and long-acting (darbepoetin alfa or PEG-epoetin) erythropoiesis-stimulating agents (ESAs) are commonly prescribed for patients with kidney failure undergoing maintenance hemodialysis. We compared the risks of major adverse cardiovascular events (MACE) and of all-cause mortality associated with receipt of short- vs. long-acting ESAs. This retrospective cohort analysis included Medicare hemodialysis beneficiaries aged ≥ 18 years in the United States Renal Data System from January 2015 to December...
Source: Clinical Pharmacology and Therapeutics - April 17, 2024 Category: Drugs & Pharmacology Authors: Raj Desai Ikenna Unigwe Munaza Riaz Steven M Smith Ashutosh M Shukla Rajesh Mohandas Nakyung Jeon Haesuk Park Source Type: research
The "July effect" on patients admitted with diabetes ketoacidosis: a national retrospective cohort study
CONCLUSIONS: In this retrospective cohort study of patients admitted with DKA, inpatient care during July and August did not increase the odds of inpatient mortality.PMID:38628343 | PMC:PMC11018014 | DOI:10.1080/08998280.2024.2307833 (Source: Baylor University Medical Center Proceedings)
Source: Baylor University Medical Center Proceedings - April 17, 2024 Category: Universities & Medical Training Authors: Garry Francis-Morel Nehemias Guevara-Rodriguez Shellsea Portillo-Canales Carlos Ernesto Arias Morales David Sotello Source Type: research
Receipt of rheumatology care and lupus-specific labs among young adults with systemic lupus erythematosus: A US Medicare retention in care cohort study
CONCLUSION: Disparities in care, measured by rheumatology visits and serology testing, exist by neighborhood disadvantage, race and ethnicity, and region among young adults with lupus, despite uniform Medicare coverage. Findings support evaluating lupus care quality measures and their impact on US lupus outcomes.PMID:38631342 | DOI:10.1177/09612033241247905 (Source: Lupus)
Source: Lupus - April 17, 2024 Category: Rheumatology Authors: Maria Schletzbaum W Ryan Powell Shivani Garg Joseph Kramer Brad C Astor Andrea Gilmore-Bykovskyi Amy J Kind Christie M Bartels Source Type: research
Comparative Safety of Long-Acting vs. Short-Acting Erythropoiesis-Stimulating Agents Among Patients Undergoing Hemodialysis
Clin Pharmacol Ther. 2024 Apr 17. doi: 10.1002/cpt.3271. Online ahead of print.ABSTRACTBoth short-acting (epoetin alfa or beta) and long-acting (darbepoetin alfa or PEG-epoetin) erythropoiesis-stimulating agents (ESAs) are commonly prescribed for patients with kidney failure undergoing maintenance hemodialysis. We compared the risks of major adverse cardiovascular events (MACE) and of all-cause mortality associated with receipt of short- vs. long-acting ESAs. This retrospective cohort analysis included Medicare hemodialysis beneficiaries aged ≥ 18 years in the United States Renal Data System from January 2015 to December...
Source: Clinical Pharmacology and Therapeutics - April 17, 2024 Category: Drugs & Pharmacology Authors: Raj Desai Ikenna Unigwe Munaza Riaz Steven M Smith Ashutosh M Shukla Rajesh Mohandas Nakyung Jeon Haesuk Park Source Type: research
The "July effect" on patients admitted with diabetes ketoacidosis: a national retrospective cohort study
CONCLUSIONS: In this retrospective cohort study of patients admitted with DKA, inpatient care during July and August did not increase the odds of inpatient mortality.PMID:38628343 | PMC:PMC11018014 | DOI:10.1080/08998280.2024.2307833 (Source: Baylor University Medical Center Proceedings)
Source: Baylor University Medical Center Proceedings - April 17, 2024 Category: Universities & Medical Training Authors: Garry Francis-Morel Nehemias Guevara-Rodriguez Shellsea Portillo-Canales Carlos Ernesto Arias Morales David Sotello Source Type: research
The "July effect" on patients admitted with diabetes ketoacidosis: a national retrospective cohort study
CONCLUSIONS: In this retrospective cohort study of patients admitted with DKA, inpatient care during July and August did not increase the odds of inpatient mortality.PMID:38628343 | PMC:PMC11018014 | DOI:10.1080/08998280.2024.2307833 (Source: Baylor University Medical Center Proceedings)
Source: Baylor University Medical Center Proceedings - April 17, 2024 Category: Universities & Medical Training Authors: Garry Francis-Morel Nehemias Guevara-Rodriguez Shellsea Portillo-Canales Carlos Ernesto Arias Morales David Sotello Source Type: research
The "July effect" on patients admitted with diabetes ketoacidosis: a national retrospective cohort study
CONCLUSIONS: In this retrospective cohort study of patients admitted with DKA, inpatient care during July and August did not increase the odds of inpatient mortality.PMID:38628343 | PMC:PMC11018014 | DOI:10.1080/08998280.2024.2307833 (Source: Baylor University Medical Center Proceedings)
Source: Baylor University Medical Center Proceedings - April 17, 2024 Category: Universities & Medical Training Authors: Garry Francis-Morel Nehemias Guevara-Rodriguez Shellsea Portillo-Canales Carlos Ernesto Arias Morales David Sotello Source Type: research
