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Implications of eligibility category churn for pediatric payment in Medicaid.
CONCLUSIONS: Switching between eligibility categories is common and affects average capitation but not health service use. PMID: 30875179 [PubMed - in process]
Source: The American Journal of Managed Care - February 28, 2019 Category: Health Management Authors: Chisolm DJ, Gleeson SP, Kelleher KJ, Domino ME, Alexy E, Xu WY, Song PH Tags: Am J Manag Care Source Type: research

Pulling Care Out of Hospital —By Phone, Ambulance, and Good Ol ’ House Calls.
By REBECCA FOGG In the 20th century, hospitals completed their transformation from the hospice-like institutions of the Middle Ages, into large, gleaming centers of advanced medical expertise and technology that save and improve lives every day. But an unintended consequence of hospitals’ dazzling capabilities is a staggering cost burden that’s proving toxic to the American economy. Today, hospital care accounts for approximately 33% of the US’ $3.5 trillion annual health care expenditures, according to CMS. The drivers of hospital costs are complex and hard to tackle, including (but not limited to) market cons...
Source: The Health Care Blog - May 1, 2019 Category: Consumer Health News Authors: Christina Liu Tags: Hospitals Patients Physicians The Business of Health Care health innovation Home Health Rebecca Fogg Telehealth The Christensen Institute Source Type: blogs

Asthma-related emergency department (ED) visits and post-ED visit hospital and critical care admissions, National Hospital Ambulatory Medical Care Survey, 2010-2015.
Conclusions: Both asthma-related ED visits and post-ED hospitalizations were greater for children, blacks, and Hispanics. ED visits were also greater for Medicaid/CHIP. These findings might help prompt future studies on identifying additional potential risk factors for frequent ED visits among disproportionally affected subpopulations. PMID: 31922923 [PubMed - as supplied by publisher]
Source: Journal of Asthma - January 12, 2020 Category: Respiratory Medicine Tags: J Asthma Source Type: research

Sepsis Among Medicare Beneficiaries: 3. The Methods, Models, and Forecasts of Sepsis, 2012–2018*
Conclusions: A sepsis inpatient admission is associated with marked increase in risk of death that is comparable to the risks associated with inpatient admissions for other common and serious chronic illnesses. The aggregate costs of sepsis care for Medicare beneficiaries will continue to increase.
Source: Critical Care Medicine - February 15, 2020 Category: Emergency Medicine Tags: Late Breaker Articles Source Type: research

Impact of the Affordable Care Act's Medicaid Expansion on Tertiary, Pediatric Surgical Care
We examined the effect of ME on rates of elective, ambulatory surgery (EAS), especially among publicly-insured and ethnoracial-minority patients.
Source: Journal of Pediatric Surgery - April 27, 2021 Category: Surgery Authors: Megan E. Bouchard, Soyang Kwon, Benjamin T. Many, Jonathan C. Vacek, Fizan Abdullah, Hassan Ghomrawi Source Type: research

Under-recognition of sleep-disordered breathing and other common health conditions in the West Virginia Medicaid population: a driver of poor health outcomes
Journal of Clinical Sleep Medicine, Ahead of Print.
Source: Journal of Clinical Sleep Medicine : JCSM - October 21, 2021 Category: Sleep Medicine Authors: Robert Stansbury Patrick Strollo Nathan Pauly Ira Sharma Marco Schaaf Anina Aaron Judith Feinberg 1Section of Pulmonary, Critical Care and Sleep Medicine, West Virginia University Department of Medicine, Morgantown, West Virginia 2Department of Medicine V Source Type: research

Outcomes and Factors Associated With Prehospital Treatment of Pediatric Anaphylaxis
Conclusions Prehospital treatment with EPI remains low, and barriers to optimal treatment are more pronounced in children with public insurance. Prehospital treatment with EPI was associated with decreased morbidity including hospitalization and intensive care unit admission.
Source: Pediatric Emergency Care - January 1, 2022 Category: Emergency Medicine Tags: Original Articles Source Type: research

Impact of the Affordable Care Act's Medicaid expansion on tertiary pediatric surgical care
We examined the effect of ME on rates of elective, ambulatory surgery (EAS), especially among publicly-insured and ethnoracial-minority patients.
Source: Journal of Pediatric Surgery - April 27, 2021 Category: Surgery Authors: Megan E. Bouchard, Soyang Kwon, Benjamin T. Many, Jonathan C. Vacek, Fizan Abdullah, Hassan Ghomrawi Source Type: research

Underrecognition of sleep-disordered breathing and other common health conditions in the West Virginia Medicaid population: a driver of poor health outcomes
Journal of Clinical Sleep Medicine,<a href="https://jcsm.aasm.org/toc/jcsm/18/3">Volume 18, Issue 3</a>, Page 817-824, March 2022.
Source: Journal of Clinical Sleep Medicine : JCSM - March 1, 2022 Category: Sleep Medicine Authors: Robert Stansbury Patrick Strollo Nathan Pauly Ira Sharma Marco Schaaf Anina Aaron Judith Feinberg 1Section of Pulmonary, Critical Care, and Sleep Medicine, West Virginia University Department of Medicine, Morgantown, West Virginia 2Department of Medicine, Source Type: research

NQF Endorses SSC Measures
The National Quality Forum (NQF) ratified the measures for the treatment and management of patients with severe sepsis and septic shock as submitted collaboratively by the Henry Ford Hospital, the Infectious Diseases Society of America, and the Society of Critical Care Medicine. Measures ratified by NQF are considered by the Centers for Medicare & Medicaid Services (CMS) for public reporting and payment programs. The measures are consistent with the updated Surviving Sepsis Campaign (SSC) bundles. The SSC’s North American Steering Committee will conduct grand rounds with CMS on March 27 to outline the measures and data t...
Source: SCCM RSS News - March 22, 2013 Category: Intensive Care Source Type: news

Comparisons of Health Care Utilization Outcomes in Children With Asthma Enrolled in Private Insurance Plans Versus Medicaid
Abstract: Objectives: Very few studies have captured the differences in the outcomes of pediatric patients based on the patients’ type of health insurance plan. The purpose of this retrospective cohort study was to examine the impact of the type of health insurance plan (public insurance vs. private insurance) on outcomes (health care utilization and medication adherence) in children with asthma.Methods: This retrospective cohort study analyzed Medicaid/commercial data from eight states licensed under Thomson Medstat. Subjects were 11,027 children with asthma (6435 enrolled in Medicaid and 4592 enrolled in a commercial h...
Source: Journal of Pediatric Health Care - January 10, 2013 Category: Pediatrics Authors: Jongwha Chang, Gary L. Freed, Lisa A. Prosser, Isha Patel, Steven R. Erickson, Richard P. Bagozzi, Rajesh Balkrishnan Tags: Articles Source Type: research

Gaming Hospital-Level Pneumonia 30-Day Mortality and Readmission Measures by Legitimate Changes to Diagnostic Coding*
Conclusions: Hospitals can improve apparent pneumonia mortality and readmission rates by recoding pneumonia patients. Centers for Medicare and Medicaid Services should consider changes to their methods used to calculate hospital-level pneumonia outcome measures to make them less susceptible to gaming.
Source: Critical Care Medicine - April 17, 2015 Category: Emergency Medicine Tags: Clinical Investigations Source Type: research

Improving Discharge Instructions in a Pediatric Emergency Department: Impact of a Quality Initiative
Background: Effective communication between physician and patient is essential to optimize care after discharge from the emergency department (ED). Written discharge care instructions (DCI) complement verbal instructions and have been shown to improve communication and patient management. In 2012, Centers for Medicare and Medicaid Services proposed a quality measure (OP-19) that assesses compliance with key elements considered essential for high-quality written DCI. Objective: To evaluate the impact of a QI intervention on improving quality of written DCI in a pediatric emergency department (PED). Methods: A QI initiativ...
Source: Pediatric Emergency Care - January 1, 2017 Category: Emergency Medicine Tags: Original Articles Source Type: research

Adult Caregiver Influenza Vaccination Through Administration in Pediatric Outpatient Clinics: A Cocooning Healthcare Improvement Project
Conclusions: ACs readily accepted influenza vaccination at their child’s pediatric primary care office. Increased vaccination acceptance occurred when ACs were female, had private insurance, if their child had a chronic illness and if the vaccination was offered the same day as their child’s appointment. Likely reason for low acceptance in ACs with Medicaid insurance is high cost; thus, staff, well-aware of Medicaid’s nonreimbursement, likely offered the vaccine less to these parents.
Source: The Pediatric Infectious Disease Journal - August 15, 2018 Category: Infectious Diseases Tags: Vaccine Reports Source Type: research

Compliance With the National SEP-1 Quality Measure and Association With Sepsis Outcomes: A Multicenter Retrospective Cohort Study*
Objectives: Many septic patients receive care that fails the Centers for Medicare and Medicaid Services’ SEP-1 measure, but it is unclear whether this reflects meaningful lapses in care, differences in clinical characteristics, or excessive rigidity of the “all-or-nothing” measure. We compared outcomes in cases that passed versus failed SEP-1 during the first 2 years after the measure was implemented. Design: Retrospective cohort study. Setting: Seven U.S. hospitals. Patients: Adult patients included in SEP-1 reporting between October 2015 and September 2017. Interventions: None. Measurements and Main ...
Source: Critical Care Medicine - September 15, 2018 Category: Emergency Medicine Tags: Feature Articles Source Type: research