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Keywords: reimbursement
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Journal Article
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Characteristics of Verified and Designated Burn Centers
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Anastasiya Ivanko and others
Journal of Burn Care & Research, iraf035, https://doi.org/10.1093/jbcr/iraf035
Published: 24 March 2025
... in burn care, aiming to improve care quality, accessibility, and equity. Burn burn center verification quality characteristics revenue outcomes American Burn Association reimbursement policy Accepted Manuscript Characteristics of Verified and Designated Burn Centers Authors: Anastasiya Ivanko...
Journal Article
EDITOR'S CHOICE
Reimbursement recommendations before and after adoption of application fees by the Canadian Agency for Drugs and Technologies in Health: a cross-sectional study
Joel Lexchin
Journal of Pharmaceutical Health Services Research, Volume 16, Issue 1, March 2025, rmaf004, https://doi.org/10.1093/jphsr/rmaf004
Published: 27 February 2025
... Objectives To determine if the introduction of drug company payment of application fees to the Canadian Agency for Drugs and Technologies in Health (CADTH) had an effect on its reimbursement recommendations to public drug funders for drugs with oncology and non-oncology indications. Methods Drug...
Journal Article
Reimbursement for services provided by clinical pharmacists in primary care: Description of changes over time in an academic primary care network in Ohio following the recognition of pharmacists as providers
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Cory P Coffey and others
American Journal of Health-System Pharmacy, zxaf021, https://doi.org/10.1093/ajhp/zxaf021
Published: 06 February 2025
... in pharmacist-provided services that were billed and reimbursed, 2) the percent change in pharmacist-provided services that were billed as “incident-to” versus with the pharmacist as provider, and (3) the percent change in reimbursement per encounter as a result of pharmacist-provided services. Methods...
Journal Article
Civil Lawfare
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April D Fernandes and others
Social Problems, spaf005, https://doi.org/10.1093/socpro/spaf005
Published: 28 January 2025
... racialized sentencing laws, targeted policing, and exponential incarceration rates. pay-to-stay civil law prison reimbursement monetary sanctions civil lawfare One of the most effective ways to wage war on a population is to bury them in debt. If you can legally defend your right to do this, even better...
Journal Article
Medicaid billing for community health worker services growing, but remains low, 2016-2020
Clese Erikson and others
Health Affairs Scholar, Volume 3, Issue 1, January 2025, qxae164, https://doi.org/10.1093/haschl/qxae164
Published: 13 January 2025
... in number of CHW beneficiaries in states with direct reimbursement policies by state, 2016-2020. Source: T-MSIS database, analysis conducted by authors. Notes: 1. Nine states included in analysis: CA, IN, MI, ND, OH, OR, VT, WA, and WI. Data from MN, MN, and WV are excluded due to data quality issues; data...
Journal Article
Financial reimbursement of a pharmacist-led chronic care management program utilizing pharmacist extenders within a privately owned family medicine clinic
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Keri Mack
American Journal of Health-System Pharmacy, zxae383, https://doi.org/10.1093/ajhp/zxae383
Published: 10 December 2024
...:https://dbpia.nl.go.kr/pages/standard-publication-reuse-rights ) Abstract Purpose To evaluate the financial reimbursement of a pharmacist-led chronic care management (CCM) program utilizing student pharmacists and pharmacy residents as pharmacist extenders in a privately owned primary care practice. Methods...
Journal Article
Assessing the utilization of Current Procedural Terminology codes in pharmacists’ services using MarketScan data
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Smita Rawal and others
American Journal of Health-System Pharmacy, Volume 82, Issue 9, 1 May 2025, Pages e431–e437, https://doi.org/10.1093/ajhp/zxae314
Published: 18 October 2024
... pharmacy medication therapy management pharmacists reimbursement Quality patient-centered care involves continual monitoring and evaluation to ensure safe and appropriate medication use. 1 In 2006, the Centers for Medicare and Medicaid Services (CMS) established the Medicare Part D program...
Journal Article
Sorry you asked? Mayo, Myriad, and the battles over patent-eligibility
Robert Cook-Deegan and others
Journal of Law and the Biosciences, Volume 11, Issue 1, January-June 2024, lsae010, https://doi.org/10.1093/jlb/lsae010
Published: 04 June 2024
... decisions and specify narrow statutory exclusions to patent-eligibility in §101 of the US Patent Act. What would be the consequences of doing so? The Supreme Court decisions coincided with changes in how genetic tests were performed, reimbursed and regulated. Multi-gene sequencing supplanted oligo-gene...
Journal Article
Health care cost accounting in the Indian hospital sector
Yashika Chugh and others
Health Policy and Planning, Volume 39, Issue 7, August 2024, Pages 731–740, https://doi.org/10.1093/heapol/czae040
Published: 30 May 2024
... and severity. Such systems rely on transparent and robust evidence to inform both diagnosis groupings and their reimbursement tariffs. In particular, data are needed for standardized patient classification around diagnosis and procedures, how costs might vary with case mix and severity and the average costs...
Journal Article
Commercial Versus Medicaid Insurance and Use of High-Priced Anticancer Treatments
Aaron P Mitchell and others
The Oncologist, Volume 29, Issue 6, June 2024, Pages 527–533, https://doi.org/10.1093/oncolo/oyae035
Published: 14 March 2024
.... Commercially insured and Medicaid-insured patients received high-priced treatments in similar proportion overall, but commercially insured patients were more likely to receive high-priced treatments in community practice settings. antineoplastic agents practice pattern clinical reimbursement incentive fee...
Journal Article
US payment policy for medications to treat opioid use disorder: landscape and opportunities
Emma E McGinty and others
Health Affairs Scholar, Volume 2, Issue 3, March 2024, qxae024, https://doi.org/10.1093/haschl/qxae024
Published: 27 February 2024
... not receive medication. Payment policy, defined as public and private payers’ approaches to covering and reimbursing providers for MOUD, is 1 contributor to this treatment gap. We conducted a policy analysis and qualitative interviews (n = 21) and surveys (n = 31) with US MOUD payment policy...
Journal Article
Trends of Medicare reimbursement rates for gender affirmation procedures
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Charalampos Siotos and others
The Journal of Sexual Medicine, Volume 21, Issue 2, February 2024, Pages 181–191, https://doi.org/10.1093/jsxmed/qdad160
Published: 06 December 2023
... reimbursed by Medicare. The Affordable Care Act of 2010 greatly expanded health care coverage for transgender and gender-diverse people. 15 However, it was not until 2014 that the US Department of Health and Human Services reversed its blanket ban on the use of Medicare coverage for gender...
Journal Article
Paying a Heavy Price: Costs of Care for People With Severe Obesity in Nursing Homes
Luisa Fernandez and others
The Gerontologist, Volume 64, Issue 7, July 2024, gnad150, https://doi.org/10.1093/geront/gnad150
Published: 31 October 2023
... shortage, expensive and unique equipment needs, inadequate general reimbursement with an absence of obesity-specific reimbursement supplements, and competing short- and long-term management solutions. Discussion and Implications This qualitative study of nursing home staff and leadership underscores...
Journal Article
Tele-Neuropsychology: From Science to Policy to Practice
Scott A Sperling and others
Archives of Clinical Neuropsychology, Volume 39, Issue 2, March 2024, Pages 227–248, https://doi.org/10.1093/arclin/acad066
Published: 15 September 2023
... professionals, the latter of which include psychologists, were reimbursed at the lower facility rate. Audio-only telehealth was not reimbursed, patients could not receive telehealth services in their home, and telehealth services were restricted to originating sites and certain geographic areas. Moreover...
Journal Article
Payer reimbursement practices and incentives for improving interpretation of germline genetic testing
Patricia Deverka and others
Journal of Law and the Biosciences, Volume 10, Issue 2, July-December 2023, lsad020, https://doi.org/10.1093/jlb/lsad020
Published: 09 July 2023
... to guide users of genetic tests regarding coding, coverage, and reimbursement. Mary Majumder is a lawyer-bioethicist at Baylor College of Medicine. Zuzana Skvarkova is a research associate who edited and formatted references. Robert Cook-Deegan is a physician and poiicy analyst at Arizona State...
Journal Article
Perspectives of private payers on multicancer early-detection tests: informing research, implementation, and policy
Julia R Trosman and others
Health Affairs Scholar, Volume 1, Issue 1, July 2023, qxad005, https://doi.org/10.1093/haschl/qxad005
Published: 20 June 2023
... Covered technologies can be included in an enrollee's benefits package and their use could be reimbursed. Therefore, payers’ coverage impacts providers’ decisions to adopt a test or treatment. 34 , 35 Coverage decision making is a complex process of evaluating available evidence of benefits...
Journal Article
Should Canada adopt managed access agreements in Canada for expensive drugs?
Melanie McPhail and Tania Bubela
Journal of Law and the Biosciences, Volume 10, Issue 1, January-June 2023, lsad014, https://doi.org/10.1093/jlb/lsad014
Published: 15 June 2023
... in Health (CADTH) is an independent, not-for-profit, quasi-federal organization responsible for providing reimbursement recommendations to participating drug plans. All the provinces and territories (with the exception of Quebec) participate in the CADTH Health Technology Assessment (HTA) process...
Journal Article
Expansion of services within primary care clinics due to quality initiatives and revenue generation
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Chelsea A Keedy and others
American Journal of Health-System Pharmacy, Volume 80, Issue 15, 1 August 2023, Pages 962–966, https://doi.org/10.1093/ajhp/zxad098
Published: 10 May 2023
... to the attention of the prescriber when necessary. clinical pharmacists community medicine health metrics primary health care quality improvement reimbursement mechanisms Models for advancement of ambulatory care pharmacy practice and state scope of practice continue to advocate for pharmacists to practice...
Journal Article
Scaling up quality in an anesthesia practice
Richard P Dutton and others
International Journal for Quality in Health Care, Volume 35, Issue 1, 2023, mzad011, https://doi.org/10.1093/intqhc/mzad011
Published: 11 March 2023
...Richard P Dutton; Thomas H Swygert; Matthew Maloney; Mo Azam; D Kurt Jones; Olivia Lounsbury; Aesha S Shukla; Paul Taheri Improving health-care quality has received significant recognition, as evidenced by the number of reimbursement and incentive metrics associated with quality improvement (QI...
Journal Article
Real-World Evidence of Effectiveness and Safety of Vedolizumab for Inflammatory Bowel Disease in Taiwan: A Prospective Nationwide Registry (VIOLET) Study
Wei-Chen Lin and others
Inflammatory Bowel Diseases, Volume 29, Issue 11, November 2023, Pages 1730–1740, https://doi.org/10.1093/ibd/izac269
Published: 10 January 2023
... case report form. The input data were updated quarterly. VDZ was administered as an intravenous infusion (300 mg) at weeks 0, 2, and 6 and every 8 weeks thereafter, with no dose intensification allowed according to the reimbursement criteria. Treatment effectiveness; concomitant medication; and adverse...
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