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Journal articles on the topic 'Health care reimbursement'

Author: Grafiati

Published: 4 June 2021

Last updated: 5 February 2022

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1

Levi, Shoshana, Emily Alberto, Dakota Urban, Nicholas Petrelli, and Gregory Tiesi. "Health-Care Workers’ Perception of Reimbursement for Complex Surgical Oncology Procedures." American Surgeon 86, no. 2 (February 2020): 140–45. http://dx.doi.org/10.1177/000313482008600234.

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Perception of physician reimbursement for surgical procedures is not well studied. The few existing studies illustrate that patients believe compensation to be higher than in reality. These studies focus on patient perceptions and have not assessed health-care workers’ views. Our study examined health-care workers’ perception of reimbursement for complex surgical oncology procedures. An anonymous online survey was distributed to employees at our cancer center with descriptions and illustrations of three oncology procedures—hepatectomy, gastrectomy, and pancreaticoduodenectomy. Participants estimated the Medicare fee and gave their perceived value of each procedure. Participants recorded their perception of surgeon compensation overall, both before and after revealing the Medicare fee schedule. Most of the 113 participants were physicians (33.6%) and nurses (28.3%). When blinded to the Medicare fee schedules, most felt that reimbursements were too low for all procedures (60–64%) and that surgeons were overall undercompensated (57%). Value predictions for each procedure were discordant from actual Medicare fee schedules, with overestimates up to 374 per cent. After revealing the Medicare fee schedules, 55 per cent of respondents felt that surgeons were undercompensated. Even among health-care workers, a large discrepancy exists between perceived and actual reimbursement. Revealing actual reimbursements did not alter perception on overall surgeon compensation.

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Hilt, Robert J. "Reimbursement for Primary Care Mental Health." Pediatric Annals 42, no. 10 (October 1, 2013): 394. http://dx.doi.org/10.3928/00904481-20130924-03.

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3

Preskitt, John T. "Health Care Reimbursement: Clemens to Clinton." Baylor University Medical Center Proceedings 21, no. 1 (January 2008): 40–44. http://dx.doi.org/10.1080/08998280.2008.11928358.

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4

Cowan, Dale H. "Legal aspects of health care reimbursement." Journal of Legal Medicine 6, no. 4 (December 1985): 553–62. http://dx.doi.org/10.1080/01947648509513460.

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5

Barros, Pedro Pita, and Xavier Martinez-Giralt. "Technological Adoption in Health Care – The Role of Payment Systems." B.E. Journal of Economic Analysis & Policy 15, no. 2 (April 1, 2015): 709–45. http://dx.doi.org/10.1515/bejeap-2014-0113.

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Abstract This paper examines the incentive to adopt a new technology resulting from common payment systems, namely mixed cost reimbursement and DRG reimbursement. Adoption is based on a cost–benefit criterion. We find that retrospective payment systems require a large enough patient benefit to yield adoption, while under DRG-linked payment, adoption may arise in the absence of patients benefits when the differential reimbursement for the old vs new technology is large enough. Also, mixed cost reimbursement leads to higher adoption under conditions on the differential reimbursement levels and patient benefits. In policy terms, mixed cost reimbursement system may be more effective than a DRG payment system to induce technology adoption. Our analysis also shows that current economic evaluation criteria for new technologies do not capture the different ways payment systems influence technology adoption. This gives a new dimension to the discussion of prospective vs retrospective payment systems of the last decades centered on the debate of quality vs cost containment.

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Melzer, S. M., and S. R. Poole. "Reimbursement for Telephone Care." PEDIATRICS 109, no. 2 (February 1, 2002): 290–93. http://dx.doi.org/10.1542/peds.109.2.290.

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7

Wilamowsky, Yonah, Aliza Rotenstein, and Sheldon Epstein. "Developing Transparent Health Care Reimbursement Auditing Procedures." Journal of Business Case Studies (JBCS) 10, no. 1 (December 31, 2013): 1–6. http://dx.doi.org/10.19030/jbcs.v10i1.8323.

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The continued computerization of health care records has enabled easier sampling and analysis of large sets of medical records, making it easier than ever for Medicare, Medicaid and other private insurers to use statistical audits to determine and demand return of alleged overpayments to health care providers. However, there are sometimes statistical difficulties with the audits, and there is frequently not sufficient transparency in the procedures or their application to reproduce the results in order to determine whether they have been carried out correctly. This paper addresses concerns in sampling and analysis of data records by looking at the case of a specific audit of a medical practice carried out by a private insurer. If done properly, statistical audits can be a very useful tool, but often the methodologies are vague and the implementation is either wrong or not explained fully enough to reproduce and analyze.

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Polovoy, Carol. "A ‘Sea Change’ in Health Care Reimbursement." ASHA Leader 17, no. 13 (October 2012): 4. http://dx.doi.org/10.1044/leader.otp.17132012.4.

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9

Besdine, Richard W. "Improving Health Care Quality by Reimbursement Policy." Journal of the American Geriatrics Society 46, no. 6 (June 1998): 788–90. http://dx.doi.org/10.1111/j.1532-5415.1998.tb03820.x.

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10

Bielitzki, Linda, and Michael A. Maffetone. "Medicare reimbursement of emerging health care technologies." Clinical Immunology Newsletter 10, no. 10 (October 1990): 154–57. http://dx.doi.org/10.1016/0197-1859(90)90044-9.

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11

Sonchak, Lyudmyla. "Medicaid reimbursement, prenatal care and infant health." Journal of Health Economics 44 (December 2015): 10–24. http://dx.doi.org/10.1016/j.jhealeco.2015.08.008.

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12

Morrissey, Joseph P., Russell P. Harris, Jean Kincade-Norburn, Curtis McLaughlin, Joanne M. Garrett, Anne M. Jackman, Jane S. Stein, et al. "Medicare Reimbursement for Preventive Care." Medical Care 33, no. 4 (April 1995): 315–31. http://dx.doi.org/10.1097/00005650-199504000-00001.

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13

Siljander, Eero. "Incentives of Health Care Expenditure." Farmeconomia. Health economics and therapeutic pathways 13, no. 4 (December 15, 2012): 175–89. http://dx.doi.org/10.7175/fe.v13i4.273.

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The incentives of health care expenditure (HCE) have been a topic of discussion in the USA (Obama reforms) and in Europe (adjustment to debt crisis). There are competing views of institutional versus GDP (unit income elasticity) and productivity related factors of growth of expenditure. However ageing of populations, technology change and economic incentives related to institutions are also key drivers of growth according to the OECD and EU’s AWG committee. Simulation models have been developed to forecast the growth of social expenditure (including HCEs) to 2050. In this article we take a historical perspective to look at the institutional structures and their relationship to HCE growth. When controlling for age structure, price developments, doctor density and in-patient and public shares of expenditures, we find that fee-for-service in primary care, is according to the results, in at least 20 percent more costly than capitation or salary remuneration. Capitation and salary (or wage) remuneration are at same cost levels in primary care. However we did not find the cost lowering effect for gatekeeping which could have been expected based on previous literature. Global budgeting 30 (partly DRG based) percent less costly in specialized care than other reimbursement schemes like open contracting or volume based reimbursement. However the public integration of purchaser and provider cost seems to result to about 20 higher than public reimbursement or public contracting. Increasing the number of doctors or public financing share results in increased HCEs. Therefore expanding public reimbursement share of health services seems to lead to higher HCE. On the contrary, the in-patient share reduced expenditures. Compared to the previous literature, the finding on institutional dummies is in line with similar modeling papers. However the results for public expansion of services is a contrary one to previous works on the subject. The median lag length of adjustment is 6.6 years or 26 quarters for countries to move half way to the eventual equilibrium in HCE/GDP-ratios in response to a shock in demand factors which indicates “hysteresis” in demand.

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Bunker, J. P., and R. W. Schaffarzick. "Reimbursement Incentives for Hospital Care." Annual Review of Public Health 7, no. 1 (May 1986): 391–409. http://dx.doi.org/10.1146/annurev.pu.07.050186.002135.

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15

Falen, Thomas, and Aaron Liberman. "Coding, Reimbursement, and Managed Care." Health Care Manager 28, no. 3 (July 2009): 194–208. http://dx.doi.org/10.1097/hcm.0b013e3181b3f1ac.

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16

Mozaffari, Essy, and Sean D. Sullivan. "Home care reimbursement for intravenous ganciclovir therapy." American Journal of Health-System Pharmacy 53, no. 2 (January 15, 1996): 161–63. http://dx.doi.org/10.1093/ajhp/53.2.161.

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Variability in reimbursement for home i.v. ganciclovir therapy among three types of payers was investigated. A survey was developed to estimate reimbursement for drug and medical supplies and nursing services associated with preparing i.v. ganciclovir and administering it to persons with cytomegalovirus (CMV)-associated retinitis in the home care setting. The questionnaire was mailed to 45 home health care agencies and 11 nursing agencies. Of the 56 surveys mailed, 26 (46%) were returned and considered usable. Of the 26 respondents, 22 were home health care companies, 4 were nursing ageiicies, 22 served patients covered by managed care or state assistance that reimbursed on a per diem trasis, and 9 did not provide care to fee-for-service patients. The mean total daily-reimbursement rate (for ganciclovir, supplies, and nursing services) from managed care per diem plans was $137.69 per patient, compared with $I29.18 from fee-for-service plans and $72.68 from state assistance per diem plans. The dissimilarity may have been due to geographic variations in reimbursement and different mechanisms of reimbursement. Providers of home i.v. ganciclovir therapy for persons with CMV retinitis received the highest tnean total daily reimbursement from managed care per diem plans, followed by fee-for-service plans and state assistance per diem plans.

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17

Howley, Michael J., Edgar Y. Chou, Nancy Hansen, and Prudence W. Dalrymple. "The long-term financial impact of electronic health record implementation." Journal of the American Medical Informatics Association 22, no. 2 (August 27, 2014): 443–52. http://dx.doi.org/10.1136/amiajnl-2014-002686.

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Abstract Objective To examine the financial impact of electronic health record (EHR) implementation on ambulatory practices. Methods We tracked the practice productivity (ie, number of patient visits) and reimbursement of 30 ambulatory practices for 2 years after EHR implementation and compared each practice to their pre-EHR implementation baseline. Results Reimbursements significantly increased after EHR implementation even though practice productivity (ie, the number of patient visits) decreased over the 2-year observation period. We saw no evidence of upcoding or increased reimbursement rates to explain the increased revenues. Instead, they were associated with an increase in ancillary office procedures (eg, drawing blood, immunizations, wound care, ultrasounds). Discussion The bottom line result—that EHR implementation is associated with increased revenues—is reassuring and offers a basis for further EHR investment. While the productivity losses are consistent with field reports, they also reflect a type of efficiency—the practices are receiving more reimbursement for fewer seeing patients. For the practices still seeing fewer patients after 2 years, the solution likely involves advancing their EHR functionality to include analytics. Although they may still see fewer patients, with EHR analytics, they can focus on seeing the right patients. Conclusions Practice reimbursements increased after EHR implementation, but there was a long-term decrease in the number of patient visits seen in this ambulatory practice context.

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18

McKnight, Robin. "Home care reimbursement, long-term care utilization, and health outcomes." Journal of Public Economics 90, no. 1-2 (January 2006): 293–323. http://dx.doi.org/10.1016/j.jpubeco.2004.11.006.

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19

Gesme, Dean H., and Marian Wiseman. "How to Negotiate With Health Care Plans." Journal of Oncology Practice 6, no. 4 (July 2010): 220–22. http://dx.doi.org/10.1200/jop.777011.

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20

Burrows, Anthony M., Richard P. Moser, John P. Weaver, Demetrius E. Litwin, and Julie G. Pilitsis. "Massachusetts health insurance mandate: effects on neurosurgical practice." Journal of Neurosurgery 112, no. 1 (January 2010): 202–7. http://dx.doi.org/10.3171/2009.6.jns09499.

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Object Massachusetts' health insurance mandate and subsidized insurance program, Commonwealth Care, have been active for 2 years. Methods The financial impact on the neurosurgery division and demographics of the relevant patient groups were assessed. The billing records of neurosurgical patients from January 2007 to September 2008 were collected and analyzed. Results Commonwealth Care comprised 2.2% of neurosurgical inpatients, and these patients did not have significantly different acuity or lengths of stay from the average. Length of stay of MassHealth patients was significantly greater, although acuity was significantly lower than the average. Increased free care reimbursement and increased MassHealth/Commonwealth Care enrollment resulted in a net gain in reimbursement of hospital charges. Conclusions The increased insurance rates have resulted in increased reimbursement for the neurosurgical division.

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21

Meyer, Judy, Pat Purvis, and Applied Media Technologies Corp. "Home Health Care Records and Documentation for Reimbursement." American Journal of Nursing 86, no. 3 (March 1986): 350. http://dx.doi.org/10.2307/3425483.

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22

Blayney, Douglas W. "Pricing, Reimbursement, and Health Care Trends to Watch." Journal of Oncology Practice 3, no. 4 (July 2007): 181. http://dx.doi.org/10.1200/jop.0740501.

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23

&NA;. "Home Health Care Records and Documentation for Reimbursement." AJN, American Journal of Nursing 86, no. 3 (March 1986): 350. http://dx.doi.org/10.1097/00000446-198603000-00047.

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24

Davis, Christopher. "Non‐reimbursement for preventable health care‐acquired conditions." Medical Journal of Australia 204, no. 3 (February 2016): 98–99. http://dx.doi.org/10.5694/mja15.00952.

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25

Swan, Linda. "Non‐reimbursement for preventable health care‐acquired conditions." Medical Journal of Australia 205, no. 1 (July 2016): 42. http://dx.doi.org/10.5694/mja16.00323.

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Davis, Christopher. "Non‐reimbursement for preventable health care‐acquired conditions." Medical Journal of Australia 205, no. 1 (July 2016): 42–43. http://dx.doi.org/10.5694/mja16.00364.

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27

Palley, Michael A., and Sue Conger. "Health care information systems and formula-based reimbursement." Health Care Management Review 20, no. 2 (1995): 74–84. http://dx.doi.org/10.1097/00004010-199521000-00010.

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28

Schafermeyer, Robert M. "Academic centers and change in health care reimbursement." Pediatric Emergency Care 12, no. 3 (June 1996): 155. http://dx.doi.org/10.1097/00006565-199606000-00002.

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Shahinian, Lee. "HEALTH CARE POLICY: MARGINAL VS AVERAGE COST REIMBURSEMENT." Ophthalmic Surgery, Lasers and Imaging Retina 24, no. 10 (October 1993): 711. http://dx.doi.org/10.3928/1542-8877-19931001-20.

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30

Katzman, Mitchell. "Freestanding Emergency Centers: Regulation and Reimbursement." American Journal of Law & Medicine 11, no. 1 (1985): 105–29. http://dx.doi.org/10.1017/s009885880000914x.

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AbstractThe freestanding emergency center, which combines the functions of a doctor's office and a hospital emergency room, has emerged as a new provider of health care. These centers have generated considerable controversy over their role in the health care market. Proponents argue that freestanding emergency centers reduce costs by providing care in a more efficient manner and cause other health care providers such as hospital emergency rooms to reduce costs and improve service. Opponents argue that the centers create an additional layer of health care which duplicates existing services and increases total health care costs. This Note examines the controversial issues of licensure, regulation and reimbursement. The Note concludes that freestanding emergency centers can help to reduce health care costs and discusses the steps that should be taken to aid centers in achieving this goal.

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Whedon, James M. "Regarding." Journal of Evidence-Based Integrative Medicine 23 (January 1, 2018): 2515690X1878800. http://dx.doi.org/10.1177/2515690x18788002.

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In the article, “Insurance Reimbursement for Complementary Healthcare Services,” we reported that the likelihood of reimbursement for complementary health care services in New Hampshire was significantly lower as compared with services of primary care physicians. The relatively low likelihood of reimbursement for integrative health care suggests that many patients who want such services must pay for them out of pocket. Affordable access to these services may be similarly limited in other states; certainly the utilization of integrative health care services varies significantly across the US states, and such variation may be tied to likelihood of reimbursement. Unwarranted geographic variation in reimbursement for integrative health care services is likely to compound inequities in access to health care in general, particularly for people of lower socioeconomic status. The aspirational value of Health Justice asserts the obligation of societies to attend to the basic health needs of all, with particular attention to the disadvantaged. A new project under development, The Atlas of Integrative Healthcare, is intended to support the advancement of health justice. The Atlas project is expected to support the policy goals of the integrative health care community with regard to helping patients access the high-value integrative health care services that they need and want.

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Agrawal, Rishi, Parag Shah, Kathy Zebracki, Kathy Sanabria, Claire Kohrman, and Arthur F. Kohrman. "Barriers to Care for Children and Youth With Special Health Care Needs." Clinical Pediatrics 51, no. 1 (August 19, 2011): 39–45. http://dx.doi.org/10.1177/0009922811417288.

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Objective. To assess primary care pediatricians’ (PCPs’) perceptions of caring for children and youth with special health care needs (CYSHCN). Methods. Cross-sectional survey of Illinois pediatricians. Results. Thirty-five percent of surveys were returned and 26% were analyzed. The top 3 perceived barriers were insufficient time (72%), insufficient reimbursement (68%), and lack of support services (59%). Insufficient interest was the least cited barrier (19%). Preparedness to perform tasks related to care of CYSHCN ranged from 89% for accessing early intervention services to 24% for billing and coding. The percentage of PCPs somewhat or very comfortable providing primary care to patients with technology dependence ranged from 75% for blood glucose monitoring to 12% for dialysis. Conclusions. The issues of time, reimbursement, billing, and coding are perceived as significant barriers to the care CYSHCN. There is substantial variation in PCPs’ comfort in the care of CYSHCN who require the assistance of medical technologies.

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Leenders, Josette, and Lars-Åke Marké. "An Annotated Bibliography on Home Care Technologies." International Journal of Technology Assessment in Health Care 1, no. 2 (April 1985): 371–93. http://dx.doi.org/10.1017/s0266462300000155.

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Curtiss, F. R. (1984). Reimbursement dilemma regarding home health-care products and services. Am. J. Hosp. Pharm., August, 41(8), 1548–57.Reimbursement mechanisms for home health-care products and services are discussed in detail. The two major categories of the home health care industry—(1) skilled nursing, homemaker, and other services, and (2) equipment, supplies, and other products (including drugs)—are reimbursed by third-party payers differently. While prospective pricing of inpatient care encourages the growth of home-care services, government administrators are concerned about potential spending growth at time of ballooning deficits, and private health insurers are uncertain about coverage criteria. Nuances of Medicare coverage criteria and private insurance reimbursement for home health care services are described. Medicaid coverage of drugs and biologicals for home patients is also described. The Health Care Financing Administration (HCFA) is expected to clarify and restrict Medicare coverage and payment of home-care products, equipment, and supplies. Medical justification will probably become more specific with greater attention to patient diagnoses and prognosis of patient therapies. Per-case payment methods will be refined to encompass home care. The government and private insurance programs will move toward capitation payment methods under which institutions will have even greater incentives to develop sophisticated home-care programs to substitute for institutional care. L.A.M.

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Cowart, Marie E. "Policy issues: financial reimbursement for home care." Family & Community Health 8, no. 2 (August 1985): 1–10. http://dx.doi.org/10.1097/00003727-198508000-00003.

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Hameed, Aamir. "Health-Care Delivery System and Reimbursement Policies in Pakistan." Value in Health 11 (March 2008): S160—S162. http://dx.doi.org/10.1111/j.1524-4733.2008.00380.x.

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Fuloria, Prashant C., and Stefanos A. Zenios. "Outcomes-Adjusted Reimbursement in a Health-Care Delivery System." Management Science 47, no. 6 (June 2001): 735–51. http://dx.doi.org/10.1287/mnsc.47.6.735.9816.

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Naito, Hidemune. "The Japanese Health-Care System and Reimbursement for Dialysis." Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis 26, no. 2 (March 2006): 155–61. http://dx.doi.org/10.1177/089686080602600206.

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Like most countries, Japan is facing constraints on expansion of health system financial resources. There are almost 250000 Japanese patients with end-stage renal disease and almost all are managed by chronic dialysis. Hospital hemodialysis is the modality used by 96% of these patients. The Japanese health-care system has tended to support resource-intensive treatments because the fee-for-service remuneration system has rewarded their utilization. This has benefited hemodialysis at the expense of peritoneal dialysis. However, this may now be changing. Case management and global budget-related approaches are being more widely introduced, as are incentives to reward more efficient treatment options. The relative costs of dialysis modalities are difficult to appreciate, as center-based services, such as hospital hemodialysis, are dependent upon fixed resources, while home-based options, such as peritoneal dialysis, are dependent upon variable resources. The aim of this review is to reconcile various sources of information relevant to end-stage renal disease funding in Japan. The review will suggest that modifying the approach to modality selection could lead to more efficient allocation of future dialysis-related resources and so reduce the strain on Japan's health-care budget.

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Curtiss, Frederic R. "Recent developments in federal reimbursement for home health care." American Journal of Health-System Pharmacy 43, no. 1 (January 1, 1986): 132–39. http://dx.doi.org/10.1093/ajhp/43.1.132.

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39

Smits, Helen L., and Abby Baum. "Health Care Financing Administration (HCFA) and reimbursement in telemedicine." Journal of Medical Systems 19, no. 2 (April 1995): 139–42. http://dx.doi.org/10.1007/bf02257064.

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Douven, Rudy, Minke Remmerswaal, and Ilaria Mosca. "Unintended effects of reimbursement schedules in mental health care." Journal of Health Economics 42 (July 2015): 139–50. http://dx.doi.org/10.1016/j.jhealeco.2015.03.008.

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Schlenker, Robert E., and Peter W. Shaughnessy. "Medicare Home Health Reimbursement Alternatives." Home Health Care Services Quarterly 13, no. 1-2 (May 19, 1993): 91–115. http://dx.doi.org/10.1300/j027v13n01_05.

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42

Boltong, Anna G., Jenelle M. Loeliger, and Belinda L. Steer. "Using a public hospital funding model to strengthen a case for improved nutritional care in a cancer setting." Australian Health Review 37, no. 3 (2013): 286. http://dx.doi.org/10.1071/ah13010.

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Objective. This study aimed to measure the prevalence of malnutrition risk and assessed malnutrition in patients admitted to a cancer-specific public hospital, and to model the potential hospital funding opportunity associated with implementing routine malnutrition screening. Methods. A point-prevalence audit of malnutrition risk and diagnosable malnutrition was conducted. A retrospective audit of hospital funding associated with documented cases of malnutrition was conducted. Audit results were used to estimate annual malnutrition prevalence, associated casemix-based reimbursement potential and the clinical support resources required to adequately identify and treat malnutrition. Results. Sixty-four percent of inpatients were at risk of malnutrition. Of these, 90% were assessed as malnourished. Twelve percent of malnourished patients produced a positive change in the diagnosis-related group (DRG) and increased allocated financial reimbursement. Identifying and diagnosing all cases of malnutrition could contribute an additional AU$413644 reimbursement funding annually. Conclusions. Early identification of malnutrition may expedite appropriate nutritional management and improve patient outcomes in addition to contributing to casemix-based reimbursement funding for health services. A successful business case for additional clinical resources to improve nutritional care was aided by demonstrating the link between malnutrition screening, hospital reimbursements and improved nutritional care. What is known about the topic? It is known that between 20 and 50% of hospital patients are malnourished and oncology patients are 1.7 times more likely to be malnourished than are other hospitalised patients. Despite the existence of practice guidelines for malnutrition screening of at-risk oncology patients, these are not routinely implemented. Identification of malnutrition in hospitalised patients is linked to casemix funding via DRG. Casemix reimbursement for malnutrition can be enhanced if: (1) malnutrition risk is identified; (2) malnutrition is diagnosed; (3) the word ‘malnutrition’ and an associated action plan is documented in the medical record; and (4) malnutrition is recognised and recorded by the clinical coder. Amendments to the ICD-10-AM in 2008 allowing malnutrition to be recognised as a complication for coding when it is documented by a dietitian in the medical history has hospital reimbursement implications for dietetic practice. Reimbursement potential for malnutrition has been calculated in public hospitals in Australia with varying results. What does this paper add? This paper reports the components of a successful business case made to enhance resources for identification and treatment of malnutrition on the basis of improved treatment as well as enhanced reimbursement potential resulting from changes to the ICD-10-AM. The present study adds to the body of literature showing that malnutrition coding contributes to casemix funding in Australian public hospitals, as well as internationally, and highlights the previously unreported opportunity for a cancer-specific health service. This work demonstrated that reassignment of a DRG based on a diagnosis of malnutrition altered the overall casemix funding value for 12% of audited patients. This compares with the findings of other authors who demonstrated hypothetical DRG changes and financial reallocation. What are the implications for practitioners? This paper highlights that practitioner-centred strategies are needed to enhance malnutrition identification, diagnosis, documentation and coding to maximise casemix reimbursement and better treat malnutrition in hospitals. Strategies include education of the dietetics, medical and health-information workforce. This manuscript provides a description of the conduct of quality-improvement activities that may support successful business cases for increased dietetic resources in future.

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Philipson, Tomas J. "Paying for cost-effective health care: Does it violate both static- and dynamic efficiency?" Nordic Journal of Health Economics 5, no. 1 (March 9, 2015): 58–61. http://dx.doi.org/10.5617/njhe.1289.

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Recent research has questioned the rationales of using cost-effectiveness metrics of medical technologies to guide reimbursement. I discuss here the underlying ideas of this research, which argues that reimbursement based on cost effectiveness criteria leads to both static- and dynamic inefficiencies.

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44

Schwartz, Randy. "Third Party Reimbursement for Diabetes Care." Diabetes Educator 11, no. 2 (June 1985): 70. http://dx.doi.org/10.1177/014572178501100230.

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Leichter, Steven B. "Third Party Reimbursement for Diabetes Care." Diabetes Educator 11, no. 2 (June 1985): 71. http://dx.doi.org/10.1177/014572178501100231.

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46

Omelyanovskiy, V. V., E. S. Saybel, T. P. Bezdenezhnykh, and G. R. Khachatryan. "The health technology assessment system in Australia." FARMAKOEKONOMIKA. Modern Pharmacoeconomic and Pharmacoepidemiology 12, no. 4 (February 18, 2020): 333–41. http://dx.doi.org/10.17749/2070-4909.2019.12.4.333-341.

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In Australia, the federal government is in charge of providing the health care to patients. The government agencies determine the list of reimbursable pharmaceuticals and medical services and also define the preferential categories of the population. The states and territories may have their own health care programs in addition to the federal ones. The Pharmaceutical Benefits Advisory Committee (PBAC) is responsible for the health technology assessment (HTA) and decides which technology is eligible for reimbursement by the federal budget. The drug evaluation process includes five stages: a review of general information about the product, assessment of its clinical efficacy, cost-effectiveness analysis, assessment of financial implications of including the drug in the reimbursement list, and consideration of any other factors that may influence the committee decision. In addition to the full reimbursement of pharmaceuticals, the committee may decide to provide funding based on a managed entry agreement.

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Powell, Adam C., Matthias B. Bowman, and Henry T. Harbin. "Reimbursement of Apps for Mental Health: Findings From Interviews." JMIR Mental Health 6, no. 8 (August 6, 2019): e14724. http://dx.doi.org/10.2196/14724.

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Background Although apps and other digital and mobile health tools are helping improve the mental health of Americans, they are currently being reimbursed through a varied range of means, and most are not being reimbursed by payers at all. Objective The aim of this study was to shed light on the state of app reimbursement. We documented ways in which apps can be reimbursed and surveyed stakeholders to understand current reimbursement practices. Methods Individuals from over a dozen stakeholder organizations in the domains of digital behavioral and mental health, care delivery, and managed care were interviewed. A review of Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCSPCS) codes was conducted to determine potential means for reimbursement. Results Interviews and the review of codes revealed that potential channels for app reimbursement include direct payments by employers, providers, patients, and insurers. Insurers are additionally paying for apps using channels originally designed for devices, drugs, and laboratory tests, as well as via value-based payments and CPT and HCSPCS codes. In many cases, it is only possible to meet the requirements of a CPT or HCSPCS code if an app is used in conjunction with human time and services. Conclusions Currently, many apps face significant barriers to reimbursement. CPT codes are not a viable means of providing compensation for the use of all apps, particularly those involving little physician work. In some cases, apps have sought clearance from the US Food and Drug Administration for prescription use as digital therapeutics, a reimbursement mechanism with as yet unproven sustainability. There is a need for simpler, more robust reimbursement mechanisms to cover stand-alone app-based treatments.

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Harris, Burton H., Kathryn Dirkes Bass, and Mary D. O'Brien. "Hospital reimbursement for pediatric trauma care." Journal of Pediatric Surgery 31, no. 1 (January 1996): 78–81. http://dx.doi.org/10.1016/s0022-3468(96)90323-1.

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Bowling, Brandon, David Newman, Craig White, Ashley Wood, and Alberto Coustasse. "Provider Reimbursement Following the Affordable Care Act." Health Care Manager 37, no. 2 (2018): 129–35. http://dx.doi.org/10.1097/hcm.0000000000000205.

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Ellis, Shellie D., Ronald C. Chen, Stacie B. Dusetzina, Stephanie B. Wheeler, George L. Jackson, Matthew E. Nielsen, William R. Carpenter, and Morris Weinberger. "Are Small Reimbursement Changes Enough to Change Cancer Care? Reimbursement Variation in Prostate Cancer Treatment." Journal of Oncology Practice 12, no. 4 (April 2016): e423-e436. http://dx.doi.org/10.1200/jop.2015.007344.

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Purpose: The Centers for Medicare and Medicaid Services recently initiated small reimbursement adjustments to improve the value of care delivered under fee-for-service. To estimate the degree to which reimbursement influences physician decision making, we examined utilization of gonadotropin-releasing hormone (GnRH) agonists among urologists as Part B drug reimbursement varied in a fee-for-service environment. Methods: We analyzed treatment patterns of urologists treating 15,128 men included in SEER-linked Medicare claims who were diagnosed with localized prostate cancer between January 1, 2000, and December 31, 2003. We calculated a reimbursement generosity index to measure differences in GnRH agonist reimbursement among regional Medicare carriers and over time. We used multilevel analysis to control for patient and provider characteristics. Results: Among urologists treating early-stage and lower grade prostate cancer, variation in reimbursement was not associated with overuse of GnRH agonists from 2000 to 2003, a period of guideline stability (odds ratio, 1.00; 95% CI, 0.99 to 1.00). Conclusion: Small differences in androgen-deprivation therapy reimbursement generosity were not associated with differential use. Fee-for-service reimbursement changes currently being implemented to improve quality in fee-for-service Medicare may not affect patterns of cancer care.

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