The American journal of managed care
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To examine changes in hospital outpatient surgery trends and case mix for Medicare and privately insured patients needing total knee arthroplasty (TKA) following Medicare's removal of TKA from its Inpatient Only list on January 1, 2018. ⋯ Market and financial pressures are encouraging more outpatient care delivery; however, the speed of transition is dictated, in part, by regulatory constraints. Our results suggest that Medicare policy may influence surgical treatment approaches for Medicare and privately insured patients. Spillover implications need to be considered when weighing future Medicare regulatory decisions.
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Group 1 pulmonary hypertension (or pulmonary arterial hypertension) is a rare, highly complex, and progressive disorder that is incurable and ultimately can lead to premature death. PAH causes significant physical, social, work, and emotional burdens among affected patients and their caregivers. Early diagnosis and initiation of treatment is required for best outcomes; however, the clinical presentation of PAH is nonspecific and frequently overlaps with several other conditions, often leading to a delay in diagnosis or misdiagnosis. ⋯ Because PAH is classified into 7 subgroups, it is essential that individuals are grouped appropriately for the efficacy of treatment and avoidance of harm. As health-related quality of life for PAH is multifactorial, it is important that patients are involved in the clinical decision-making process and have access to multidisciplinary care. The purpose of this review is to update healthcare professionals on the management of PAH with the most current information on epidemiology, pathophysiology, clinical presentation, and diagnostic considerations.
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Dry eye disease is a common but underdiagnosed disorder in the United States, and its prevalence is likely to increase as the nation's population ages. Although still regarded as little more than a nuisance by many clinicians and payers alike, dry eye disease is known to have both clinical consequences for ocular health and effects on vision-related quality of life in many people, impairing their ability to function well in vocational and social settings. Pharmaceutical treatments consist mainly of over-the-counter ocular lubricants ("artificial tears") and a few prescription drugs that address the inflammatory component of dry eye disease through immunomodulation and/or inhibition of T-cell activity. ⋯ They pointed to an existing unmet need in knowledge and therapeutics that can address the underlying causes of dry eye disease. Oyster Point Pharma supported the authorship of this article; the authors were members of the panel, and all panelists were compensated by Oyster Point Pharma. This article provides an overview of dry eye disease and summarizes the panel discussion.
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Inpatients with extended length of stay (LOS), referred to as LOS outliers, pose a challenge to health systems by contributing to high costs while assuming all the risks associated with hospital-acquired conditions. Limited research has been conducted within the US health system to better define LOS outliers and the risk factors for becoming an outlier in the setting of inpatient medicine stays. ⋯ In-hospital complications, hospital-acquired infections, and discharge to a facility are all predictors of not only increasing hospital days for patients but also increasing the risk of becoming LOS outliers, who stay disproportionately longer and use disproportionately more resources than predicted.
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Observational Study
Behavior-based diabetes management: impact on care, hospitalizations, and costs.
To (1) examine the impact of the Diabetes Care Rewards (DCR) program on adherence to care standards and (2) evaluate the economic impact of adherence to care standards. ⋯ A behavioral science- and incentive-based diabetes management program was associated with greater rates of adherence to recommended diabetes monitoring care standards, increased routine clinic visits, decreased hospital admissions, and decreased inpatient days. Anticipated increases in pharmaceutical expenditures were offset by overall lower medical expenditures. Results indicate the economic benefits of adherence to evidence-based standards for diabetes care.