medicaid

Many patients in the US struggle to afford their prescription drugs. The inability to take medications as prescribed can lead to worse health outcomes.

Below are 7 strategies that patients can use to respond to high prescription drug costs in the US.

Author/s:

Kristin L Walter

Interventional Treatments for Acute and Chronic Pain: Systematic Review

Bethie Seay — Mon, 13 Sep 2021 05:00:00 +0000

Date Added:

September 13, 2021

Type:

Meta-analyses, Reviews, and Guidelines

DOI (1):

10.23970/AHRQEPCCER247

A review of the evidence regarding the use of vertebroplasty, kyphoplasty, and cool radiofrequency denervation for acute and chronic back pain.

View

Objective. To evaluate the benefits and harms of selected interventional procedures for acute and chronic pain that are not currently covered by the Centers for Medicare & Medicaid Services (CMS) but are relevant for and have potential utility for use in the Medicare population, or that are covered by CMS but for which there is important uncertainty or controversy regarding use.

Data sources. Electronic databases (Ovid® MEDLINE®, PsycINFO®, the Cochrane Central Register of Controlled Trials, and the Cochrane Database of Systematic Reviews) to April 12, 2021, reference lists, and submissions in response to a Federal Register notice.

Review methods. Using predefined criteria and dual review, we selected randomized controlled trials (RCTs) for 10 interventional procedures and conditions that evaluated pain, function, health status, quality of life, medication use, and harms. Random effects meta-analysis was conducted for vertebral compression fracture; otherwise, outcomes were synthesized qualitatively. Effects were classified as small, moderate, or large using previously defined criteria.

Results. Thirty-seven randomized trials (in 48 publications) were included. Vertebroplasty (13 trials) is probably more effective at reducing pain and improving function in older (>65 years of age) patients, but benefits are small (less than 1 point on a 10-point pain scale). Benefits appear smaller (but still present) in sham-controlled (5 trials) compared with usual care controlled trials (8 trials) and larger in trials of patients with more acute symptoms; however, testing for subgroup effects was limited by imprecision. Vertebroplasty is probably not associated with increased risk of incident vertebral fracture (10 trials). Kyphoplasty (2 trials) is probably more effective than usual care for pain and function in older patients with vertebral compression fracture at up to 1 month (moderate to large benefits) and may be more effective at >1 month to ≥1 year (small to moderate benefits) but has not been compared against sham therapy. Evidence on kyphoplasty and risk of incident fracture was conflicting. In younger (below age for Medicare eligibility) populations, cooled radiofrequency denervation for sacroiliac pain (2 trials) is probably more effective for pain and function versus sham at 1 and 3 months (moderate to large benefits). Cooled radiofrequency for presumed facet joint pain may be similarly effective versus conventional radiofrequency, and piriformis injection with corticosteroid for piriformis syndrome may be more effective than sham injection for pain. For the other interventional procedures and conditions addressed, evidence was too limited to determine benefits and harms.

Conclusions. Vertebroplasty is probably effective at reducing pain and improving function in older patients with vertebral compression fractures; benefits are small but similar to other therapies recommended for pain. Evidence was too limited to separate effects of control type and symptom acuity on effectiveness of vertebroplasty. Kyphoplasty has not been compared against sham but is probably more effective than usual care for vertebral compression fractures in older patients. In younger populations, cooled radiofrequency denervation is probably more effective than sham for sacroiliac pain. Research is needed to determine the benefits and harms of the other interventional procedures and conditions addressed in this review.

Author/s:

Chou, R., Fu, R., Dana, T., Pappas, M., Hart, E., Mauer, K. M.

The 2020 Medicare Documentation, Coding, and Payment Update

Brian Desmarais — Fri, 03 Jan 2020 19:58:25 +0000

Date Added:

January 3, 2020

Journal/Publication:

Mayo

Publisher:

American Academy of Family Physicians

Publication Date:

December 12, 2019

URL:

The 2020 Medicare Documentation, Coding, and Payment Update

Type:

Practice Management Reviews and Guidelines

Format:

Article

Keywords

coding

MeSH

Centers for Medicare and Medicaid Services, U.S.

referral and consultation

abdominal pain

Records

Major changes in coding will occur in 2021, but this 2020 update is also important. James W. Mold, MD, MPH

Free full text

View

As usual, the new year brings changes in how doctors bill and get paid for the services they provide to Medicare patients. The reforms that will most affect family physicians’ pay aren’t coming until 2021, when several changes in evaluation and management (E/M) coding and payment are projected to result in a 12% increase for family medicine.1 But there are still a host of things family physicians should know for 2020, including new codes to help you get paid for interacting with patients via the internet and new codes that should help make chronic care management (CCM) more financially rewarding. The Centers for Medicare & Medicaid Services (CMS) is also continuing its quest to streamline documentation requirements and develop new payment models intended to reward quality instead of volume. This article summarizes the 2020 changes most relevant to family medicine. As always, private payers’ policies may differ, so consult with your billing staff to understand any important differences.

Author/s:

Moore, K., Mullins, A., Solis, E.

Medicare’s Direct Provider Contracting: To Primary Care And Beyond

Brian Desmarais — Mon, 01 Jul 2019 14:40:44 +0000

Date Added:

July 1, 2019

Journal/Publication:

Health Affairs Blog

Publisher:

Health Affairs

Publication Date:

June 28, 2019

URL:

Medicare’s Direct Provider Contracting: To Primary Care And Beyond

Type:

Notifications and Opportunities

Format:

Web Page

Keywords

MeSH

Centers for Medicare and Medicaid Services (U.S.)

Social Responsibility

Quality of Health Care

Medicare is about to roll out something they are calling Direct Primary Care, which is not at the same thing as the Direct Primary Care concept that evolved as a form of “concierge medicine” in which patients pay a monthly fee for increased access and services from primary care clinicians. This is something with which I believe all primary care clinicians need to become familiar. James W. Mold, MD, MPH

Free full text

View

Direct provider contracting (DPC) is coming to Medicare.

Under a new announcement about reforming health care payment and delivery, the Centers for Medicare and Medicaid Services (CMS) has announced forthcoming DPC models as part of the effort to “deliver value-based transformation in primary care.” In particular, the agency seeks to implement models that enable it to directly contract with providers and suppliers and hold them accountable for the cost and quality of care of defined patient populations. Direct contracting shares and extends some features of existing primary care payment reforms, such as an emphasis on financial accountability over outcomes. However, DPC differs from existing primary care payment models primarily by allowing Medicare to contract with providers for a population of beneficiaries’ entire health care spending via global capitated payments. This incorporates approaches from Medicare Advantage (through which Medicare contracts with health plans for beneficiaries’ entire health care spending), while adding flexibility and emphasis on beneficiary choice.

Author/s:

Liao, J.M., Navathe, A.S.

Patients Over Paperwork

Brian Desmarais — Wed, 12 Jun 2019 19:04:56 +0000

Date Added:

June 12, 2019

Publisher:

Centers for Medicare and Medicaid Services

URL:

Patients Over Paperwork

Type:

Notifications and Opportunities

Format:

Web Page

Keywords

MeSH

Here’s your chance to make suggestions to CMS about how to put patients over paperwork and to see what others have suggested. James W. Mold, MD, MPH

Free full text

View

Patients Over Paperwork

We’re putting patients first by reviewing and streamlining our regulations so we can:

Reduce unnecessary burden
Increase efficiencies
Improve the beneficiary experience

Lung Cancer Screening: A Clinician’s Checklist

Jeffrey Wilson — Mon, 22 Oct 2018 16:17:09 +0000

Date Added:

October 22, 2018

Publisher:

Agency for Healthcare Research and Quality

Publication Date:

March 1, 2016

Issue:

URL:

Lung Cancer Screening: A Clinician’s Checklist

Type:

Clinical Decision Aids

Format:

Web Page

Keywords

MeSH

This is a checklist for use when helping smokers decide whether to be screened for lung cancer with low-dose CT.

Free full text

This checklist was developed to help clinicians meet the Centers for Medicare & Medicaid Services (CMS) criteria for a lung cancer screening counseling and shared decisionmaking visit. All of the criteria listed below must be met for the screening to be covered as a preventive service benefit under Medicare.

Lung cancer screening with low-dose computed tomography (LDCT) reduces mortality from lung cancer. There are also potential harms associated with lung cancer screening, including a high-false positive rate and the associated need for diagnostic followup, known and unknown risks of additional testing associated with incidental findings, cumulative radiation exposure, and overdiagnosis. Shared decisionmaking is a collaborative patient-centered process in which patients and clinicians make decisions together, within the context of the best evidence and recommendations and based on the patient’s values and preferences.

Medical-Legal Partnership

Tracy Ashby — Thu, 11 Oct 2018 05:00:00 +0000

Date Added:

October 11, 2018

Type:

Notifications and Opportunities

Keywords

MeSH

delivery of health care

poverty

This is an opportunity to collaborate with Legal Aid of OK to connect patients to legal services when appropriate

Free full text

In Oklahoma, 1 in 5 people live in poverty and also have at least one health-harming civil legal need. Creating a system to screen for these legal needs will allow us to address problems not otherwise attended to, reducing patient stressors and saving health care partner’s money in terms of reducing illness, increasing
adjustment rate payments and reimbursement potential. The Medical-Legal Partnership (MLP) model integrates civil legal aid attorneys in health care teams to address health-harming legal needs for low-income populations.

Author/s:

Legal Aid Services of Oklahoma, Inc.