The Centers for Medicare and Medicaid Services (CMS) overhauled the reimbursement system for skilled nursing facilities (SNFs) with the intent to improve payments by ensuring therapy services were focused on meeting the needs and preferences for beneficiaries, rather than the volume of services provided. The Patient-Driven Payment Model (PDPM) went into effect on 10/1/19. Because the payment model employs a new methodology for reimbursement, there are multiple concerns that some SNFs may inappropriately manipulate therapy services to increase profits, such as by mandating therapists to maximize the use of group and concurrent therapy regardless of the resident’s needs. The doctoral program addresses PDPM from a regulatory oversight perspective. Surveyors will receive updated investigatory pathways and training regarding how to investigate therapy services to address the impact PDPM may be having on the provision of therapy, functional performance, and falls. Surveyors will have the knowledge and skills to ensure SNF beneficiaries across the nation receive quality, individualized rehabilitation services to satisfy the intent behind PDPM.

There is a growing recognition that we cannot afford the provision of all new health care technologies, even those that are proven to be beneficial. This is increasingly true in the US, where health care spending is on an unsustainable upward trajectory. US health care spending is greatly in excess of that of other countries; however, with respect to key health metrics, the US health care system performs relatively poorly. Despite this, unlike many other developed countries economic evaluation, and more specifically cost effectiveness evidence, is used sparingly in the US health care system. Notably, the Centers for Medicare and Medicaid Services (CMS), administrators of the Medicare programme, state that cost-effectiveness evidence is not relevant to coverage decisions for medical technology and interventions evaluated as part of National Coverage Determinations (NCDs). The empirical aspect of this thesis evaluates the current use and potential value of using cost-effectiveness evidence in CMS NCDs. A database was built using data obtained from NCD decision memoranda, the medical literature, a Medicare claims database, and Medicare reimbursement information. The findings of the empirical work show that, CMS’s stated position notwithstanding, cost-effectiveness evidence has been cited or discussed in a number of coverage decisions, and there is a statistically significant difference between positive and non-coverage decisions with respect to cost effectiveness. When controlling for factors likely to have an effect on coverage decisions, the availability of cost-effectiveness evidence is a statistically significant predictor of coverage. In addition, the quality of the supporting clinical evidence, the availability of alternative interventions, and the recency of the decision are statistically significant variables. Further, when hypothetically reallocating resources in accordance with cost-effectiveness substantial gains in aggregate health are estimated. It is shown that using cost-effectiveness to guide resource allocation has an effect on resource allocation across patient populations and types of technology.

Reimbursement Decree and DRG mechanism and their influence on acute in-patient care Abstract The thesis focuses on Czech reimbursement mechanisms and their influence on volume of healthcare provided. The main Czech reimbursement legal documents are presented and formalized and their influence on volume of provided care tested. The thesis also offers a discussion of possible ineffectiveness which may be caused by the reimbursement decree for 2012. Keywords: healthcare, DRG, reimbursement mechanism

Following implementation of the Patient Protection and Affordable Care Act, hospitals have seen a reduction in Medicare reimbursement for 30-day post-discharge readmissions of acute myocardial infarction patient. The purpose of this project was to develop a plan for a navigator program to improve a patient's health status post discharge and reduce readmission rates. The Johns Hopkins nursing evidence-based practice model and guidelines were used in determining the quality of obtained experimental and non-experimental studies with or without meta-analysis and popular source articles. The literature revealed the most successful programs involved providing best practices for a navigator program allowed better patient education, discharge planning, safety and quality of care, improved communication and post-discharge follow-up, and improved facility finances to achieve positive results for the patient and the hospital. Watson's caring theory was used as the theoretical framework since it incorporated the aspect of caring to create a good working nurse-patient relationship. A navigator program training module, job description, objectives, program forms, mission and goal statements, and a health care team were developed and seen as crucial to the success of the program and its evaluation process. Using navigator practices, based on evidence, formed the infrastructure and management process for the facility and health care providers, thereby increasing the quality of patient care. The resulting social change was positive, benefiting the patient, family, the organization, and the region served. With implementation, this project was anticipated to reduce 30-day readmissions and increased facility reimbursement.

Thesis equivalent (M.P.H.)--University of Michigan, 1947.

Thesis equivalent (M.P.H.)--University of Michigan, 1947.

No description available.

This dissertation aims to explore the performance of health provider participation inthe Medicare Quality Payment Program by investigating the relationship among the performance metrics of value and quality and the capacities of geography, technology, finance, and administration. There is a theory-practice gap in the research that examines the impact of these capacities on the value and quality of clinical services delivered by healthcare providers participating in the Medicare Quality Payment Program. The study will address this theory-practice gap by applying the capacity-performance paradigm to better understand the influences of geographical, technological, financial, and administrative capacity have on the performance of value and quality metrics of healthcare providers engaging in the Medicare Quality Payment Program. This study also provides prudent findings that demonstrate the impact of the capacities on the performance of value and quality among healthcare providers which can influence programmatic policy reforms by policymakers who are overseeing the Quality Payment Program. This study utilizes the CMS 2021 QPP Experience dataset which contains the performance outcome metrics of value and quality among healthcare providers participating in the program. Ordinary Least Squares (OLS) regression is employed to examine the relationship among the capacities of geography, technology, finance, and administration and the performance providers. The findings of this study show a significant relationship between these capacities and the performance outcome metrics of value and quality among healthcare providers participating in the Medicare Quality Payment Program.

The main reason for the choice of the topic "business trip" and the focus of that particular sector of labour-law is, that most of us will actually enter an employment relationship one day. The concept of a business trip is well known by the public, yet the specific legal regulations of the conditions of sending employees for a business trip and providing travel cost reimbursement, contained in the Labour Code, are not known as well. The general concept of the business trip and its kinds (domestic and foreign business trip) and the closely related terms such as the place of work and regular place of work are the main concern of the first part of my thesis. The focus then shifts onto the conditions of sending employees for business trip, specifically onto the agreement with the employee and its historical development, duration of a business trip and other conditions like the start time and the end of a business trip or means of transport and accommodation. The thesis continues with the focus on the process of a business trip, describing work assignment, working hours and interruption of business trip, furthermore describes the instructions for a business trip with the orientation on the definition of the chief employee and the practice of the courts in this issue. Towards conclusion my thesis concerns travel...

L’efficacité d’une thérapeutique repose, en grande partie, sur la bonne observance de la prescription. Une mauvaise observance est susceptible de provoquer un échec thérapeutique et une escalade dans les traitements. Elle est également génératrice de surcoûts pour le système de protection sociale. La base de données Erasme, base de remboursement du régime général de l’assurance maladie (Cnam-TS), constitue une source d’information importante pour la mesure de l’utilisation des médicaments et donc, possiblement, de l’observance. Hors, depuis de nombreuses années, il a été proposé des descripteurs de l’observance calculable à partir des remboursements de différents systèmes d’assurance maladie dans le monde. Le but de ce travail était de : - recenser ces indicateurs et les appliquer à la base Erasme ; - proposer de nouveaux indicateurs ; - catégoriser ces indicateurs. Dans une première partie nous faisons l’état des lieux de la notion et du concept d’observance médicamenteuse et de sa mesure à partir des bases de données de remboursement. Dans une deuxième partie, nous présentons la base Erasme et proposons des nouveaux indicateurs. Afin d’illustrer nos propos, nous présentons les études que nous avons réalisé à partir de l’étude de médicaments ayant des profils de consommation différents : traitement au long cours d’une affection symptomatique (asthme), traitement au long cours d’une affection asymptomatique (hypercholestérolémie), traitement au long cours d’une affection grave (diabète), traitement « minute » (infection urinaire) et un traitement de durée moyenne (contraception orale). / The efficacy of a therapeutic response depends largely on good adherence to the prescription. Poor adherence may lead to therapeutic failure and an escalation of treatment. Furthermore, this generates excess cost for the health insurance system. The Erasme reimbursement database of the largest health insurance system in France (régime général de l'assurance maladie, Cnam-TS), represents an important source of information on the use of medicines, and, therefore, possibly adherence. This is particularly the case as several indicators have been proposed to describe adherence from reimbursements in the different health insurance systems around the world. The objective of the current work was to: - identify the indicators and to apply these to the Erasme database; - propose new indicators; - categorise these indicators. The first part introduces the notion and concept of medication adherence and its measurement from reimbursement databases. The second part describes the Erasme database and the propositions for new indicators. This will then be illustrated by the studies that we have performed on medicines that have different profiles of use: long-term treatment of symptomatic disease (asthma), long-term treatment of asymptomatic disease (hypercholesterolaemia), long-term treatment of serious disease (diabetes), short-term treatment (urinary infection), and medium-term treatment (oral contraceptives).