The use of severity-of-illness measures, such as age, to estimate the risk (measurable or predictable chance of loss, injury or death) to which a patient is subject before receiving some health care intervention. This adjustment allows comparison of performance and quality across organizations, practitioners, and communities. (from JCAHO, Lexikon, 1994)
Adverse or favorable selection bias exhibited by insurers or enrollees resulting in disproportionate enrollment of certain groups of people.
A method of payment for health services in which an individual or institutional provider is paid a fixed, per capita amount without regard to the actual number or nature of services provided to each patient.
Alternative health care delivery mechanisms, such as PREFERRED PROVIDER ORGANIZATIONS or other health insurance services or prepaid plans (other than HEALTH MAINTENANCE ORGANIZATIONS), that meet Medicare qualifications for a risk-sharing contract. (From Facts on File Dictionary of Health Care Management, 1988)
A method of examining and setting levels of payments.
The discipline concerned with using the combination of conventional ALLOPATHIC MEDICINE and ALTERNATIVE MEDICINE to address the biological, psychological, social, and spiritual aspects of health and illness.
A system for classifying patient care by relating common characteristics such as diagnosis, treatment, and age to an expected consumption of hospital resources and length of stay. Its purpose is to provide a framework for specifying case mix and to reduce hospital costs and reimbursements and it forms the cornerstone of the prospective payment system.
A vital statistic measuring or recording the rate of death from any cause in hospitalized populations.
Hospital department responsible for the flow of patients and the processing of admissions, discharges, transfers, and also most procedures to be carried out in the event of a patient's death.
A component of the Department of Health and Human Services to oversee and direct the Medicare and Medicaid programs and related Federal medical care quality control staffs. Name was changed effective June 14, 2001.
The term "United States" in a medical context often refers to the country where a patient or study participant resides, and is not a medical term per se, but relevant for epidemiological studies, healthcare policies, and understanding differences in disease prevalence, treatment patterns, and health outcomes across various geographic locations.
Norms, criteria, standards, and other direct qualitative and quantitative measures used in determining the quality of health care.
Research aimed at assessing the quality and effectiveness of health care as measured by the attainment of a specified end result or outcome. Measures include parameters such as improved health, lowered morbidity or mortality, and improvement of abnormal states (such as elevated blood pressure).
The assignment, to each of several particular cost-centers, of an equitable proportion of the costs of activities that serve all of them. Cost-center usually refers to institutional departments or services.
A strategy for purchasing health care in a manner which will obtain maximum value for the price for the purchasers of the health care and the recipients. The concept was developed primarily by Alain Enthoven of Stanford University and promulgated by the Jackson Hole Group. The strategy depends on sponsors for groups of the population to be insured. The sponsor, in some cases a health alliance, acts as an intermediary between the group and competing provider groups (accountable health plans). The competition is price-based among annual premiums for a defined, standardized benefit package. (From Slee and Slee, Health Care Reform Terms, 1993)
The amounts spent by individuals, groups, nations, or private or public organizations for total health care and/or its various components. These amounts may or may not be equivalent to the actual costs (HEALTH CARE COSTS) and may or may not be shared among the patient, insurers, and/or employers.
Hospitals providing medical care to veterans of wars.
Adaptation of the person to the social environment. Adjustment may take place by adapting the self to the environment or by changing the environment. (From Campbell, Psychiatric Dictionary, 1996)
Method of measuring performance against established standards of best practice.
Statistical formulations or analyses which, when applied to data and found to fit the data, are then used to verify the assumptions and parameters used in the analysis. Examples of statistical models are the linear model, binomial model, polynomial model, two-parameter model, etc.
Federal program, created by Public Law 89-97, Title XVIII-Health Insurance for the Aged, a 1965 amendment to the Social Security Act, that provides health insurance benefits to persons over the age of 65 and others eligible for Social Security benefits. It consists of two separate but coordinated programs: hospital insurance (MEDICARE PART A) and supplementary medical insurance (MEDICARE PART B). (Hospital Administration Terminology, AHA, 2d ed and A Discursive Dictionary of Health Care, US House of Representatives, 1976)
An aspect of personal behavior or lifestyle, environmental exposure, or inborn or inherited characteristic, which, on the basis of epidemiologic evidence, is known to be associated with a health-related condition considered important to prevent.
A system of categories to which morbid entries are assigned according to established criteria. Included is the entire range of conditions in a manageable number of categories, grouped to facilitate mortality reporting. It is produced by the World Health Organization (From ICD-10, p1). The Clinical Modifications, produced by the UNITED STATES DEPT. OF HEALTH AND HUMAN SERVICES, are larger extensions used for morbidity and general epidemiological purposes, primarily in the U.S.
National Health Insurance in the United States refers to a proposed system of healthcare financing that would provide comprehensive coverage for all residents, funded through a combination of government funding and mandatory contributions, and administered by a public agency.
Institutions with an organized medical staff which provide medical care to patients.
Review of claims by insurance companies to determine liability and amount of payment for various services. The review may also include determination of eligibility of the claimant or beneficiary or of the provider of the benefit; determination that the benefit is covered or not payable under another policy; or determination that the service was necessary and of reasonable cost and quality.
Statistical models which describe the relationship between a qualitative dependent variable (that is, one which can take only certain discrete values, such as the presence or absence of a disease) and an independent variable. A common application is in epidemiology for estimating an individual's risk (probability of a disease) as a function of a given risk factor.
The qualitative or quantitative estimation of the likelihood of adverse effects that may result from exposure to specified health hazards or from the absence of beneficial influences. (Last, Dictionary of Epidemiology, 1988)
The integration of epidemiologic, sociological, economic, and other analytic sciences in the study of health services. Health services research is usually concerned with relationships between need, demand, supply, use, and outcome of health services. The aim of the research is evaluation, particularly in terms of structure, process, output, and outcome. (From Last, Dictionary of Epidemiology, 2d ed)
I'm sorry for any confusion, but the term "Chile" is not a medical concept or condition, it is a country located in South America. If you have any questions related to medical topics, I would be happy to help answer those!
#### My apologies, but the term 'Washington' is not a medical concept or condition that has a defined meaning within the medical field. It refers to various concepts, primarily related to the U.S. state of Washington or the District of Columbia, where the nation's capital is located. If you have any questions about medical topics or conditions, please feel free to ask!
Method of charging whereby a physician or other practitioner bills for each encounter or service rendered. In addition to physicians, other health care professionals are reimbursed via this mechanism. Fee-for-service plans contrast with salary, per capita, and prepayment systems, where the payment does not change with the number of services actually used or if none are used. (From Discursive Dictionary of Health Care, 1976)
Procedures for finding the mathematical function which best describes the relationship between a dependent variable and one or more independent variables. In linear regression (see LINEAR MODELS) the relationship is constrained to be a straight line and LEAST-SQUARES ANALYSIS is used to determine the best fit. In logistic regression (see LOGISTIC MODELS) the dependent variable is qualitative rather than continuously variable and LIKELIHOOD FUNCTIONS are used to find the best relationship. In multiple regression, the dependent variable is considered to depend on more than a single independent variable.
The levels of excellence which characterize the health service or health care provided based on accepted standards of quality.
I'm sorry for any confusion, but the term "Michigan" is not a medical concept or condition that has a defined meaning within the medical field. It refers to a state in the United States, and does not have a direct medical connotation.
Studies used to test etiologic hypotheses in which inferences about an exposure to putative causal factors are derived from data relating to characteristics of persons under study or to events or experiences in their past. The essential feature is that some of the persons under study have the disease or outcome of interest and their characteristics are compared with those of unaffected persons.
Health insurance plans for employees, and generally including their dependents, usually on a cost-sharing basis with the employer paying a percentage of the premium.
Insurance providing coverage of medical, surgical, or hospital care in general or for which there is no specific heading.
Studies in which subsets of a defined population are identified. These groups may or may not be exposed to factors hypothesized to influence the probability of the occurrence of a particular disease or other outcome. Cohorts are defined populations which, as a whole, are followed in an attempt to determine distinguishing subgroup characteristics.
Extensive collections, reputedly complete, of facts and data garnered from material of a specialized subject area and made available for analysis and application. The collection can be automated by various contemporary methods for retrieval. The concept should be differentiated from DATABASES, BIBLIOGRAPHIC which is restricted to collections of bibliographic references.
The ratio of two odds. The exposure-odds ratio for case control data is the ratio of the odds in favor of exposure among cases to the odds in favor of exposure among noncases. The disease-odds ratio for a cohort or cross section is the ratio of the odds in favor of disease among the exposed to the odds in favor of disease among the unexposed. The prevalence-odds ratio refers to an odds ratio derived cross-sectionally from studies of prevalent cases.
Extraction of the FETUS by means of abdominal HYSTEROTOMY.
Surgery performed on the heart.
Observation of a population for a sufficient number of persons over a sufficient number of years to generate incidence or mortality rates subsequent to the selection of the study group.
Levels within a diagnostic group which are established by various measurement criteria applied to the seriousness of a patient's disorder.
A set of techniques used when variation in several variables has to be studied simultaneously. In statistics, multivariate analysis is interpreted as any analytic method that allows simultaneous study of two or more dependent variables.
Maladaptive reactions to identifiable psychosocial stressors occurring within a short time after onset of the stressor. They are manifested by either impairment in social or occupational functioning or by symptoms (depression, anxiety, etc.) that are in excess of a normal and expected reaction to the stressor.
Components of a national health care system which administer specific services, e.g., national health insurance.
The presence of co-existing or additional diseases with reference to an initial diagnosis or with reference to the index condition that is the subject of study. Comorbidity may affect the ability of affected individuals to function and also their survival; it may be used as a prognostic indicator for length of hospital stay, cost factors, and outcome or survival.
Evaluation undertaken to assess the results or consequences of management and procedures used in combating disease in order to determine the efficacy, effectiveness, safety, and practicability of these interventions in individual cases or series.
I'm sorry for any confusion, but "California" is a place, specifically a state on the western coast of the United States, and not a medical term or concept. Therefore, it doesn't have a medical definition.
Age as a constituent element or influence contributing to the production of a result. It may be applicable to the cause or the effect of a circumstance. It is used with human or animal concepts but should be differentiated from AGING, a physiological process, and TIME FACTORS which refers only to the passage of time.
The period of confinement of a patient to a hospital or other health facility.
Activities and programs intended to assure or improve the quality of care in either a defined medical setting or a program. The concept includes the assessment or evaluation of the quality of care; identification of problems or shortcomings in the delivery of care; designing activities to overcome these deficiencies; and follow-up monitoring to ensure effectiveness of corrective steps.
An infant during the first month after birth.
Postnatal deaths from BIRTH to 365 days after birth in a given population. Postneonatal mortality represents deaths between 28 days and 365 days after birth (as defined by National Center for Health Statistics). Neonatal mortality represents deaths from birth to 27 days after birth.
The measurement of the health status for a given population using a variety of indices, including morbidity, mortality, and available health resources.
The systems and processes involved in the establishment, support, management, and operation of registers, e.g., disease registers.
Developmental abnormalities involving structures of the heart. These defects are present at birth but may be discovered later in life.
In screening and diagnostic tests, the probability that a person with a positive test is a true positive (i.e., has the disease), is referred to as the predictive value of a positive test; whereas, the predictive value of a negative test is the probability that the person with a negative test does not have the disease. Predictive value is related to the sensitivity and specificity of the test.
Theoretical representations that simulate the behavior or activity of systems, processes, or phenomena. They include the use of mathematical equations, computers, and other electronic equipment.
Surgical therapy of ischemic coronary artery disease achieved by grafting a section of saphenous vein, internal mammary artery, or other substitute between the aorta and the obstructed coronary artery distal to the obstructive lesion.
The statistical reproducibility of measurements (often in a clinical context), including the testing of instrumentation or techniques to obtain reproducible results. The concept includes reproducibility of physiological measurements, which may be used to develop rules to assess probability or prognosis, or response to a stimulus; reproducibility of occurrence of a condition; and reproducibility of experimental results.
Elements of limited time intervals, contributing to particular results or situations.
The confinement of a patient in a hospital.
The concept concerned with all aspects of providing and distributing health services to a patient population.

Risk-adjusted capitation based on the Diagnostic Cost Group Model: an empirical evaluation with health survey information. (1/409)

OBJECTIVE: To evaluate the predictive accuracy of the Diagnostic Cost Group (DCG) model using health survey information. DATA SOURCES/STUDY SETTING: Longitudinal data collected for a sample of members of a Dutch sickness fund. In the Netherlands the sickness funds provide compulsory health insurance coverage for the 60 percent of the population in the lowest income brackets. STUDY DESIGN: A demographic model and DCG capitation models are estimated by means of ordinary least squares, with an individual's annual healthcare expenditures in 1994 as the dependent variable. For subgroups based on health survey information, costs predicted by the models are compared with actual costs. Using stepwise regression procedures a subset of relevant survey variables that could improve the predictive accuracy of the three-year DCG model was identified. Capitation models were extended with these variables. DATA COLLECTION/EXTRACTION METHODS: For the empirical analysis, panel data of sickness fund members were used that contained demographic information, annual healthcare expenditures, and diagnostic information from hospitalizations for each member. In 1993, a mailed health survey was conducted among a random sample of 15,000 persons in the panel data set, with a 70 percent response rate. PRINCIPAL FINDINGS: The predictive accuracy of the demographic model improves when it is extended with diagnostic information from prior hospitalizations (DCGs). A subset of survey variables further improves the predictive accuracy of the DCG capitation models. The predictable profits and losses based on survey information for the DCG models are smaller than for the demographic model. Most persons with predictable losses based on health survey information were not hospitalized in the preceding year. CONCLUSIONS: The use of diagnostic information from prior hospitalizations is a promising option for improving the demographic capitation payment formula. This study suggests that diagnostic information from outpatient utilization is complementary to DCGs in predicting future costs.  (+info)

Dissociable deficits in the decision-making cognition of chronic amphetamine abusers, opiate abusers, patients with focal damage to prefrontal cortex, and tryptophan-depleted normal volunteers: evidence for monoaminergic mechanisms. (2/409)

We used a novel computerized decision-making task to compare the decision-making behavior of chronic amphetamine abusers, chronic opiate abusers, and patients with focal lesions of orbital prefrontal cortex (PFC) or dorsolateral/medial PFC. We also assessed the effects of reducing central 5-hydroxytryptamine (5-HT) activity using a tryptophan-depleting amino acid drink in normal volunteers. Chronic amphetamine abusers showed suboptimal decisions (correlated with years of abuse), and deliberated for significantly longer before making their choices. The opiate abusers exhibited only the second of these behavioral changes. Importantly, both sub-optimal choices and increased deliberation times were evident in the patients with damage to orbitofrontal PFC but not other sectors of PFC. Qualitatively, the performance of the subjects with lowered plasma tryptophan was similar to that associated with amphetamine abuse, consistent with recent reports of depleted 5-HT in the orbital regions of PFC of methamphetamine abusers. Overall, these data suggest that chronic amphetamine abusers show similar decision-making deficits to those seen after focal damage to orbitofrontal PFC. These deficits may reflect altered neuromodulation of the orbitofrontal PFC and interconnected limbic-striatal systems by both the ascending 5-HT and mesocortical dopamine (DA) projections.  (+info)

Evaluating and improving the delivery of heart care: the University of Michigan experience. (3/409)

With increasing pressure to curb escalating costs in medical care, there is particular emphasis on the delivery of cardiovascular services, which account for a substantial portion of the current healthcare dollar spent in the United States. A variety of tools were used to improve performance at the University of Michigan Health System, one of the oldest university-affiliated hospitals in the United States. The tools included initiatives to understand outcomes after coronary bypass operations and coronary angioplasty through use of proper risk-adjusted models. Critical pathways and guidelines were implemented to streamline care and improve quality in interventional cardiology, management of myocardial infarction, and preoperative assessment of patients undergoing vascular operations. Strategies to curb unnecessary costs included competitive bidding of vendors for expensive cardiac commodities, pharmacy cost reductions, and changes in nursing staff. Methods were instituted to improve guest services and partnerships with the community in disease prevention and health promotion.  (+info)

Health-based payment and computerized patient record systems. (4/409)

Health care information technology is changing rapidly and dramatically. A small but growing number of clinicians, especially those in staff and group model HMOs and hospital-affiliated practices, are automating their patient medical records in response to pressure to improve quality and reduce costs. Computerized patient record systems in HMOs track risks, diagnoses, patterns of care, and outcomes across large populations. These systems provide access to large amounts of clinical information; as a result, they are very useful for risk-adjusted or health-based payment. The next stage of evolution in health-based payment is to switch from fee-for-service (claims) to HMO technology in calculating risk coefficients. This will occur when HMOs accumulate data sets containing records on provider-defined disease episodes, with every service linked to its appropriate disease episode for millions of patients. Computerized patient record systems support clinically meaningful risk-assessment models and protect patients and medical groups from the effects of adverse selection. They also offer significant potential for improving quality of care.  (+info)

Risk-adjusted outcome models for public mental health outpatient programs. (5/409)

OBJECTIVE: To develop and test risk-adjustment outcome models in publicly funded mental health outpatient settings. We developed prospective risk models that used demographic and diagnostic variables; client-reported functioning, satisfaction, and quality of life; and case manager clinical ratings to predict subsequent client functional status, health-related quality of life, and satisfaction with services. DATA SOURCES/STUDY SETTING: Data collected from 289 adult clients at five- and ten-month intervals, from six community mental health agencies in Washington state located primarily in suburban and rural areas. Data sources included client self-report, case manager ratings, and management information system data. STUDY DESIGN: Model specifications were tested using prospective linear regression analyses. Models were validated in a separate sample and comparative agency performance examined. PRINCIPAL FINDINGS: Presence of severe diagnoses, substance abuse, client age, and baseline functional status and quality of life were predictive of mental health outcomes. Unadjusted versus risk-adjusted scores resulted in differently ranked agency performance. CONCLUSIONS: Risk-adjusted functional status and patient satisfaction outcome models can be developed for public mental health outpatient programs. Research is needed to improve the predictive accuracy of the outcome models developed in this study, and to develop techniques for use in applied settings. The finding that risk adjustment changes comparative agency performance has important consequences for quality monitoring and improvement. Issues in public mental health risk adjustment are discussed, including static versus dynamic risk models, utilization versus outcome models, choice and timing of measures, and access and quality improvement incentives.  (+info)

Anthem Blue Cross and Blue Shield's coronary services network: a managed care organization's approach to improving the quality of cardiac care for its members. (6/409)

OBJECTIVE: To describe a managed care organization's efforts to improve value for its members by forming a coronary services network (CSN). DESIGN: To identify high-quality facilities for its CSN, Anthem Blue Cross and Blue Shield reviewed claims data and clinical data from hospitals that met its general quality standards. An external firm measured and risk-adjusted applicant hospitals' mortality rates. Hospitals that demonstrated superior performance were eligible to join the CSN. In 1996, 2 years after the CSN was formed, clinical outcomes of participants and new applicants were analyzed again by the same external firm. PATIENTS AND METHODS: Data on more than 10,000 consecutive (all-payer) inpatients discharged after coronary bypass surgery in 1993 were collected from 16 applicant hospitals using a uniform format and data definitions. This analysis was expanded to 23 participating and applicant hospitals that discharged more than 13,000 patients who underwent either bypass surgery or coronary revascularization in 1995. We compared risk-adjusted routine length of stay (a measure of efficiency), mortality rates, and adverse outcome rates between CSN and non-CSN facilities. RESULTS: From 1993 to 1995, overall length of stay in the network decreased by 20%, from 12.3 to 9.8 days (P < or = 0.01) and severity-adjusted mortality rates decreased by 7.3%, from 2.9% to 2.7%. Initially, facilities outside the network had comparable efficiency but much higher mortality. However, they improved so much in both measures that their severity-adjusted mortality rate for bypass surgery in 1995 was no more than 10% higher than that of CSN hospitals. CONCLUSION: The creation of a statewide CSN that emphasized and improved the level of performance among providers ultimately benefited the carrier's managed care members. The desirability of participation was evidenced by an increase in the number of applicant hospitals over the 2 years. This may have stimulated quality improvement among competing providers in the region and among CSN facilities themselves.  (+info)

Comparing AMI mortality among hospitals in patients 65 years of age and older: evaluating methods of risk adjustment. (7/409)

BACKGROUND: Interest in the reporting of risk-adjusted outcomes for patients with acute myocardial infarction is growing. A useful risk-adjustment model must balance parsimony and ease of data collection with predictive ability. METHODS AND RESULTS: From our analysis of 82 359 patients >/=65 years of age admitted with acute myocardial infarction to 2401 hospitals, we derived a parsimonious model that predicts 30-day mortality. The model was validated on a similar group of 78 699 patients from 2386 hospitals. Of the 73 candidate predictor variables examined, 7 variables describing patient characteristics on arrival were selected for inclusion in the final model: age, cardiac arrest, anterior or lateral location of myocardial infarction, systolic blood pressure, white blood cell count, serum creatinine, and congestive heart failure. The area under the receiver-operating characteristic curve for the final model was 0.77 in the derivation cohort and 0.77 in the validation cohort. The rankings of hospitals by performance (in deciles) with this model were most similar to a comprehensive 27-variable model based on medical chart review and least similar to models based on administrative billing codes. CONCLUSIONS: A simple 7-variable risk model performs as well as more complex models in comparing hospital outcomes for acute myocardial infarction. Although there is a continuing need to improve methods of risk adjustment, our results provide a basis for hospitals to develop a simple approach to compare outcomes.  (+info)

Case mix adjustment in nursing systems research: the case of resident outcomes in nursing homes. (8/409)

Case mix indicates, for a resident population, the degree of risk for developing favorable or unfavorable outcomes. In a study of 164 nursing homes, we explored two methods for combining resident assessment data into a case mix index (CMI). We compared a facility-level, composite CMI to a prevalence-based CMI comprised of 22 separate resident characteristics for their adequacy in explaining resident outcomes. The prevalence-based CMI consistently explained more variance in outcomes than the facility level, composite CMI. This study indicates a reasonable method for using administrative databases containing resident assessment data to adjust for the influence of case mix on nursing home resident outcomes.  (+info)

Risk adjustment is a statistical method used in healthcare financing and delivery to account for differences in the health status and expected healthcare costs among groups of enrollees. It is a process that modifies payment rates or capitation amounts based on the relative risk of each enrollee, as measured by demographic factors such as age, sex, and chronic medical conditions. The goal of risk adjustment is to create a more level playing field for healthcare providers and insurers by reducing the financial impact of serving patients who are sicker or have greater healthcare needs. This allows for a more fair comparison of performance and payment across different populations and helps to ensure that resources are distributed equitably.

"Insurance Selection Bias" is not a widely recognized medical term. However, in the context of health services research and health economics, "selection bias" generally refers to the distortion of study results due to the non-random selection of individuals into different groups, such as treatment and control groups. In the context of health insurance, selection bias may occur when individuals who choose to enroll in a particular insurance plan have different characteristics (such as age, health status, or income) than those who do not enroll, leading to biased estimates of the plan's effectiveness or cost.

For example, if healthier individuals are more likely to choose a particular insurance plan because it has lower premiums, while sicker individuals are more likely to choose a different plan with more comprehensive coverage, then any comparison of health outcomes or costs between the two plans may be biased due to the differences in the health status of the enrollees.

Therefore, researchers must take steps to control for selection bias in their analyses, such as adjusting for confounding variables or using statistical methods like propensity score matching to create more comparable groups.

A capitation fee is a payment model in healthcare systems where physicians or other healthcare providers receive a set amount of money per patient assigned to their care, per period of time, whether or not that patient seeks care. This fee is intended to cover all the necessary medical services for that patient during that time frame. It is a type of risk-based payment model that encourages providers to manage resources efficiently and provide appropriate care to keep patients healthy and avoid unnecessary procedures or hospitalizations. The amount of the capitation fee can vary based on factors such as the patient's age, health status, and any specific healthcare needs they may have.

"Competitive medical plans" is not a standard term in the medical field. However, in the context of health insurance and healthcare policy, it generally refers to multiple health plan options that are available for individuals or employers to choose from, typically within a regulated marketplace or exchange. These plans compete with each other to offer the best coverage, benefits, and costs to attract customers. The goal of having competitive medical plans is to increase access to quality healthcare, promote competition among insurers, and drive down healthcare costs through choice and negotiation.

"Rate setting and review" is not a commonly used medical term with a specific definition in the field. However, I can provide you with information about what these terms might refer to in a broader healthcare context:

Rate setting generally refers to the process of determining the payment rates for healthcare services, programs, or products. This could involve setting reimbursement rates for medical procedures, medications, or durable medical equipment under government-funded health insurance programs like Medicare and Medicaid, or in the private insurance sector. Rate setting can be influenced by various factors, including the cost of providing care, resource utilization, quality metrics, and market competition.

Review, in this context, typically refers to the process of evaluating and assessing healthcare services, programs, or products to ensure their quality, effectiveness, and efficiency. This could involve reviewing medical records, clinical outcomes, and financial data to determine if the care provided is consistent with evidence-based guidelines, industry best practices, and regulatory requirements. Regular reviews are essential for maintaining high standards of care, identifying areas for improvement, and ensuring that resources are allocated efficiently.

Together, "rate setting and review" may refer to a comprehensive approach to managing healthcare costs and quality by establishing appropriate payment rates while continuously monitoring and improving the effectiveness and efficiency of healthcare services.

Integrative Medicine (IM) is a comprehensive, whole-person approach to healthcare that combines conventional medicine with evidence-based complementary and alternative therapies. The goal of IM is to achieve optimal health and healing by addressing the physical, emotional, mental, social, and spiritual aspects of an individual's life.

The principles of Integrative Medicine include:

1. Patient-centered care: Treating each patient as a unique individual and considering their personal needs, values, and preferences in the treatment plan.
2. Collaboration: Working together with patients, families, and other healthcare providers to create a coordinated and comprehensive care plan.
3. Evidence-informed practice: Using the best available evidence from both conventional and complementary medicine to inform clinical decision making.
4. Incorporation of lifestyle modifications: Encouraging patients to make lifestyle changes that promote health and wellness, such as diet, exercise, stress management, and sleep hygiene.
5. Use of both conventional and complementary therapies: Utilizing a range of treatments, including pharmaceuticals, surgery, acupuncture, herbs, nutrition, and mind-body techniques, to address the root causes of illness and promote healing.
6. Attention to all aspects of health: Addressing physical, emotional, mental, social, and spiritual factors that contribute to health and wellness.
7. Focus on prevention and wellness: Emphasizing the importance of preventing illness and promoting overall health and well-being.
8. Continuous learning and improvement: Staying up-to-date with the latest research and best practices in both conventional and complementary medicine, and using this knowledge to improve patient care.

Diagnosis-Related Groups (DRGs) are a system of classifying hospital patients based on their severity of illness, resource utilization, and other factors. DRGs were developed by the US federal government to determine the relative cost of providing inpatient care for various types of diagnoses and procedures.

The DRG system categorizes patients into one of several hundred groups based on their diagnosis, treatment, and other clinical characteristics. Each DRG has a corresponding payment weight that reflects the average resource utilization and costs associated with caring for patients in that group. Hospitals are then reimbursed for inpatient services based on the DRG payment weights, providing an incentive to provide more efficient and cost-effective care.

DRGs have been widely adopted as a tool for managing healthcare costs and improving quality of care. They are used by Medicare, Medicaid, and many private insurers to determine payments for inpatient hospital services. DRGs can also be used to compare the performance of hospitals and healthcare providers, identify best practices, and support quality improvement initiatives.

Hospital mortality is a term used to describe the number or rate of deaths that occur in a hospital setting during a specific period. It is often used as a measure of the quality of healthcare provided by a hospital, as a higher hospital mortality rate may indicate poorer care or more complex cases being treated. However, it's important to note that hospital mortality rates can be influenced by many factors, including the severity of illness of the patients being treated, patient demographics, and the availability of resources and specialized care. Therefore, hospital mortality rates should be interpreted with caution and in the context of other quality metrics.

The Admitting Department in a hospital is the area where patients are formally registered and admitted for further medical treatment or procedures. When a patient arrives at the hospital for admission, they first go through the admitting department to provide necessary information such as their personal details, insurance information, medical history, and reason for admission. The staff in this department verifies the patient's insurance coverage, obtains any required authorizations for procedures, and creates a medical record for the patient. After completing the admitting process, the patient is then directed to the appropriate hospital unit or department for further care.

I'm sorry for any confusion, but "United States" is a geopolitical entity, specifically the name of the country consisting of 50 states, and it is not a medical term or concept. Therefore, I can't provide a medical definition for it. If you have any questions related to health, medicine, or biology, I would be happy to try to help answer those!

Healthcare Quality Indicators (QIs) are measurable elements that can be used to assess the quality of healthcare services and outcomes. They are often based on evidence-based practices and guidelines, and are designed to help healthcare providers monitor and improve the quality of care they deliver to their patients. QIs may focus on various aspects of healthcare, such as patient safety, clinical effectiveness, patient-centeredness, timeliness, and efficiency. Examples of QIs include measures such as rates of hospital-acquired infections, adherence to recommended treatments for specific conditions, and patient satisfaction scores. By tracking these indicators over time, healthcare organizations can identify areas where they need to improve, make changes to their processes and practices, and ultimately provide better care to their patients.

Cost allocation is the process of distributing or assigning costs to different departments, projects, products, or services within an organization. The goal of cost allocation is to more accurately determine the true cost of producing a product or providing a service, taking into account all related expenses. This can help organizations make better decisions about pricing, resource allocation, and profitability analysis.

There are various methods for allocating costs, including activity-based costing (ABC), which assigns costs based on the activities required to produce a product or provide a service; traditional costing, which uses broad categories such as direct labor, direct materials, and overhead; and causal allocation, which assigns costs based on a specific cause-and-effect relationship.

In healthcare, cost allocation is particularly important for determining the true cost of patient care, including both direct and indirect costs. This can help hospitals and other healthcare organizations make informed decisions about resource allocation, pricing, and reimbursement strategies.

"Managed competition" is not a term that has a specific medical or clinical definition. However, it is a concept that is often discussed in the context of healthcare policy and economics. Here's a general definition:

Managed competition is a model for organizing healthcare markets where multiple health plans compete for enrollment, while also being subject to regulatory oversight and quality standards. The goal of managed competition is to promote high-quality care, cost containment, and consumer choice through competition among health plans that are held accountable for their performance.

In a managed competition system, consumers are encouraged to choose among competing health plans based on factors such as price, quality, and provider networks. At the same time, health plans have an incentive to negotiate lower prices with healthcare providers and to invest in preventive care and disease management programs that can improve outcomes and reduce costs over time.

The managed competition model has been implemented in various forms in different countries and regions around the world, including the Netherlands and some U.S. states such as Massachusetts. However, there is ongoing debate about the strengths and limitations of this approach to healthcare reform.

Health expenditures refer to the total amount of money spent on health services, goods, and resources in a given period. This can include expenses for preventive care, medical treatments, medications, long-term care, and administrative costs. Health expenditures can be made by individuals, corporations, insurance companies, or governments, and they can be measured at the national, regional, or household level.

Health expenditures are often used as an indicator of a country's investment in its healthcare system and can reflect the overall health status of a population. High levels of health expenditures may indicate a strong commitment to healthcare, but they can also place a significant burden on individuals, businesses, and governments. Understanding patterns and trends in health expenditures is important for policymakers, healthcare providers, and researchers who are working to improve the efficiency, effectiveness, and accessibility of healthcare services.

Veterans hospitals, also known as Veterans Administration (VA) hospitals, are healthcare facilities provided by the US Department of Veterans Affairs. These hospitals offer comprehensive medical care, including inpatient and outpatient services, to eligible veterans. The services offered include surgery, mental health counseling, rehabilitation, long-term care, and other specialized treatments. The mission of veterans hospitals is to provide high-quality healthcare to those who have served in the US military.

Social adjustment, in the context of mental health and psychology, refers to an individual's ability to adapt and function effectively within their social environment. It involves developing and maintaining positive relationships with others, fulfilling various social roles (such as being a family member, friend, or employee), and meeting the expectations and demands of one's social group.

Social adjustment can be affected by various factors, including an individual's personality traits, coping skills, mental and physical health status, and life experiences. Poor social adjustment can lead to feelings of isolation, loneliness, and dissatisfaction with life, as well as increased risk for mental health problems such as depression and anxiety.

Assessing social adjustment is an important aspect of mental health care, as it can provide valuable insights into an individual's overall functioning and quality of life. Treatments such as psychotherapy and social skills training may be used to help improve social adjustment in individuals who are struggling in this area.

Benchmarking in the medical context refers to the process of comparing healthcare services, practices, or outcomes against a widely recognized standard or within best practice recommendations, with the aim of identifying areas for improvement and implementing changes to enhance the quality and efficiency of care. This can involve comparing data on various metrics such as patient satisfaction, clinical outcomes, costs, and safety measures. The goal is to continuously monitor and improve the quality of healthcare services provided to patients.

Statistical models are mathematical representations that describe the relationship between variables in a given dataset. They are used to analyze and interpret data in order to make predictions or test hypotheses about a population. In the context of medicine, statistical models can be used for various purposes such as:

1. Disease risk prediction: By analyzing demographic, clinical, and genetic data using statistical models, researchers can identify factors that contribute to an individual's risk of developing certain diseases. This information can then be used to develop personalized prevention strategies or early detection methods.

2. Clinical trial design and analysis: Statistical models are essential tools for designing and analyzing clinical trials. They help determine sample size, allocate participants to treatment groups, and assess the effectiveness and safety of interventions.

3. Epidemiological studies: Researchers use statistical models to investigate the distribution and determinants of health-related events in populations. This includes studying patterns of disease transmission, evaluating public health interventions, and estimating the burden of diseases.

4. Health services research: Statistical models are employed to analyze healthcare utilization, costs, and outcomes. This helps inform decisions about resource allocation, policy development, and quality improvement initiatives.

5. Biostatistics and bioinformatics: In these fields, statistical models are used to analyze large-scale molecular data (e.g., genomics, proteomics) to understand biological processes and identify potential therapeutic targets.

In summary, statistical models in medicine provide a framework for understanding complex relationships between variables and making informed decisions based on data-driven insights.

Medicare is a social insurance program in the United States, administered by the Centers for Medicare & Medicaid Services (CMS), that provides health insurance coverage to people who are aged 65 and over; or who have certain disabilities; or who have End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant).

The program consists of four parts:

1. Hospital Insurance (Part A), which helps pay for inpatient care in hospitals, skilled nursing facilities, hospices, and home health care.
2. Medical Insurance (Part B), which helps pay for doctors' services, outpatient care, medical supplies, and preventive services.
3. Medicare Advantage Plans (Part C), which are private insurance plans that provide all of your Part A and Part B benefits, and may include additional benefits like dental, vision, and hearing coverage.
4. Prescription Drug Coverage (Part D), which helps pay for medications doctors prescribe for treatment.

Medicare is funded by payroll taxes, premiums paid by beneficiaries, and general revenue. Beneficiaries typically pay a monthly premium for Part B and Part D coverage, while Part A is generally free for those who have worked and paid Medicare taxes for at least 40 quarters.

Medical Definition:

"Risk factors" are any attribute, characteristic or exposure of an individual that increases the likelihood of developing a disease or injury. They can be divided into modifiable and non-modifiable risk factors. Modifiable risk factors are those that can be changed through lifestyle choices or medical treatment, while non-modifiable risk factors are inherent traits such as age, gender, or genetic predisposition. Examples of modifiable risk factors include smoking, alcohol consumption, physical inactivity, and unhealthy diet, while non-modifiable risk factors include age, sex, and family history. It is important to note that having a risk factor does not guarantee that a person will develop the disease, but rather indicates an increased susceptibility.

The International Classification of Diseases (ICD) is a standardized system for classifying and coding mortality and morbidity data, established by the World Health Organization (WHO). It provides a common language and framework for health professionals, researchers, and policymakers to share and compare health-related information across countries and regions.

The ICD codes are used to identify diseases, injuries, causes of death, and other health conditions. The classification includes categories for various body systems, mental disorders, external causes of injury and poisoning, and factors influencing health status. It also includes a section for symptoms, signs, and abnormal clinical and laboratory findings.

The ICD is regularly updated to incorporate new scientific knowledge and changing health needs. The most recent version, ICD-11, was adopted by the World Health Assembly in May 2019 and will come into effect on January 1, 2022. It includes significant revisions and expansions in several areas, such as mental, behavioral, neurological disorders, and conditions related to sexual health.

In summary, the International Classification of Diseases (ICD) is a globally recognized system for classifying and coding diseases, injuries, causes of death, and other health-related information, enabling standardized data collection, comparison, and analysis across countries and regions.

National Health Insurance (NHI) in the United States does not refer to a specific federal program, but rather it is often used to describe the concept of universal healthcare financing, where all residents have access to necessary healthcare services, and the costs are shared among the entire population.

However, the closest equivalent to NHI in the US is Medicare, which is a federal social insurance program that provides health insurance coverage to people aged 65 and older, some younger people with disabilities, and people with end-stage renal disease. It is not a true NHI system because it does not cover all residents of the country.

Therefore, there is no widely accepted medical definition of 'National Health Insurance, United States' in the context of an actual existing program or policy.

A hospital is a healthcare facility where patients receive medical treatment, diagnosis, and care for various health conditions, injuries, or diseases. It is typically staffed with medical professionals such as doctors, nurses, and other healthcare workers who provide round-the-clock medical services. Hospitals may offer inpatient (overnight) stays or outpatient (same-day) services, depending on the nature of the treatment required. They are equipped with various medical facilities like operating rooms, diagnostic equipment, intensive care units (ICUs), and emergency departments to handle a wide range of medical situations. Hospitals may specialize in specific areas of medicine, such as pediatrics, geriatrics, oncology, or trauma care.

An insurance claim review is the process conducted by an insurance company to evaluate a claim made by a policyholder for coverage of a loss or expense. This evaluation typically involves examining the details of the claim, assessing the damages or injuries incurred, verifying the coverage provided by the policy, and determining the appropriate amount of benefits to be paid. The insurance claim review may also include investigating the circumstances surrounding the claim to ensure its validity and confirming that it complies with the terms and conditions of the insurance policy.

Logistic models, specifically logistic regression models, are a type of statistical analysis used in medical and epidemiological research to identify the relationship between the risk of a certain health outcome or disease (dependent variable) and one or more independent variables, such as demographic factors, exposure variables, or other clinical measurements.

In contrast to linear regression models, logistic regression models are used when the dependent variable is binary or dichotomous in nature, meaning it can only take on two values, such as "disease present" or "disease absent." The model uses a logistic function to estimate the probability of the outcome based on the independent variables.

Logistic regression models are useful for identifying risk factors and estimating the strength of associations between exposures and health outcomes, adjusting for potential confounders, and predicting the probability of an outcome given certain values of the independent variables. They can also be used to develop clinical prediction rules or scores that can aid in decision-making and patient care.

Risk assessment in the medical context refers to the process of identifying, evaluating, and prioritizing risks to patients, healthcare workers, or the community related to healthcare delivery. It involves determining the likelihood and potential impact of adverse events or hazards, such as infectious diseases, medication errors, or medical devices failures, and implementing measures to mitigate or manage those risks. The goal of risk assessment is to promote safe and high-quality care by identifying areas for improvement and taking action to minimize harm.

Health services research (HSR) is a multidisciplinary field of scientific investigation that studies how social factors, financing systems, organizational structures and processes, health technologies, and personal behaviors affect access to healthcare, the quality and cost of care, and ultimately, our health and well-being. The goal of HSR is to inform policy and practice, improve system performance, and enhance the health and well-being of individuals and communities. It involves the use of various research methods, including epidemiology, biostatistics, economics, sociology, management science, political science, and psychology, to answer questions about the healthcare system and how it can be improved.

Examples of HSR topics include:

* Evaluating the effectiveness and cost-effectiveness of different healthcare interventions and technologies
* Studying patient-centered care and patient experiences with the healthcare system
* Examining healthcare workforce issues, such as shortages of primary care providers or the impact of nurse-to-patient ratios on patient outcomes
* Investigating the impact of health insurance design and financing systems on access to care and health disparities
* Analyzing the organization and delivery of healthcare services in different settings, such as hospitals, clinics, and long-term care facilities
* Identifying best practices for improving healthcare quality and safety, reducing medical errors, and eliminating wasteful or unnecessary care.

I apologize for any confusion, but "Chile" is not a medical term or concept. It is a country located in South America, known for its long and narrow geography, diverse landscapes, and rich cultural heritage. If you have any questions related to medicine or health, I would be happy to try and help answer those for you.

I'm sorry for any confusion, but "Washington" is not a medical term. It is a place name, referring to the U.S. state of Washington or the city of Washington, D.C., the capital of the United States. If you have any questions about medical terms or concepts, I would be happy to help answer those for you!

Fee-for-service (FFS) plans are a type of medical reimbursement model in which healthcare providers are paid for each specific service or procedure they perform. In this system, the patient or their insurance company is charged separately for each appointment, test, or treatment, and the provider receives payment based on the number and type of services delivered.

FFS plans can be either traditional fee-for-service or modified fee-for-service. Traditional FFS plans offer providers more autonomy in setting their fees but may lead to higher healthcare costs due to potential overutilization of services. Modified FFS plans, on the other hand, involve pre-negotiated rates between insurance companies and healthcare providers, aiming to control costs while still allowing providers to be compensated for each service they deliver.

It is important to note that FFS plans can sometimes create financial incentives for healthcare providers to perform more tests or procedures than necessary, potentially leading to increased healthcare costs and potential overtreatment. As a result, alternative payment models like capitation, bundled payments, and value-based care have emerged as alternatives to address these concerns.

Regression analysis is a statistical technique used in medicine, as well as in other fields, to examine the relationship between one or more independent variables (predictors) and a dependent variable (outcome). It allows for the estimation of the average change in the outcome variable associated with a one-unit change in an independent variable, while controlling for the effects of other independent variables. This technique is often used to identify risk factors for diseases or to evaluate the effectiveness of medical interventions. In medical research, regression analysis can be used to adjust for potential confounding variables and to quantify the relationship between exposures and health outcomes. It can also be used in predictive modeling to estimate the probability of a particular outcome based on multiple predictors.

Quality of health care is a term that refers to the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge. It encompasses various aspects such as:

1. Clinical effectiveness: The use of best available evidence to make decisions about prevention, diagnosis, treatment, and care. This includes considering the benefits and harms of different options and making sure that the most effective interventions are used.
2. Safety: Preventing harm to patients and minimizing risks associated with healthcare. This involves identifying potential hazards, implementing measures to reduce errors, and learning from adverse events to improve systems and processes.
3. Patient-centeredness: Providing care that is respectful of and responsive to individual patient preferences, needs, and values. This includes ensuring that patients are fully informed about their condition and treatment options, involving them in decision-making, and providing emotional support throughout the care process.
4. Timeliness: Ensuring that healthcare services are delivered promptly and efficiently, without unnecessary delays. This includes coordinating care across different providers and settings to ensure continuity and avoid gaps in service.
5. Efficiency: Using resources wisely and avoiding waste, while still providing high-quality care. This involves considering the costs and benefits of different interventions, as well as ensuring that healthcare services are equitably distributed.
6. Equitability: Ensuring that all individuals have access to quality healthcare services, regardless of their socioeconomic status, race, ethnicity, gender, age, or other factors. This includes addressing disparities in health outcomes and promoting fairness and justice in healthcare.

Overall, the quality of health care is a multidimensional concept that requires ongoing evaluation and improvement to ensure that patients receive the best possible care.

I'm sorry for any confusion, but "Michigan" is not a medical term or concept. It is a geographical location, referring to the state of Michigan in the United States. If you have any questions related to medical topics, I would be happy to try and help answer those for you!

Retrospective studies, also known as retrospective research or looking back studies, are a type of observational study that examines data from the past to draw conclusions about possible causal relationships between risk factors and outcomes. In these studies, researchers analyze existing records, medical charts, or previously collected data to test a hypothesis or answer a specific research question.

Retrospective studies can be useful for generating hypotheses and identifying trends, but they have limitations compared to prospective studies, which follow participants forward in time from exposure to outcome. Retrospective studies are subject to biases such as recall bias, selection bias, and information bias, which can affect the validity of the results. Therefore, retrospective studies should be interpreted with caution and used primarily to generate hypotheses for further testing in prospective studies.

A Health Benefit Plan for Employees refers to a type of insurance policy that an employer provides to their employees as part of their benefits package. These plans are designed to help cover the costs of medical care and services for the employees and sometimes also for their dependents. The specific coverage and details of the plan can vary depending on the terms of the policy, but they typically include a range of benefits such as doctor visits, hospital stays, prescription medications, and preventative care. Employers may pay all or part of the premiums for these plans, and employees may also have the option to contribute to the cost of coverage. The goal of health benefit plans for employees is to help protect the financial well-being of workers by helping them manage the costs of medical care.

Health Insurance is a type of insurance that covers the whole or a part of the risk of a person incurring medical expenses, spreading the risk over a large number of persons. By purchasing health insurance, insured individuals pay a premium to an insurance company, which then pools those funds with other policyholders' premiums to pay for the medical care costs of individuals who become ill or injured. The coverage can include hospitalization, medical procedures, prescription drugs, and preventive care, among other services. The goal of health insurance is to provide financial protection against unexpected medical expenses and to make healthcare services more affordable.

A cohort study is a type of observational study in which a group of individuals who share a common characteristic or exposure are followed up over time to determine the incidence of a specific outcome or outcomes. The cohort, or group, is defined based on the exposure status (e.g., exposed vs. unexposed) and then monitored prospectively to assess for the development of new health events or conditions.

Cohort studies can be either prospective or retrospective in design. In a prospective cohort study, participants are enrolled and followed forward in time from the beginning of the study. In contrast, in a retrospective cohort study, researchers identify a cohort that has already been assembled through medical records, insurance claims, or other sources and then look back in time to assess exposure status and health outcomes.

Cohort studies are useful for establishing causality between an exposure and an outcome because they allow researchers to observe the temporal relationship between the two. They can also provide information on the incidence of a disease or condition in different populations, which can be used to inform public health policy and interventions. However, cohort studies can be expensive and time-consuming to conduct, and they may be subject to bias if participants are not representative of the population or if there is loss to follow-up.

A factual database in the medical context is a collection of organized and structured data that contains verified and accurate information related to medicine, healthcare, or health sciences. These databases serve as reliable resources for various stakeholders, including healthcare professionals, researchers, students, and patients, to access evidence-based information for making informed decisions and enhancing knowledge.

Examples of factual medical databases include:

1. PubMed: A comprehensive database of biomedical literature maintained by the US National Library of Medicine (NLM). It contains citations and abstracts from life sciences journals, books, and conference proceedings.
2. MEDLINE: A subset of PubMed, MEDLINE focuses on high-quality, peer-reviewed articles related to biomedicine and health. It is the primary component of the NLM's database and serves as a critical resource for healthcare professionals and researchers worldwide.
3. Cochrane Library: A collection of systematic reviews and meta-analyses focused on evidence-based medicine. The library aims to provide unbiased, high-quality information to support clinical decision-making and improve patient outcomes.
4. OVID: A platform that offers access to various medical and healthcare databases, including MEDLINE, Embase, and PsycINFO. It facilitates the search and retrieval of relevant literature for researchers, clinicians, and students.
5. ClinicalTrials.gov: A registry and results database of publicly and privately supported clinical studies conducted around the world. The platform aims to increase transparency and accessibility of clinical trial data for healthcare professionals, researchers, and patients.
6. UpToDate: An evidence-based, physician-authored clinical decision support resource that provides information on diagnosis, treatment, and prevention of medical conditions. It serves as a point-of-care tool for healthcare professionals to make informed decisions and improve patient care.
7. TRIP Database: A search engine designed to facilitate evidence-based medicine by providing quick access to high-quality resources, including systematic reviews, clinical guidelines, and practice recommendations.
8. National Guideline Clearinghouse (NGC): A database of evidence-based clinical practice guidelines and related documents developed through a rigorous review process. The NGC aims to provide clinicians, healthcare providers, and policymakers with reliable guidance for patient care.
9. DrugBank: A comprehensive, freely accessible online database containing detailed information about drugs, their mechanisms, interactions, and targets. It serves as a valuable resource for researchers, healthcare professionals, and students in the field of pharmacology and drug discovery.
10. Genetic Testing Registry (GTR): A database that provides centralized information about genetic tests, test developers, laboratories offering tests, and clinical validity and utility of genetic tests. It serves as a resource for healthcare professionals, researchers, and patients to make informed decisions regarding genetic testing.

The odds ratio (OR) is a statistical measure used in epidemiology and research to estimate the association between an exposure and an outcome. It represents the odds that an event will occur in one group versus the odds that it will occur in another group, assuming that all other factors are held constant.

In medical research, the odds ratio is often used to quantify the strength of the relationship between a risk factor (exposure) and a disease outcome. An OR of 1 indicates no association between the exposure and the outcome, while an OR greater than 1 suggests that there is a positive association between the two. Conversely, an OR less than 1 implies a negative association.

It's important to note that the odds ratio is not the same as the relative risk (RR), which compares the incidence rates of an outcome in two groups. While the OR can approximate the RR when the outcome is rare, they are not interchangeable and can lead to different conclusions about the association between an exposure and an outcome.

A Cesarean section, often referred to as a C-section, is a surgical procedure used to deliver a baby. It involves making an incision through the mother's abdomen and uterus to remove the baby. This procedure may be necessary when a vaginal delivery would put the mother or the baby at risk.

There are several reasons why a C-section might be recommended, including:

* The baby is in a breech position (feet first) or a transverse position (sideways) and cannot be turned to a normal head-down position.
* The baby is too large to safely pass through the mother's birth canal.
* The mother has a medical condition, such as heart disease or high blood pressure, that could make vaginal delivery risky.
* The mother has an infection, such as HIV or herpes, that could be passed to the baby during a vaginal delivery.
* The labor is not progressing and there are concerns about the health of the mother or the baby.

C-sections are generally safe for both the mother and the baby, but like any surgery, they do carry some risks. These can include infection, bleeding, blood clots, and injury to nearby organs. In addition, women who have a C-section are more likely to experience complications in future pregnancies, such as placenta previa or uterine rupture.

If you have questions about whether a C-section is necessary for your delivery, it's important to discuss your options with your healthcare provider.

Cardiac surgical procedures are operations that are performed on the heart or great vessels (the aorta and vena cava) by cardiothoracic surgeons. These surgeries are often complex and require a high level of skill and expertise. Some common reasons for cardiac surgical procedures include:

1. Coronary artery bypass grafting (CABG): This is a surgery to improve blood flow to the heart in patients with coronary artery disease. During the procedure, a healthy blood vessel from another part of the body is used to create a detour around the blocked or narrowed portion of the coronary artery.
2. Valve repair or replacement: The heart has four valves that control blood flow through and out of the heart. If one or more of these valves become damaged or diseased, they may need to be repaired or replaced. This can be done using artificial valves or valves from animal or human donors.
3. Aneurysm repair: An aneurysm is a weakened area in the wall of an artery that can bulge out and potentially rupture. If an aneurysm occurs in the aorta, it may require surgical repair to prevent rupture.
4. Heart transplantation: In some cases, heart failure may be so severe that a heart transplant is necessary. This involves removing the diseased heart and replacing it with a healthy donor heart.
5. Arrhythmia surgery: Certain types of abnormal heart rhythms (arrhythmias) may require surgical treatment. One such procedure is called the Maze procedure, which involves creating a pattern of scar tissue in the heart to disrupt the abnormal electrical signals that cause the arrhythmia.
6. Congenital heart defect repair: Some people are born with structural problems in their hearts that require surgical correction. These may include holes between the chambers of the heart or abnormal blood vessels.

Cardiac surgical procedures carry risks, including bleeding, infection, stroke, and death. However, for many patients, these surgeries can significantly improve their quality of life and longevity.

Prospective studies, also known as longitudinal studies, are a type of cohort study in which data is collected forward in time, following a group of individuals who share a common characteristic or exposure over a period of time. The researchers clearly define the study population and exposure of interest at the beginning of the study and follow up with the participants to determine the outcomes that develop over time. This type of study design allows for the investigation of causal relationships between exposures and outcomes, as well as the identification of risk factors and the estimation of disease incidence rates. Prospective studies are particularly useful in epidemiology and medical research when studying diseases with long latency periods or rare outcomes.

A Severity of Illness Index is a measurement tool used in healthcare to assess the severity of a patient's condition and the risk of mortality or other adverse outcomes. These indices typically take into account various physiological and clinical variables, such as vital signs, laboratory values, and co-morbidities, to generate a score that reflects the patient's overall illness severity.

Examples of Severity of Illness Indices include the Acute Physiology and Chronic Health Evaluation (APACHE) system, the Simplified Acute Physiology Score (SAPS), and the Mortality Probability Model (MPM). These indices are often used in critical care settings to guide clinical decision-making, inform prognosis, and compare outcomes across different patient populations.

It is important to note that while these indices can provide valuable information about a patient's condition, they should not be used as the sole basis for clinical decision-making. Rather, they should be considered in conjunction with other factors, such as the patient's overall clinical presentation, treatment preferences, and goals of care.

Multivariate analysis is a statistical method used to examine the relationship between multiple independent variables and a dependent variable. It allows for the simultaneous examination of the effects of two or more independent variables on an outcome, while controlling for the effects of other variables in the model. This technique can be used to identify patterns, associations, and interactions among multiple variables, and is commonly used in medical research to understand complex health outcomes and disease processes. Examples of multivariate analysis methods include multiple regression, factor analysis, cluster analysis, and discriminant analysis.

According to the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5), an Adjustment Disorder is a mental health condition that occurs as a reaction to a stressful life event or significant change. It is characterized by emotional or behavioral symptoms that cause distress and interfere with daily functioning, but do not meet the criteria for other more specific mental disorders.

The symptoms of an Adjustment Disorder typically develop within three months of the identified stressor and may include:

* Depressed mood
* Anxiety
* Irritability or anger
* Worrying
* Difficulty sleeping
* Loss of appetite
* Difficulty concentrating
* Physical symptoms, such as headaches or stomachaches

The symptoms must be out of proportion to the severity or intensity of the stressor and may lead to significant impairment in social, occupational, or academic functioning. The diagnosis is not given if the symptoms persist for more than six months after the stressor has ended.

There are several subtypes of Adjustment Disorders, including:

* Adjustment Disorder with Depressed Mood
* Adjustment Disorder with Anxiety
* Adjustment Disorder with Mixed Anxiety and Depressed Mood
* Adjustment Disorder with Disturbance of Conduct
* Adjustment Disorder with Emotional or Behavioral Symptoms Not Otherwise Specified

Treatment for Adjustment Disorders typically involves psychotherapy, such as cognitive-behavioral therapy (CBT) or solution-focused brief therapy, to help individuals develop coping skills and manage their symptoms. In some cases, medication may also be recommended to alleviate symptoms of anxiety or depression.

National health programs are systematic, large-scale initiatives that are put in place by national governments to address specific health issues or improve the overall health of a population. These programs often involve coordinated efforts across various sectors, including healthcare, education, and social services. They may aim to increase access to care, improve the quality of care, prevent the spread of diseases, promote healthy behaviors, or reduce health disparities. Examples of national health programs include immunization campaigns, tobacco control initiatives, and efforts to address chronic diseases such as diabetes or heart disease. These programs are typically developed based on scientific research, evidence-based practices, and public health data, and they may be funded through a variety of sources, including government budgets, grants, and private donations.

Comorbidity is the presence of one or more additional health conditions or diseases alongside a primary illness or condition. These co-occurring health issues can have an impact on the treatment plan, prognosis, and overall healthcare management of an individual. Comorbidities often interact with each other and the primary condition, leading to more complex clinical situations and increased healthcare needs. It is essential for healthcare professionals to consider and address comorbidities to provide comprehensive care and improve patient outcomes.

Treatment outcome is a term used to describe the result or effect of medical treatment on a patient's health status. It can be measured in various ways, such as through symptoms improvement, disease remission, reduced disability, improved quality of life, or survival rates. The treatment outcome helps healthcare providers evaluate the effectiveness of a particular treatment plan and make informed decisions about future care. It is also used in clinical research to compare the efficacy of different treatments and improve patient care.

"California" is a geographical location and does not have a medical definition. It is a state located on the west coast of the United States, known for its diverse landscape including mountains, beaches, and forests. However, in some contexts, "California" may refer to certain medical conditions or situations that are associated with the state, such as:

* California encephalitis: a viral infection transmitted by mosquitoes that is common in California and other western states.
* California king snake: a non-venomous snake species found in California and other parts of the southwestern United States, which can bite and cause allergic reactions in some people.
* California roll: a type of sushi roll that originated in California and is made with avocado, cucumber, and crab meat, which may pose an allergy risk for some individuals.

It's important to note that these uses of "California" are not medical definitions per se, but rather descriptive terms that refer to specific conditions or situations associated with the state.

"Age factors" refer to the effects, changes, or differences that age can have on various aspects of health, disease, and medical care. These factors can encompass a wide range of issues, including:

1. Physiological changes: As people age, their bodies undergo numerous physical changes that can affect how they respond to medications, illnesses, and medical procedures. For example, older adults may be more sensitive to certain drugs or have weaker immune systems, making them more susceptible to infections.
2. Chronic conditions: Age is a significant risk factor for many chronic diseases, such as heart disease, diabetes, cancer, and arthritis. As a result, age-related medical issues are common and can impact treatment decisions and outcomes.
3. Cognitive decline: Aging can also lead to cognitive changes, including memory loss and decreased decision-making abilities. These changes can affect a person's ability to understand and comply with medical instructions, leading to potential complications in their care.
4. Functional limitations: Older adults may experience physical limitations that impact their mobility, strength, and balance, increasing the risk of falls and other injuries. These limitations can also make it more challenging for them to perform daily activities, such as bathing, dressing, or cooking.
5. Social determinants: Age-related factors, such as social isolation, poverty, and lack of access to transportation, can impact a person's ability to obtain necessary medical care and affect their overall health outcomes.

Understanding age factors is critical for healthcare providers to deliver high-quality, patient-centered care that addresses the unique needs and challenges of older adults. By taking these factors into account, healthcare providers can develop personalized treatment plans that consider a person's age, physical condition, cognitive abilities, and social circumstances.

"Length of Stay" (LOS) is a term commonly used in healthcare to refer to the amount of time a patient spends receiving care in a hospital, clinic, or other healthcare facility. It is typically measured in hours, days, or weeks and can be used as a metric for various purposes such as resource planning, quality assessment, and reimbursement. The length of stay can vary depending on the type of illness or injury, the severity of the condition, the patient's response to treatment, and other factors. It is an important consideration in healthcare management and can have significant implications for both patients and providers.

Quality Assurance in the context of healthcare refers to a systematic approach and set of activities designed to ensure that health care services and products consistently meet predetermined standards of quality and safety. It includes all the policies, procedures, and processes that are put in place to monitor, assess, and improve the quality of healthcare delivery.

The goal of quality assurance is to minimize variability in clinical practice, reduce medical errors, and ensure that patients receive evidence-based care that is safe, effective, timely, patient-centered, and equitable. Quality assurance activities may include:

1. Establishing standards of care based on best practices and clinical guidelines.
2. Developing and implementing policies and procedures to ensure compliance with these standards.
3. Providing education and training to healthcare professionals to improve their knowledge and skills.
4. Conducting audits, reviews, and evaluations of healthcare services and processes to identify areas for improvement.
5. Implementing corrective actions to address identified issues and prevent their recurrence.
6. Monitoring and measuring outcomes to evaluate the effectiveness of quality improvement initiatives.

Quality assurance is an ongoing process that requires continuous evaluation and improvement to ensure that healthcare delivery remains safe, effective, and patient-centered.

A newborn infant is a baby who is within the first 28 days of life. This period is also referred to as the neonatal period. Newborns require specialized care and attention due to their immature bodily systems and increased vulnerability to various health issues. They are closely monitored for signs of well-being, growth, and development during this critical time.

Infant Mortality is the death of a baby before their first birthday. The infant mortality rate is typically expressed as the number of deaths per 1,000 live births. This is a key indicator of the overall health of a population and is often used to measure the well-being of children in a society.

Infant mortality can be further categorized into neonatal mortality (death within the first 28 days of life) and postneonatal mortality (death after 28 days of life but before one year). The main causes of infant mortality vary by country and region, but generally include premature birth, low birth weight, congenital anomalies, sudden infant death syndrome (SIDS), and infectious diseases.

Reducing infant mortality is a major public health goal for many countries, and efforts to improve maternal and child health, access to quality healthcare, and socioeconomic conditions are crucial in achieving this goal.

Health status indicators are measures used to assess and monitor the health and well-being of a population. They provide information about various aspects of health, such as mortality rates, morbidity rates, prevalence of chronic diseases, lifestyle factors, environmental exposures, and access to healthcare services. These indicators can be used to identify trends and disparities in health outcomes, inform policy decisions, allocate resources, and evaluate the effectiveness of public health interventions. Examples of health status indicators include life expectancy, infant mortality rate, prevalence of diabetes, smoking rates, and access to primary care.

A registry in the context of medicine is a collection or database of standardized information about individuals who share a certain condition or attribute, such as a disease, treatment, exposure, or demographic group. These registries are used for various purposes, including:

* Monitoring and tracking the natural history of diseases and conditions
* Evaluating the safety and effectiveness of medical treatments and interventions
* Conducting research and generating hypotheses for further study
* Providing information to patients, clinicians, and researchers
* Informing public health policy and decision-making

Registries can be established for a wide range of purposes, including disease-specific registries (such as cancer or diabetes registries), procedure-specific registries (such as joint replacement or cardiac surgery registries), and population-based registries (such as birth defects or cancer registries). Data collected in registries may include demographic information, clinical data, laboratory results, treatment details, and outcomes.

Registries can be maintained by a variety of organizations, including hospitals, clinics, academic medical centers, professional societies, government agencies, and industry. Participation in registries is often voluntary, although some registries may require informed consent from participants. Data collected in registries are typically de-identified to protect the privacy of individuals.

Congenital heart defects (CHDs) are structural abnormalities in the heart that are present at birth. They can affect any part of the heart's structure, including the walls of the heart, the valves inside the heart, and the major blood vessels that lead to and from the heart.

Congenital heart defects can range from mild to severe and can cause various symptoms depending on the type and severity of the defect. Some common symptoms of CHDs include cyanosis (a bluish tint to the skin, lips, and fingernails), shortness of breath, fatigue, poor feeding, and slow growth in infants and children.

There are many different types of congenital heart defects, including:

1. Septal defects: These are holes in the walls that separate the four chambers of the heart. The two most common septal defects are atrial septal defect (ASD) and ventricular septal defect (VSD).
2. Valve abnormalities: These include narrowed or leaky valves, which can affect blood flow through the heart.
3. Obstruction defects: These occur when blood flow is blocked or restricted due to narrowing or absence of a part of the heart's structure. Examples include pulmonary stenosis and coarctation of the aorta.
4. Cyanotic heart defects: These cause a lack of oxygen in the blood, leading to cyanosis. Examples include tetralogy of Fallot and transposition of the great arteries.

The causes of congenital heart defects are not fully understood, but genetic factors and environmental influences during pregnancy may play a role. Some CHDs can be detected before birth through prenatal testing, while others may not be diagnosed until after birth or later in childhood. Treatment for CHDs may include medication, surgery, or other interventions to improve blood flow and oxygenation of the body's tissues.

The Predictive Value of Tests, specifically the Positive Predictive Value (PPV) and Negative Predictive Value (NPV), are measures used in diagnostic tests to determine the probability that a positive or negative test result is correct.

Positive Predictive Value (PPV) is the proportion of patients with a positive test result who actually have the disease. It is calculated as the number of true positives divided by the total number of positive results (true positives + false positives). A higher PPV indicates that a positive test result is more likely to be a true positive, and therefore the disease is more likely to be present.

Negative Predictive Value (NPV) is the proportion of patients with a negative test result who do not have the disease. It is calculated as the number of true negatives divided by the total number of negative results (true negatives + false negatives). A higher NPV indicates that a negative test result is more likely to be a true negative, and therefore the disease is less likely to be present.

The predictive value of tests depends on the prevalence of the disease in the population being tested, as well as the sensitivity and specificity of the test. A test with high sensitivity and specificity will generally have higher predictive values than a test with low sensitivity and specificity. However, even a highly sensitive and specific test can have low predictive values if the prevalence of the disease is low in the population being tested.

The term "Theoretical Models" is used in various scientific fields, including medicine, to describe a representation of a complex system or phenomenon. It is a simplified framework that explains how different components of the system interact with each other and how they contribute to the overall behavior of the system. Theoretical models are often used in medical research to understand and predict the outcomes of diseases, treatments, or public health interventions.

A theoretical model can take many forms, such as mathematical equations, computer simulations, or conceptual diagrams. It is based on a set of assumptions and hypotheses about the underlying mechanisms that drive the system. By manipulating these variables and observing the effects on the model's output, researchers can test their assumptions and generate new insights into the system's behavior.

Theoretical models are useful for medical research because they allow scientists to explore complex systems in a controlled and systematic way. They can help identify key drivers of disease or treatment outcomes, inform the design of clinical trials, and guide the development of new interventions. However, it is important to recognize that theoretical models are simplifications of reality and may not capture all the nuances and complexities of real-world systems. Therefore, they should be used in conjunction with other forms of evidence, such as experimental data and observational studies, to inform medical decision-making.

Coronary artery bypass surgery, also known as coronary artery bypass grafting (CABG), is a surgical procedure used to improve blood flow to the heart in patients with severe coronary artery disease. This condition occurs when the coronary arteries, which supply oxygen-rich blood to the heart muscle, become narrowed or blocked due to the buildup of fatty deposits, called plaques.

During CABG surgery, a healthy blood vessel from another part of the body is grafted, or attached, to the coronary artery, creating a new pathway for oxygen-rich blood to flow around the blocked or narrowed portion of the artery and reach the heart muscle. This bypass helps to restore normal blood flow and reduce the risk of angina (chest pain), shortness of breath, and other symptoms associated with coronary artery disease.

There are different types of CABG surgery, including traditional on-pump CABG, off-pump CABG, and minimally invasive CABG. The choice of procedure depends on various factors, such as the patient's overall health, the number and location of blocked arteries, and the presence of other medical conditions.

It is important to note that while CABG surgery can significantly improve symptoms and quality of life in patients with severe coronary artery disease, it does not cure the underlying condition. Lifestyle modifications, such as regular exercise, a healthy diet, smoking cessation, and medication therapy, are essential for long-term management and prevention of further progression of the disease.

Reproducibility of results in a medical context refers to the ability to obtain consistent and comparable findings when a particular experiment or study is repeated, either by the same researcher or by different researchers, following the same experimental protocol. It is an essential principle in scientific research that helps to ensure the validity and reliability of research findings.

In medical research, reproducibility of results is crucial for establishing the effectiveness and safety of new treatments, interventions, or diagnostic tools. It involves conducting well-designed studies with adequate sample sizes, appropriate statistical analyses, and transparent reporting of methods and findings to allow other researchers to replicate the study and confirm or refute the results.

The lack of reproducibility in medical research has become a significant concern in recent years, as several high-profile studies have failed to produce consistent findings when replicated by other researchers. This has led to increased scrutiny of research practices and a call for greater transparency, rigor, and standardization in the conduct and reporting of medical research.

In the field of medicine, "time factors" refer to the duration of symptoms or time elapsed since the onset of a medical condition, which can have significant implications for diagnosis and treatment. Understanding time factors is crucial in determining the progression of a disease, evaluating the effectiveness of treatments, and making critical decisions regarding patient care.

For example, in stroke management, "time is brain," meaning that rapid intervention within a specific time frame (usually within 4.5 hours) is essential to administering tissue plasminogen activator (tPA), a clot-busting drug that can minimize brain damage and improve patient outcomes. Similarly, in trauma care, the "golden hour" concept emphasizes the importance of providing definitive care within the first 60 minutes after injury to increase survival rates and reduce morbidity.

Time factors also play a role in monitoring the progression of chronic conditions like diabetes or heart disease, where regular follow-ups and assessments help determine appropriate treatment adjustments and prevent complications. In infectious diseases, time factors are crucial for initiating antibiotic therapy and identifying potential outbreaks to control their spread.

Overall, "time factors" encompass the significance of recognizing and acting promptly in various medical scenarios to optimize patient outcomes and provide effective care.

Hospitalization is the process of admitting a patient to a hospital for the purpose of receiving medical treatment, surgery, or other health care services. It involves staying in the hospital as an inpatient, typically under the care of doctors, nurses, and other healthcare professionals. The length of stay can vary depending on the individual's medical condition and the type of treatment required. Hospitalization may be necessary for a variety of reasons, such as to receive intensive care, to undergo diagnostic tests or procedures, to recover from surgery, or to manage chronic illnesses or injuries.

The "delivery of health care" refers to the process of providing medical services, treatments, and interventions to individuals in order to maintain, restore, or improve their health. This encompasses a wide range of activities, including:

1. Preventive care: Routine check-ups, screenings, immunizations, and counseling aimed at preventing illnesses or identifying them at an early stage.
2. Diagnostic services: Tests and procedures used to identify and understand medical conditions, such as laboratory tests, imaging studies, and biopsies.
3. Treatment interventions: Medical, surgical, or therapeutic treatments provided to manage acute or chronic health issues, including medications, surgeries, physical therapy, and psychotherapy.
4. Acute care services: Short-term medical interventions focused on addressing immediate health concerns, such as hospitalizations for infections, injuries, or complications from medical conditions.
5. Chronic care management: Long-term care and support provided to individuals with ongoing medical needs, such as those living with chronic diseases like diabetes, heart disease, or cancer.
6. Rehabilitation services: Programs designed to help patients recover from illnesses, injuries, or surgeries, focusing on restoring physical, cognitive, and emotional function.
7. End-of-life care: Palliative and hospice care provided to individuals facing terminal illnesses, with an emphasis on comfort, dignity, and quality of life.
8. Public health initiatives: Population-level interventions aimed at improving community health, such as disease prevention programs, health education campaigns, and environmental modifications.

The delivery of health care involves a complex network of healthcare professionals, institutions, and systems working together to ensure that patients receive the best possible care. This includes primary care physicians, specialists, nurses, allied health professionals, hospitals, clinics, long-term care facilities, and public health organizations. Effective communication, coordination, and collaboration among these stakeholders are essential for high-quality, patient-centered care.

  • Today, the Centers for Medicare & Medicaid Services (CMS) released Part I of the Contract Year (CY) 2022 Advance Notice of Methodological Changes for Medicare Advantage Capitation Rates and Part C and Part D Payment Policies (the Advance Notice), which contains key information about the Part C CMS-Hierarchical Condition Categories (HCC) risk adjustment model and the use of encounter data for CY 2022. (cms.gov)
  • Location: REMOTE Job Summary Analyzes and translates concurrent, prospective, and retrospective medical and clinical diagnoses, procedures, injuries, and illnesses into Medicare Risk Adjustment (MRA) ICD-10 codes and Hierarchical Condition Categories (HCCs). (employdiversity.com)
  • The Hierarchical Condition Categories (HCCs) model stands out as a cornerstone methodology in the complex world of risk adjustment. (gplmedicine.org)
  • The credit valuation adjustment ( CVA ) is currently calculated in financial institutions to measure counterparty credit risk ( CCR ) on over-the-counter derivatives. (risk.net)
  • This article presents a generic model for pricing financial derivatives subject to counterparty credit risk. (uni-muenchen.de)
  • Any bank below the materiality threshold may choose to set its CVA capital requirement equal to 100% of the bank's capital requirement for counterparty credit risk (CCR). (bis.org)
  • CMS calculates risk scores using diagnoses submitted by MA organizations and from Medicare fee-for-service (FFS) claims. (cms.gov)
  • Historically, CMS has used diagnoses submitted into CMS' Risk Adjustment Processing System (RAPS) by MA organizations for the purpose of calculating risk scores for payment. (cms.gov)
  • CMS began using diagnoses from encounter data to calculate risk scores for CY 2015, and has since continued to use a blend of encounter and RAPS data-based scores through 2021, when risk scores will be calculated with 75% encounter data and 25% RAPS data. (cms.gov)
  • With the proposed full phase-in of the 2020 CMS-HCC model, which is designed to calculate risk scores using diagnoses from encounter data submissions, the Part C risk score used for payment in 2022 would rely entirely on encounter data as the source of MA diagnoses. (cms.gov)
  • Also, for CY 2022, CMS is proposing to discontinue the policy (used for CY 2019, CY 2020, and CY 2021) of supplementing diagnoses from encounter data with diagnoses from inpatient records submitted to RAPS for calculating beneficiary risk scores. (cms.gov)
  • Our NLP platform also enables organizations to transform how they identify risk adjustable comorbid diagnoses by providing automated and semi-automated disease coding. (linguamatics.com)
  • Steve Young, managing director for HealthScape Advisors, also tells me reliable diagnoses, which will be key to prospective risk adjustment, usually only come through inpatient codes. (managedhealthcareexecutive.com)
  • In the complaint, Poehling alleged that UnitedHealth Group did a "one-way look" into patient records for undercoded diagnoses, but ignored upcoded and invalid claims, results that demonstrated diagnoses unsupported by medical records, and submitted false risk adjustment attestations. (luc.edu)
  • DOJ argued that UnitedHealth Group's failure to repay the risk adjustment payments after learning that the patient diagnoses codes were invalid and exaggerated was a violation of the False Claims Act. (luc.edu)
  • Because the information reported by physicians and other providers is at the heart of payment adjustments, health plans must engage providers by requesting copies of medical records that accurately reflect diagnoses and/or underlying health conditions to comply with risk adjustment program requirements. (cmadocs.org)
  • Health outcomes can be influenced by underlying patient-related risk factors. (ncqa.org)
  • The originally proposed approach for Chapter 4 was to solicit input from surgeons and IP nurses on the types of risk factors that should be examined. (ahrq.gov)
  • The crudeness of CMS's cost and quality measurement, and the high noise-to-signal ratio of the feedback to physicians such measurement guarantees, is due primarily to two intractable problems: CMS's inability to determine accurately which patients "belong" to which physicians (the attribution problem), and CMS's inability to adjust cost and quality scores for factors outside physician control (the risk adjustment problem). (thehealthcareblog.com)
  • Failure to take these factors into consideration could lead to an incomplete picture of a patient's health risks and possibly insufficient risk scores. (gplmedicine.org)
  • To address this issue, risk models must be improved to include socioeconomic factors, resulting in a more complete and precise evaluation of health hazards. (gplmedicine.org)
  • CVA risk is defined as the risk of losses arising from changing CVA values in response to changes in counterparty credit spreads and market risk factors that drive prices of derivative transactions and SFTs. (bis.org)
  • Finally, current research follows a more holistic understanding of academic success, focusing not only on students' achievement outcomes but also on their psychological adjustment (Makarova & Birman, 2016) and highlighting that not only risk but also resource factors are important determinants of individual resilience in the acculturation process (Castro & Murray, 2010). (eera-ecer.de)
  • In this vein, the present study aims to provide a more comprehensive understanding of the determinants of minority students' academic success, by analyzing family-related risk and resource factors that may affect their acculturation and school adjustment. (eera-ecer.de)
  • There are certain risk factors for high levels of distress in people with cancer. (cancer.gov)
  • Factors that increase the risk of anxiety and distress are not always related to the cancer. (cancer.gov)
  • To account for this increased susceptibility, ATSDR applies age-dependent adjustment factors (ADAFs) to its cancer risk equation for these contaminants. (cdc.gov)
  • Biomechanical risk factors for carpal tunnel syndrome: a pooled study of 2474 workers. (cdc.gov)
  • Objective: This analysis examined the associations between workplace biomechanical factors and incidence of dominant-hand CTS, adjusting for personal risk factors. (cdc.gov)
  • Nearly all of these studies were performed in populations made up predominantly of white men, even though associations between modifiable risk factors such as calcium intake and prostate cancer risk may differ by race. (cdc.gov)
  • 001 for trend) after adjustment for other major risk factors. (who.int)
  • However, risk factors that capture the degree models be improved. (who.int)
  • There are multiple methods for risk adjustment. (ncqa.org)
  • The project is reviewing the use of specific triggers and exchange methods and interoperability standards, and some FHIR resources to verify and facilitate documentation that supports risk adjustment, HCC models and version. (healthdatamanagement.com)
  • METHODS: We selected cases that had the greatest discrepancy between observed mortality and predicted probability of mortality from seven hospitals involved in validation of the DAVROS risk-adjustment model. (whiterose.ac.uk)
  • Instrument adjustments - often the gentlest methods of adjusting the spine. (wikipedia.org)
  • Similar to Medicare risk adjustment audits, the commercial risk adjustment program is designed to identify the health status and demographic characteristics of enrollees in non-grandfathered plans in the individual and small group markets to determine a risk score average. (cmadocs.org)
  • Specifically, per the 21st Century Cures Act, the 2020 model adds variables that count conditions in the risk adjustment model ("payment conditions") and includes for payment additional conditions for mental health, substance use disorder, and chronic kidney disease. (cms.gov)
  • This represents a change from the blend for 2021 of 75% of the risk score calculated using the 2020 CMS-HCC model and 25% of the risk score calculated using the older 2017 CMS-HCC model. (cms.gov)
  • There are five Measure Specific Tables, one for each risk-adjusted measure (please note, for HEDIS MY 2020 and 2021, there will be an additional table "RAU Table - PCR Medicaid" that provides the diagnosis code to clinical category mapping to be used for the risk adjustment calculations of the Plan All-Cause Readmissions (PCR) Medicaid product line ONLY). (ncqa.org)
  • 2020). On the other hand, dollar appreciation may amplify the adverse impact of global risk shocks in the rest of the world via a financial channel, as it deteriorates the net worth of borrowers that are subject to currency mismatches and thereby induces a tightening in global financial conditions (Bruno and Shin 2015, Jiang et al. (cepr.org)
  • Just as I was getting used to the 2020 V24 risk adjustment model , The Centers for Medicare and Medicaid Services (CMS) made some much-needed updates and released Version 28 for contract year 2024 . (hddaccess.com)
  • Before implementing the 2024 changes, the 2020 risk adjustment model used diagnosis codes from 2014 and costs from 2015. (hddaccess.com)
  • Completes assignments with an emphasis on completeness, accuracy, and supporting clinical care plans as it pertains to Risk Adjustment Data Validation (RADV) timelines. (employdiversity.com)
  • The height of Affordable Care Act Risk Adjustment Data Validation - Initial Validation Audit (ACA-RADV IVA) season is here. (bcbstx.com)
  • On Jan., CMS announced that it will seek to crack down on Medicare Advantage plans through changes to the risk adjustment data validation (RADV) program in a newly proposed rule. (flmedical.org)
  • The SIR and SUR metrics are calculated using the 2015 national baseline and risk adjustment methodology. (cdc.gov)
  • In this article, we conduct a critical analysis of the methodology patients into risk categories. (who.int)
  • New Mexico Health Connections, a small health insurer in the Mountain States region, is welcoming the move by the Centers for Medicare and Medicaid Services (CMS) to freeze the Affordable Care Act risk-adjustment program. (thinkadvisor.com)
  • The records requests are a result of the commercial risk adjustment program created by Section 1343 of the Affordable Care Act. (cmadocs.org)
  • A risk adjustment factor score (RAF score) refers to a medical risk adjustment model employed by the Centers for Medicare & Medicaid Services (CMS) to represent the status of a patient's health. (linguamatics.com)
  • The traditionally manual process involved in risk adjustment can be facilitated with standard protocols that help facilitate the communication of a patient's risk-adjusted conditions, which ensures more accurate assessment of conditions that should impact the cost of covering that patient under value-based contracts. (healthdatamanagement.com)
  • The goal for this implementation guide is to provide a standard for adopting and communicating risk-based coding gaps to better inform clinicians of opportunities to address patient's risk-adjusted conditions, and conversely, it will better enable payers to communicate risk-adjusted information to providers. (healthdatamanagement.com)
  • In essence, risk adjustment ensures a fair and just compensation model by matching financial incentives with the patient's actual health requirements. (gplmedicine.org)
  • Challenges in risk adjustment currently lies in the communication of potential missing risk adjustment data, which may be either done differently and sometime not at all by payers. (healthdatamanagement.com)
  • Our NLP also supports population health and risk stratification with publication grade accuracy . (linguamatics.com)
  • N-terminal B-type natriuretic peptide or troponin elevations, or the Background use of inotropes during admission, are much more powerful and Risk stratification and prediction is an integral part of clinical accurate predictors than admission to hospital alone. (who.int)
  • b Adjustment A, adjusted for potential confounders within each exposure group. (cdc.gov)
  • c Adjustment B, adjusted for other significant variables from all four exposure groups. (cdc.gov)
  • Estimates of exposure levels posing minimal risk to humans (MRLs) have been made, where data were believed reliable, for the most sensitive noncancer effect for each exposure duration. (cdc.gov)
  • In conclusion, this study adds to the body of evidence linking exposure to road traffic noise with higher risk of mortality. (lu.se)
  • Obamacare created the risk-adjustment program to discourage insurers from "cherry-picking" healthy enrollees. (pacificresearch.org)
  • To combat adverse selection, governments increasingly base payments to health plans and providers on enrollees' scores from risk-adjustment formulae. (aeaweb.org)
  • The program is supposed to use cash from health insurers that end up with relatively low-risk individual major medical and small-group enrollees to compensate insurers that end up with higher risk enrollees. (thinkadvisor.com)
  • If at the end of the annual risk adjustment assessment, Plan A has a lower-risk average score than Plan B, then Plan A has to issue a payment to Plan B. In a nutshell, the program is intended to prevent payors from cherry-picking only healthy enrollees. (cmadocs.org)
  • It is essential that healthcare organizations capture a complete picture of their patients in order to predict risk and outcomes accurately, to deliver effective and appropriate care. (linguamatics.com)
  • Evaluation of the DAVROS (Development And Validation of Risk-adjusted Outcomes for Systems of emergency care) risk-adjustment model as a quality indicator for healthcare. (whiterose.ac.uk)
  • The Development And Validation of Risk-adjusted Outcomes for Systems of emergency care (DAVROS) model predicts 7-day mortality in emergency medical admissions. (whiterose.ac.uk)
  • Addressing the impact of socioeconomic determinants on health outcomes is a unique challenge for risk adjustment. (gplmedicine.org)
  • Comorbidity-adjusted outcomes in longitudinal administrative data analyses may be biased by nonconstant risk over time, changes in completeness of coding, and between-hospital variations in coding. (nih.gov)
  • CMS says it will have to freeze the program temporarily because the U.S. District Court in New Mexico has blocked its ability to use its current risk-adjustment procedures. (thinkadvisor.com)
  • It validates the position that new and small local health plans are disproportionately disadvantaged by the current risk adjustment formula. (thinkadvisor.com)
  • New Mexico Health Connections said in its statement that the fact that the ACA risk-adjustment program is taking from smaller, poorer carriers in New Mexico and giving the cash to bigger, richer competitors shows that the ACA risk-adjustment program managers acted in an arbitrary and capricious fashion when they developed the current risk-adjustment formula. (thinkadvisor.com)
  • Ask the expert: Am I required to respond to medical record requests for commercial risk adjustment? (cmadocs.org)
  • Additionally, the commercial risk adjustment audits usually involve only a handful of patients per practice, but if the request is voluminous, practices may wish to contact the payor and request that it send a copy/scanner service out to the practice. (cmadocs.org)
  • For more information on the commercial risk adjustment program, click here . (cmadocs.org)
  • What girls know and perceive of BC risk and its psychosocial impact is unknown. (aacrjournals.org)
  • Parents/guardians completed surveys reporting on their daughters' psychosocial adjustment (PSA). (aacrjournals.org)
  • With healthcare now transitioning to value-based care, more payers are being reimbursed based on the healthcare needs of their patients, a practice known as risk adjustment. (healthdatamanagement.com)
  • Inaccurate or inconsistent documentation and coding can leave healthcare organizations exposed to much higher levels of financial risk. (linguamatics.com)
  • BACKGROUND AND OBJECTIVE: Risk-adjusted mortality rates can be used as a quality indicator if it is assumed that the discrepancy between predicted and actual mortality can be attributed to the quality of healthcare (ie, the model has attributional validity). (whiterose.ac.uk)
  • CONCLUSIONS: We found little evidence that deaths occurring in patients with a low predicted mortality from risk-adjustment could be attributed to the quality of healthcare provided. (whiterose.ac.uk)
  • Healthcare organizations will want to pay close attention to the 2024 risk adjustment updates. (hddaccess.com)
  • A basic component of modern healthcare, risk adjustment is essential to ensuring that healthcare professionals are paid fairly and accurately. (gplmedicine.org)
  • Healthcare risk adjustment is a complex process that involves altering payments in accordance with patient health. (gplmedicine.org)
  • Risk adjustment has a significant impact on patient care since it serves as a motivator for encouraging all-encompassing healthcare. (gplmedicine.org)
  • Risk adjustment enables healthcare providers to take a comprehensive approach to patient well-being by taking into consideration the complexity and severity of patients' diseases. (gplmedicine.org)
  • In 2019, Discovery Health published a risk adjustment model to determine standardised mortality rates across South African private hospital systems, with the aim of contributing towards quality improvement in the private healthcare sector. (who.int)
  • In response to feedback from health plans, vendors and other stakeholders, NCQA initiated the reformatting of the RAU tables to simplify the coding and calculation of risk adjustment, while also providing clear technical documentation for table use. (ncqa.org)
  • Currently, no FHIR implementation guide exists to standardize the format for the way in which risk-based coding gaps are communicated between payers and providers. (healthdatamanagement.com)
  • Understanding the recent changes and communicating effectively with your coders and physicians is critical to successfully documenting, coding, and paying for risk adjustment. (hddaccess.com)
  • Another significant difficulty in risk adjustment is the coding complexity linked to complex medical disorders. (gplmedicine.org)
  • Observational study to analyze trends in comorbidity coding in patients hospitalized for common primary diseases and the effects on comorbidity-related risk of in-hospital death. (nih.gov)
  • This self-paced Risk Adjustment Documentation & Coding Certification course is ideal for those who work best at their own pace. (findcourses.com)
  • When it comes to Risk Adjustment Coding courses, the nationally-recognized Registered Risk Adjustment Coder (RRC) credential is the certification that employers hold to a higher standard. (findcourses.com)
  • At MMI, we want to make sure that you have a successful learning experience, which is why in order to sign up for the Risk Adjustment Documentation and Coding (RRC) certification and training, you must have previous experience as a medical coder. (findcourses.com)
  • The nationally-recognized RRC Risk Adjustment Documentation and Coding certification training program is designed to prepare students to test for the Registered Risk Coder (RRC) certification exam through ARHCP. (findcourses.com)
  • Specifically, risk adjustment is designed to answer the question, "How would the performance of various units compare if hypothetically they had the same mix of patients? (ncqa.org)
  • Specifically, adjustments are intended to correct "vertebral subluxations", a non-scientific term given to the signs and symptoms that are said by chiropractors to result from abnormal alignment of vertebrae. (wikipedia.org)
  • Each year, insurers must send data to the Centers for Medicare and Medicaid Services about their premiums and their patient risk profiles in each state. (pacificresearch.org)
  • CMS crunches the data and uses an arbitrary, complex formula to decide how much each insurer must either pay in, or take out, of a risk-adjustment fund. (pacificresearch.org)
  • Formally, we follow a minimum relative entropy (MRE) approach to construct the counterfactual: we use the posterior distribution obtained from the Bayesian estimation to determine a counterfactual in which (a) the dollar does not respond to global risk shocks, but which (b) is otherwise as similar as possible to the model generating the data. (cepr.org)
  • Other sources that feed into the risk adjustment model can have data gaps, such as pharmacy data that might only code a single health issue associated with a particular prescription drug. (managedhealthcareexecutive.com)
  • While pharmacy data might be the only fallback in some states, because it's coded for payment, it lacks a more telling indicator of risk, such as a chronic condition, for example. (managedhealthcareexecutive.com)
  • Comprehensive, prospective data and adequate analysis of the modeling results will be key to accurate risk scores. (managedhealthcareexecutive.com)
  • Finance Director for UnitedHealth Group brought qui tam suit against UnitedHealth Group, Inc. alleging that the organization upcoded risk adjustment data resulting in increased payments (more than $1.14 billion ) to UnitedHealth Group. (luc.edu)
  • The holding in this case shields managed care providers from some degree of risk in attesting to their risk adjustment data. (luc.edu)
  • 3. From the perspective of the distribution of shares: we can find that in the weekly update of the "Dividend Assignment Adjustment of the Week" data, DAX30 has maintained a value of 0 for a long time. (vtmarkets.com)
  • MRLs include adjustments to reflect human variability from laboratory animal data to humans. (cdc.gov)
  • 2] A prediction model that and transparency of such risk adjustment models, and to widen uses a `history of coronary heart disease' as a risk factor to predict discussion on the strengths and limitations of risk adjustment models death from an acute myocardial infarction (AMI) is always going based on service claims data. (who.int)
  • Development and Assessment of a New Framework for Disease Surveillance, Prediction, and Risk Adjustment: The Diagnostic Items Classification System. (umassmed.edu)
  • So I re-iterate my plea to the key opinion leaders to put out stronger statements regarding the proper use of CAC as a risk prediction enhancer for preventive therapies and not the beginning of a downstream spiral of cardiac testing. (medscape.com)
  • When designing a risk prediction model, patient-proximate variables with a sound theoretical or proven association with the outcome of interest should be used. (who.int)
  • Performance could be further improved by using summary risk prediction scores such as the EUROSCORE II for coronary artery bypass graft surgery or the GRACE risk score for acute coronary syndrome. (who.int)
  • Accurate assessment of risk depends on providers and payers obtaining a complete and accurate picture of patients' acuity - it's critical to ensuring proper reimbursement, effective cost management for high-risk members, and delivering high quality care. (healthdatamanagement.com)
  • In order to appropriately depict the severity of illnesses and support a more nuanced risk assessment, this precision is essential. (gplmedicine.org)
  • This sensitivity to demographics ensures a more individualized and precise risk assessment. (gplmedicine.org)
  • In the multisite LEGACY Girls Study, 6-13 YO daughters and their parents/guardians from BC families (FH+) and families without BC (FH-) were recruited to examine early determinants of, and responses to BC risk. (aacrjournals.org)
  • Included in the course, is the Registered Risk Adjustment Coder (RRC) Exam and RRC Credential. (findcourses.com)
  • The observed-to-expected ratio reflects risk-adjusted performance, and shows whether a plan performed better, or worse, than expected, accounting for their unique case mix. (ncqa.org)
  • Risk adjustment, in its essence, is a complex procedure painstakingly created to take into account differences in patient health, ensuring that payment reflects the real degree of treatment required. (gplmedicine.org)
  • CVA reflects the adjustment of default risk-free prices of derivatives and securities financing transactions (SFTs) due to a potential default of the counterparty. (bis.org)
  • Chiropractic authors and researchers Meeker and Haldeman write that the core clinical method that all chiropractors agree upon is spinal manipulation, although chiropractors much prefer to use the term spinal "adjustment", a term which reflects "their belief in the therapeutic and health-enhancing effect of correcting spinal joint abnormalities. (wikipedia.org)
  • At a theoretical level, co-movement between the dollar and measures of global risk can be rationalized on the ground that some US assets are particularly safe and/or liquid (Farhi and Gabaix 2016, Bianchi et al. (cepr.org)
  • The diagram below illustrates how they used NLP to maintain risk scores for family members, and to submit reimbursement claims to CMS. (linguamatics.com)
  • Both unilateral and bilateral types of credit risks are considered. (uni-muenchen.de)
  • The report, released on September 24, said the turbulence represents the first significant test of innovative financial instruments and markets used to distribute credit risks through the global financial system, with markets recognizing the extent that credit discipline has deteriorated in recent years. (imf.org)
  • In reality, aggressive risk adjustment practices in Medicare Advantage (MA) are delivering bigger payments than bonuses for high-quality coverage and care. (achp.org)
  • Over the past few months, the California Medical Association (CMA) has received several calls from practices who had received requests for medical records from various payors stating the records are needed for "risk adjustment. (cmadocs.org)
  • Normal adjustment issues. (cancer.gov)
  • Normal adjustment-A condition in which a person makes changes in his or her life to manage a stressful event such as a cancer diagnosis. (cancer.gov)
  • In normal adjustment, a person learns to cope well with emotional distress and solve problems related to cancer. (cancer.gov)
  • In early July, the Trump administration announced that it would suspend $10 billion in transfer payments to insurers after a federal court ruled that Obamacare's "risk-adjustment" program was flawed. (pacificresearch.org)
  • But just over two weeks later, after a backlash from insurers and Democrats, the administration reversed course and agreed to reinstate the risk-adjustment program. (pacificresearch.org)
  • The risk-adjustment program has failed to spur competition among insurers and hold down premiums - two of its primary goals. (pacificresearch.org)
  • Health Connections claims the government's risk adjustment formula " penalizes insurers who keep premiums low through efficiency and innovation . (pacificresearch.org)
  • Our study shows that credit risk should be modeled as American style options in most cases, which require a backward induction valuation. (uni-muenchen.de)
  • This chapter sets out how to calculate capital requirements to cover credit valuation adjustment risk. (bis.org)
  • In the context of this document, CVA stands for credit valuation adjustment specified at a counterparty level. (bis.org)
  • It recognizes that, although all students need to develop resilience capacities in the face of educational challenges, there are additional risks for immigrant students, such as linguistic and cultural differences. (eera-ecer.de)
  • Accurate risk adjustment leads to more appropriate preventative care initiated to ensure the most cost-efficient care can be delivered. (linguamatics.com)
  • I recently spoke to John Steele, managing partner for HealthScape Advisors, and he cautions that plan revenue increasingly will be driven by risk adjustment, which will depend on the ability to obtain current, accurate and complete diagnostic information as early as possible. (managedhealthcareexecutive.com)
  • The Da Vinci Project has started work on a new standard to facilitate information sharing in this area - that will help alleviate provider burden in dealing with potential missing gaps and assist payers by standardizing how risk adjustment gaps are communicated for patients. (healthdatamanagement.com)
  • Research into the impact of acculturation gaps on family adjustment (Birman 2006a, p. 568) highlights that acculturation gaps between parents and children were associated with greater family discord. (eera-ecer.de)
  • 2021). Global risk shocks are incidents that are associated with an increase in the demand for safe and liquid assets. (cepr.org)
  • The COVAX facility was developed to support equitable access to COVID-19 vaccines globally with the aim of targeting 20% coverage in all countries prioritizing high-risk populations by the end of 2021. (who.int)
  • Adjustment disorders. (cancer.gov)
  • Adjustment disorders are a reaction to stress. (uhhospitals.org)
  • Adjustment disorders happen at all ages and are quite common in children and teens. (uhhospitals.org)
  • In all adjustment disorders, the reaction to the stressor seems to be more than what is thought to be normal. (uhhospitals.org)
  • Now that the risk-adjustment program has been reinstated, New Mexico Health Connections will retroactively owe another $5.6 million in payments for 2017. (pacificresearch.org)
  • High-quality health plans that meet consumers' needs should be rewarded over plans that prioritize chasing risk adjustment revenue. (achp.org)
  • As risk selection diminishes under health reform, risk adjustment is now becoming a superior tool in a health plan's toolbox. (managedhealthcareexecutive.com)
  • He says the experience period for encounter and health status information for the initial risk adjustments could start in the middle of 2012. (managedhealthcareexecutive.com)
  • The use of severity-of-illness measures, such as age, to estimate the risk (measurable or predictable chance of loss, injury or death) to which a patient is subject before receiving some health care intervention. (umassmed.edu)
  • Risk Adjustment And Health Equity. (umassmed.edu)
  • Risk adjustment in Home Health Care CAHPS. (umassmed.edu)
  • New Mexico Health Connections said Monday that a new CMS risk-adjustment program report shows that, in New Mexico, the program is doing more harm than good. (thinkadvisor.com)
  • The court ruling that led to the risk-adjustment program freeze "is good for small insurance companies and innovative, low-cost insurance companies, and therefore to anyone who purchases health insurance," the carrier said. (thinkadvisor.com)
  • The freeze ruling "will lead to a much fairer risk-adjustment formula for all health plans," the carrier said. (thinkadvisor.com)
  • Symptoms of an adjustment disorder can look like other health problems or mental illnesses. (uhhospitals.org)
  • Both HIPAA and California's Confidentiality of Medical Information Act permit disclosures of protected health information to third-party payors for treatment and payment purposes without patient authorization, including to plans for risk adjustment purposes. (cmadocs.org)
  • Estimates of levels posing minimal risk to humans (Minimal Risk Levels, MRLs) may be of interest to health professionals and citizens alike. (cdc.gov)
  • Further, limited or incorrect use of face masks and general COVID-19 fatigue led to reduced adherence to public health and social measures, complacency and decreased risk perception to COVID-19 which poses an ongoing threat to citizens1. (who.int)
  • NCQA publishes two types of RAU tables: the Shared Table, which provides the logic for mapping diagnosis codes into clinical categories and applies across risk-adjusted measures, and the Measure Specific Tables, which provide the measure-specific risk weights used to calculate expected values as described in the measure specification. (ncqa.org)
  • Many payer and provider organizations are challenged with comprehensively and accurately identifying and documenting risk-adjusted conditions. (linguamatics.com)
  • This adjustment allows comparison of performance and quality across organizations, practitioners, and communities. (umassmed.edu)
  • Risk adjustment payments protect organizations from the risk inherent in treating "sicker" patients. (luc.edu)
  • An adjustment disorder is an unhealthy emotional or behavioral reaction to a stressful event or change in a person's life. (uhhospitals.org)
  • Inaccurate risk adjustment can cause inadequate payment to payers that don't have enough information to understand and substantiate patients' true condition and cost of care. (healthdatamanagement.com)
  • Benjamin Poehling v. UnitedHealth Group, Inc., Michael Poehling, a finance Director at UnitedHealth Group, alleged that the Medicare Advantage Insurer made patients look sicker than they were to increase risk adjustment payments and get increased payments from Medicare. (luc.edu)
  • In patients hospitalized for heart failure, shifts of comorbidity-related risk of in-hospital death occurred in nine diagnosis groups, in which eight groups were directed toward the null. (nih.gov)
  • TM patients are at risk of psychiatric symptoms and need appropriate psychiatric counselling. (who.int)
  • RÉSUMÉ La présente étude vise à examiner la qualité de vie de patients atteints de thalassémie majeure en fonction de l'âge, du sexe, des résultats scolaires, et de la gravité et des complications de la maladie. (who.int)
  • This column examines the effects of global risk shocks and the dollar's role in the international adjustment to such shocks, finding that appreciation of the dollar amplifies the adverse effect of global risk shocks considerably. (cepr.org)
  • But what are the consequences of the dollar's dominance for the international adjustment to global risk shocks? (cepr.org)
  • In a new paper, we shed light on this question as we identify global risk shocks and trace out their effect on the global economy, with a focus on the dollar (Georgiadis et al. (cepr.org)
  • We identify global risk shocks using intra-daily changes in the price of gold - the ultimate safe asset - as recorded on narratively selected dates related to global risk events as an external instrument (Piffer and Podstawski 2018, Engel and Wu 2018, Ludvigson et al. (cepr.org)
  • We find that although global risk shocks cause a contraction of economic activity that is highly synchronised in the US and the rest of the world, they cause a strong appreciation of the dollar. (cepr.org)
  • We also document that global risk shocks induce flight-to-safety effects as foreign holdings of US Treasury securities increase, an uptick in the US Treasury premium, an increase in the dollar liquidity buffers of banks, and an increase in the share of dollar-denominated international debt issuance. (cepr.org)
  • We then investigate how the dollar shapes the transmission of global risk shocks, especially the contraction of economic activity outside of the US. (cepr.org)
  • On the one hand, appreciation of the dollar dampens the adverse impact of global risk shocks in the rest of the world via a trade channel, as it induces expenditure switching from the US towards the rest of the world (Obstfeld and Rogoff 1995, Gopinath et al. (cepr.org)
  • Indeed, we find that global risk shocks that appreciate the dollar are followed by a decline in US net exports and a broad-based tightening in global financial conditions reflected, in particular, in a contraction in cross-border bank credit. (cepr.org)
  • But this doesn't tell us whether the dollar appreciation overall dampens or amplifies the effects of global risk shocks outside of the US. (cepr.org)
  • A techique for simulating the impact of shocks on the costs of external indebtedness and the response of fiscal policies in adjustment to such shocks is presented and applied to thirteen indebted Latin American countries. (iadb.org)
  • Certainly, plans with less risk will be paid less. (managedhealthcareexecutive.com)
  • Plans will have 18 months to model for risk in the insurance exchanges that launch in 2014. (managedhealthcareexecutive.com)
  • Medicare Advantage plans that are doing fairly well with their risk adjustment still need to rethink their approaches for the exchange market, Steele says. (managedhealthcareexecutive.com)
  • In 2004, Medicare began to risk-adjust capitation payments to private Medicare Advantage (MA) plans to reduce selection-driven overpayments. (aeaweb.org)
  • Indeed, after risk adjustment, MA plans enrolled individuals with higher scores but lower costs conditional on their score. (aeaweb.org)
  • The primary goal of the risk adjustment program is to spread the financial risk borne by payors more evenly in order to stabilize premiums and provide issuers the ability to offer a variety of plans to meet the needs of a diverse population. (cmadocs.org)
  • risk of complications of influenza, regardless of duration of illness. (cdc.gov)
  • The CY 2022 Advance Notice is being published in two parts due to requirements in the 21st Century Cures Act that mandate certain changes to Part C risk adjustment and a 60-day comment period for these changes. (cms.gov)
  • The Department of Justice (DOJ) intervened in the case, yet UnitedHealth Group was successful in getting the primary False Claims Act Claims dismissed by arguing that the Centers for Medicare & Medicaid Services (CMS) would not have refused to make the adjustment payments had they known of the errors in the risk adjustment. (luc.edu)
  • But the administration's detractors don't understand how Obamacare's risk-adjustment program works - or, more appropriately, doesn't work. (pacificresearch.org)
  • The risk-adjustment program was supposed to compensate the "losers" in Obamacare's exchanges - those who spent a lot of money covering the care of sick individuals. (pacificresearch.org)
  • Although the risk adjustment program is a requirement on the payor, payors typically require their contracting physicians to comply with the risk adjustment medical record requests. (cmadocs.org)
  • It will attract more insurance companies because the risk adjustment will be more predictable and will no longer penalize newer, lower-cost insurance companies with innovative approaches to delivering better and more affordable care. (thinkadvisor.com)
  • In the HCCs model, the severity of chronic illnesses becomes crucial in determining risk scores. (gplmedicine.org)
  • 6 - 8 ] For example, when women with high levels of anxiety learn that they have a genetically higher risk of developing breast cancer than they had previously believed, they might perform breast self-examination less frequently. (cancer.gov)
  • Adjustment disorder with anxiety. (uhhospitals.org)
  • Following the eco-developmental framework of human development (Bronfenbrenner, 1977), the contextual approach of acculturation research suggests that the relationship between acculturation and adjustment is shaped by the surrounding context (Birman & Simon, 2014). (eera-ecer.de)
  • We aimed to test this assumption by evaluating the attributional validity of the DAVROS risk-adjustment model. (whiterose.ac.uk)
  • Failure of the model to appropriately predict risk was judged to be responsible for 135/179 (75%) of the unexpected deaths and 2/53 (4%) of the unexpected survivors. (whiterose.ac.uk)
  • Several changes to the 2024 risk adjustment model (RA model) are worth noting. (hddaccess.com)
  • As more SA private sector medical to be inferior to a model that uses `current admission to hospital for funders explore their use, it is important that the quality of the AMI' as a risk factor. (who.int)
  • Many parents discuss familial and genetic risk of breast cancer (BC) with offspring. (aacrjournals.org)
  • Mothers and daughters 10-13 YO completed surveys reporting their PSA and perceptions of breast cancer risk. (aacrjournals.org)
  • Lerman C, Kash K, Stefanek M: Younger women at increased risk for breast cancer: perceived risk, psychological well-being, and surveillance behavior. (cancer.gov)
  • The objective of this study was to examine the association between calcium intake and prostate cancer risk. (cdc.gov)
  • We hypothesized that calcium intake would be positively associated with lower risk for prostate cancer. (cdc.gov)
  • Total calcium was associated with lower prostate cancer risk among black men but not among white men in analyses of healthy controls. (cdc.gov)
  • Calcium from food is associated with lower risk for prostate cancer, particularly among black men, and lower risk for high-grade prostate cancer among all men. (cdc.gov)
  • it has been hypothesized that dietary calcium may increase prostate cancer risk by reducing circulating levels of 1,25-dihydroxyvitamin D (1,25[OH] 2 D) (10), which promotes the differentiation and inhibits the proliferation of prostate cells (11). (cdc.gov)
  • The objective of this study was to examine the relationship between calcium intake and prostate cancer risk and determine whether this association is different for blacks and whites or for low-grade and high-grade disease. (cdc.gov)
  • For Risk Adjustment the rules of documentation change and I want to make sure this is considered to be proper documentation. (aapc.com)
  • This summer, NCQA reformatted its Risk Adjustment Utilization (RAU) Tables and developed a supplemental user manual to provide technical documentation for the tables. (ncqa.org)
  • Despite anecdotal success, there is no scientific evidence that spinal adjustment is effective against disease. (wikipedia.org)
  • These models are the source of the risk weights found in NCQA's Risk Adjusted Utilization (RAU) tables. (ncqa.org)
  • Including these aspects in risk adjustment models necessitates a sophisticated and thorough strategy. (gplmedicine.org)
  • How Does Risk Selection Respond to Risk Adjustment? (aeaweb.org)

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