No abstract available.
Medicare*

No abstract available.
Medicare*

No abstract available.
Insurance, Health* ; Medicare*

The purposes of this study were 1) to review the Medical Nutrition Therapy (MNT) Act of the United States, 2) to introduce the efforts of the American Dietetic Association (ADA) to expand the Medicare coverage for MNT and 3) to provide information about the reimbursement under Medicare Part B for the cost of MNT. The MNT Act defined MNT services as "the nutritional diagnostic, therapeutic, and counseling services provided by a Registered Dietitian or nutritional professional for the purpose of managing diabetes or renal diseases". Also, the MNT Act defined "conditions for coverage of MNT", "limitations on coverage of MNT", and "qualifications of MNT service provider". To expand the coverage of Medicare to include MNT, the ADA realized the need for development of a protocol for MNT, as well as studies to evaluate the effectiveness and cost-effectiveness of the MNT protocol developed. Therfore, the ADA supported the studies to develop a strong database of scientific investigations of nutritional services. Furthermore, the ADA needed credible data that could be used by policy makers, so the ADA contracted with the Lewin Group to carry out the study to gather the additional data needed to strengthen the ADA's position. In the report of the Lewin Group, which was entitled, "The Cost of Covering Medical Nutrition Therapy under Medicare: 1998 through 2004", it was concluded, that if coverage for MNT in the Part B portion of Medicare had begun in 1998, by 2004, approximately $ 2.3 billion would have been saved through reduced hospital spending under Part A of Medicare ($ 1.2 billion) and reduced physician visits under Part B ($ 1.1 billion). Effective January 1 2002, the US Congress extended Medicare coverage to include MNT to beneficiaries with diabetes or renal diseases. The Centers for Medicare and Medicaid Services (CMS) established the duration and frequency for the MNT based on published reports or generally accepted protocols (for example, protocols suggested by the ADA). The number of hours covered by Medicare is 3 hours for the initial MNT and 2 hours for a follow-up MNT. In 2002, a Medicare coverage policy was made to define the Physician's Current Procedural Terminology (CPT) codes 97802, 97803, and 97804 for MNT.
Administrative Personnel ; Centers for Medicare and Medicaid Services (U.S.) ; Counseling ; Current Procedural Terminology ; Follow-Up Studies ; Humans ; Medicare Part B ; Medicare* ; Nutrition Therapy* ; Nutritionists ; United States

OBJECTIVE: To provide medicare services for patients demands satisfyingly, immediate introduction of the Customer Relationship Management(CRM) is raised inevitable. In this paper we proposed that the minimizing the hospital losses by cut down the rate of cancelation of the hospital reservation, to secure patients as clients. METHODS: And to implement the data mining-based healthcare customer relationship management system applied from the back propagation algorithm of the artificial neural networks technique and the Feature GENeration(FGEN) algorithm of the decision tree technique. RESULTS: In this paper we divided a patient to an appropriate group through a data mining process and classified more correct customer through a campaign process. CONCLUSION: These results would be essential for new patients to enhance hospital reliability, for hospital to select profitable patients with high loyalty and to manage patients efficiently.
Data Mining* ; Decision Trees ; Delivery of Health Care* ; Humans ; Medicare

PURPOSE: To assess real-world treatment patterns, health care utilization, costs, and survival among Medicare enrollees with locally advanced/unresectable or metastatic gastric cancer receiving standard first-line chemotherapy. MATERIALS AND METHODS: This was a retrospective analysis of the Surveillance, Epidemiology, and End Results-Medicare linked database (2000~2009). The inclusion criteria were as follows: (1) first diagnosed with locally advanced/unresectable or metastatic gastric cancer between July 1, 2000 and December 31, 2007 (first diagnosis defined the index date); (2) > or =65 years of age at index; (3) continuously enrolled in Medicare Part A and B from 6 months before index through the end of follow-up, defined by death or the database end date (December 31, 2009), whichever occurred first; and (4) received first-line treatment with fluoropyrimidine and/or a platinum chemo-therapy agent. RESULTS: In total, 2,583 patients met the inclusion criteria. The mean age at index was 74.8+/-6.0 years. Over 90% of patients died during follow-up, with a median survival of 361 days for the overall post-index period and 167 days for the period after the completion of first-line chemotherapy. The mean total gastric cancer-related cost per patient over the entire post-index follow-up period was United States dollar (USD) 70,808+/-56,620. Following the completion of first-line chemotherapy, patients receiving further cancer-directed treatment had USD 25,216 additional disease-related costs versus patients receiving supportive care only (P<0.001). CONCLUSIONS: The economic burden of advanced gastric cancer is substantial. Extrapolating based on published incidence estimates and staging distributions, the estimated total disease-related lifetime cost to Medicare for the roughly 22,200 patients expected to be diagnosed with this disease in 2014 approaches USD 300 millions.
Aged* ; Delivery of Health Care ; Diagnosis ; Drug Therapy ; Epidemiology ; Follow-Up Studies ; Humans ; Incidence ; Medicare ; Medicare Part A ; Platinum ; Retrospective Studies ; Stomach Neoplasms* ; United States

PURPOSE: This study was to provide understanding of the meaning of the transition experiences in pregnancy and childbirth among the married immigrant women. METHODS: Data was collected through a face-to-face interview from 11 married immigrant women. Their conjugal lives were followed using the hermeneutics phenomenological method developed by van Manen: focusing on the meaning of lived experience. RESULTS: The essential themes that were associated with the transition experiences of the participants' lives during pregnancy and childbirth were as follows: "entering a strange world filled with chaos and tension where they feel like outsiders", "being pregnant and giving birth in increasingly difficult times", "giving birth to a child, which strengthens them to persevere through painful life experiences", "receiving greater support from their families". CONCLUSION: It contributes a deeper understanding of the essence of the transition experiences of married immigrant women who undergo pregnancy and childbirth after immigration. On the basis of this understanding, this study would be likely to highlight the importance of establishing an appropriate health and medicare systems and the expert network of nursing care for immigrant wom.
Child ; Emigrants and Immigrants ; Emigration and Immigration ; Female ; Humans ; Korea ; Medicare ; Nursing Care ; Parturition ; Pregnancy

BACKGROUND AND OBJECTIVES: The incidence and prevalence of hyperthyroidism has been reported to be 0.2-0.9/1000 population/year and 5-10/1000 population in foreign countries, respectively. However, there has been no nationwide survey to evaluate them in Korea. Therefore, this study was conducted to investigate the incidence and prevalence of hyperthyroidism in Korea using medicare claims data provided by the Health Insurance Review and Assessment Service. Preference for its therapeutic modalities and its change were also analyzed. MATERIALS AND METHODS: This study was performed in 308,584 (men 86,460, women 222,124) Korean patients with hyperthyroidism treated from January 2006 to June 2012. Patients with past history of hyperthyroidism were not included. RESULTS: The incidence of hyperthyroidism was 0.72/1000 population/year (men 0.40, women 1.03), and its prevalence was 3.40/1000 population (men 2.09, women 4.70) in Korea. Its peak prevalence was detected between 45 and 49 years of age. Among 177,487 patients with hyperthyroidism treated from 2007 to 2011, anti-thyroid drugs were prescribed in 97.9%, and radioiodine therapy and surgery were finally performed in 8.2% and 0.9%, respectively. The prescription of propylthiouracil (PTU) has been reduced from 63.3% in 2007 to 42.9% in 2011, but the use of methimazole (MMI) increased from 33.9% in 2007 to 54.8% in 2011. Primary physicians preferred PTU to MMI, but physicians in general hospitals preferred MMI to PTU. CONCLUSION: This is the first nationwide report to investigate the incidence and prevalence of hyperthyroidism in Korea.
Female ; Hospitals, General ; Humans ; Hyperthyroidism ; Incidence ; Insurance, Health ; Korea ; Medicare ; Methimazole ; Prescriptions ; Prevalence ; Propylthiouracil

PURPOSE: The purpose of this study is to examine factors influencing medication adherence in patients with hypertension. METHODS: This study carried out a secondary analysis of data from the 2008 Korean National Health and Nutrition Examination Survey (KNHANES). Stratified sampling was used to select a participant sample that was representative of patients with hypertension throughout the country. Using the SPSS/WIN 18.0 program, data were analyzed using descriptive statistics, chi2 test, t-test, and logistic regression. RESULTS: Of the patients with hypertension, 8.8% had showed non-adherence to medication. Medication adherence was associated with age, spouse, Medicare insurance, number of other diseases, and current smoking status. The cases with older age, a spouse, Medicare insurance, higher number of other diseases, and no current smoking status showed significantly high medication adherence. CONCLUSION: Nursing interventions and further studies are needed to achieve high levels of medication adherence based on factors influencing medication adherence such as age, spouse, Medicare insurance, number of other disease, and current smoking status.
Humans ; Hypertension* ; Insurance ; Logistic Models ; Medicare ; Medication Adherence* ; Nursing ; Nutrition Surveys* ; Smoke ; Smoking ; Spouses

OBJECTIVES: The drug utilization review (DUR) system, which checks any conflict event of medications, contributes to improve patient safety. One of the important barriers in its adoption is doctors' resistance. This study aimed to analyze the impacts of doctors' resistance on the success of the DUR system. METHODS: This study adopted an augmented the DeLone and McLean Information System (D&M IS) Success Model (2003), which used doctors' resistance as a socio-technological measure. This study framework is the same as that of the D&M IS Success Model in that it is based on qualities, such as system, information, and services. The major difference is that this study excluded the variable 'use' because it was not statistically significant for mandatory systems. A survey of doctors who used computers to enter prescriptions was conducted at a Korean tertiary hospital in February 2012. RESULTS: This study is very meaningful in that it is the first study to explore the success factors of the DUR system associated with doctors' resistance. Doctors' resistance to the DUR system was not statistically associated with user usefulness, whereas it affected user satisfaction. CONCLUSIONS: The results indicate that doctors still complain of discomfort in using the DUR system in the outpatient clinical setting, even though they admit that it contributes to patient safety. To mitigate doctors' resistance and raise user satisfaction, more opinions from doctors regarding the DUR system have to be considered and have to be reflected in the system.
Drug Utilization Review* ; Humans ; Information Systems ; Medicare Assignment ; Outpatients ; Patient Safety ; Prescriptions ; Tertiary Care Centers