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35 results on '"Turenne, Marc N."'

3. Persistent Variation in Medicare Payment Authorization for Home Hemodialysis Treatments

Author

Wilk, Adam S., Hirth, Richard A., Zhang, Wei, Wheeler, John R.C., Turenne, Marc N., Nahra, Tammie A., Sleeman, Kathryn K., and Messana, Joseph M.

Subjects
United States. Centers for Medicare and Medicaid Services -- Health policy, Electronic records -- Usage, Medicare -- Information management, Prospective payment systems (Medical care) -- Information management, Health insurance -- Information management, Company systems management, Business, Health care industry
Abstract

Objective. To analyze variation in medical care use attributable to Medicare's decentralized claims adjudication process as exemplified in home hemodialysis (HHD) therapy. Data Sources/Study Setting. Secondary data analysis using 2009-2012 paid Medicare claims for HHD and in-center hemodialysis (IHD). Study Design. We compared variation across Medicare administrative contractors (MACs) in predicted paid treatments per standardized patient-month for HHD and IHD patients. We used ordinary least-squares regression to determine whether higher paid HHD treatment counts expanded HHD programs' presence among dialysis facilities. Data Collection. We identified HHD and IHD treatments using procedure, revenue center, and claim condition codes on type 72x claims. Principal Findings. MACs varied persistently in predicted HHD treatments per patient-month, ranging from 14.3 to 21.9 treatments versus 10.9 to 12.4 IHD treatments. The presence of facilities' HHD programs was uncorrelated with average HHD payment counts. Conclusions. Medicare's claims adjudication process promotes variation in medical care use, as we observe among HHD patients. MACs' discretionary decision making, while potentially facilitating innovation, may admit inefficiency in care practice as well as inequitable access to health care services. Regulators should weigh the benefits of flexibility in local coverage decisions against those of national standards for medical necessity. Key Words. Variation, Medicare, dialysis, It is a basic assumption of much of the geographic variation literature that Medicare beneficiaries have coverage for the same set of services if they receive care in Alaska or [...]

Published
2018
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12. Does quality influence consumer choice of nursing home to nursing home transfers

Author

Hirth, Richard A., Banaszak-Holl, Jane C, Fries, Brant E., and Turenne, Marc N.

Subjects
Consumer behavior -- Influence, Nursing homes -- Quality management
Abstract

Nursing home residents and their proxies respond to quality of care by changing providers, Cox proportional hazards models were estimated using assessment data from the Minimum Data Set. The results provide some reassurance that consumers (or their proxies) reward quality in the market, and that changing care needs may initiate a search for alternative care.

Published
2003

16. Predictors of type of vascular access in hemodialysis patients

Author

Hirth, Richard A., Turenne, Marc N., Woods, John D., Young, Eric W., Port, Friedrich K., Pauly, Mark V., and Held, Philip J.

Subjects
Hemodialysis -- Methods, Blood vessels, Fistula, Arteriovenous -- Usage
Abstract

Many surgeons appear to be moving away from using an arteriovenous fistula in favor of synthetic grafts to create access for hemodialysis in patients with kidney disease. This was seen in a sample of 2,741 patients who began hemodialysis in 1986-1987 and 1,409 who began in 1990. In 1986-1987, 51% received a graft and this percentage rose to 65% in 1990. There were wide regional variations in the use of a graft, from a low in New England to a high in the East South Central region. Women were more likely to receive a graft, as were the elderly, and those with diabetes, obesity and peripheral vascular disease., Objective.---Complications from vascular access account for 15% of hospital admissions among US hemodialysis patients. Complications are less frequent with arteriovenous fistulas than with synthetic grafts. We assessed clinical and nonclinical predictors of whether patients with end-stage renal disease (ESRD) starting hemodialysis receive a fistula or graft, We also investigated changes in practice between 1986-1987 and 1990. Design.---Cross-sectional study. Setting.--United States hemodialysis population. Patients.--Random, national samples of ESRD patients who started hemodialysis in 1986-1987 (n=2741) or 1990 (n=1409) from United States Renal Data System Special Studies. Main Outcome Measure.--Type of permanent vascular access (arteriovenous fistula vs synthetic graft), analyzed using multivariate logistic regression. Results. Clinical and demographic factors as well as socioeconomic status, region of residence, and year starting hemodialysis predicted the type of vascular access. Overall, 56% of patients had grafts 30 days after starting dialysis, but graft use increased from 51% in 1986-1987 to 65% in 1990 (adjusted odds ratio [AOR], 1.67 for 1990 vs 1986-1987; 95% confidence interval [CI], 1.43-1.95; P Conclusions.--This national study documents large variations in the relative use of fistulas and grafts and a trend away from fistulas. The prevalence of comorbid conditions fails to explain these findings. Presentation and referral of patients early in the process of their ESRD, teaching surgeons to place fistulas, and training dialysis nurses to access fistulas may increase their use. JAMA. 1996;276:1303-1308

Published
1996

28. Introduction

Author

Held, Philip J., primary, Port, Friedrich K., additional, Webb, Randall L., additional, Wolfe, Robert A., additional, Bloembergen, Wendy E., additional, Turenne, Marc N., additional, Holzman, Elizabeth, additional, Ojo, Akinlolu O., additional, Young, Eric W., additional, Mauger, Elizabeth A., additional, Tedeschi, Philip J., additional, Stannard, David C., additional, Strawderman, Robert L., additional, Carroll, Caitlin E., additional, Levine, Gregory N., additional, Wood, Corbin L., additional, Smith, Dora A., additional, Jones, Camille A., additional, Greer, Joel W., additional, Hill, Daniel J., additional, Ketz, Lord-Anthony D., additional, and Agodoa, Lawrence Y.C., additional

Published
1995
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34. Part B: Outcomes With ESRD Therapy: A Critical Overview from The United States.

Author

Jacobs, C., Kjellstrand, C. M., Koch, K. M., Winchester, J. F., Port, Friedrich K., Turenne, Marc N., and Held, Philip J.

Abstract

Patient survival is a very basic but important outcome of any therapeutic intervention. In the case of end stage renal disease (ESRD), outcome studies have included several other outcomes such as quality of life indicators, morbidity measures (e.g., hospitalizations), length of time on a treatment modality (‘technique survival') and survival with a functioning kidney allograft (graft survival). The establishment of regional and national registries has markedly facilitated the evaluation of these outcomes in actual practice rather than in the referral practice or related multicenter environment. This chapter will focus primarily on population-based patient survival studies using information from the United States Renal Data System (USRDS) and the Michigan Kidney Registry [ABSTRACT FROM AUTHOR]

Published
1996
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35. Introduction

Author

Held, Philip J., Port, Friedrich K., Webb, Randall L., Wolfe, Robert A., Bloembergen, Wendy E., Turenne, Marc N., Hirth, Richard, Young, Eric W., Ojo, Akinlolu 0., Strawderman, Robert L., Woods, John D., Tedeschi, Philip J., Carroll, Caitlin E., Hulbert-Shearon, Tempie, Zhang, Qingling, Levine, Gregory N., Hatcher, Dawn, Jones, Camille A., Greer, Joel W., and Agodoa, Lawrence Y.C.

Published
1996
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