ABSTRACT
By obtaining a Medicaid waiver under Section 1115 of the Social Security Act, many states have taken advantage of an opportunity to innovate and transform their Medicaid programs. The Center for Medicare and Medicaid Innovation has granted Section 1115 waivers to several states to develop Delivery System Reform Incentive Payment (DSRIP) programs, which vary in their federal funding pools, structures, and goals, but share key characteristics, such as the withholding of payment until certain milestones and metrics are met. The DSRIP project in New York--as exemplified by Finger Lakes Performing Provider System--is being closely watched across the country as CMS and state Medicaid programs contemplate similar measures to transform Medicaid and bend its cost curve.
Subject(s)
Medicaid/legislation & jurisprudence , Reimbursement, Incentive/organization & administration , Treatment Outcome , Centers for Medicare and Medicaid Services, U.S. , Health Care Reform , Medicaid/economics , United States , Value-Based PurchasingABSTRACT
BACKGROUND: Both microgravity and simulated microgravity models, such as the 45HDT (45 degrees head-down tilt), cause a redistribution of body fluids indicating a possible adaptive process to the microgravity stressor. Understanding the physiological processes that occur in microgravity is a first step to developing countermeasures to stop its harmful effects, i.e., (edema, motion sickness) during long-term space flights. HYPOTHESIS: Because of the kidneys' functional role in the regulation of fluid volume in the body, it plays a key role in the body's adaptation to microgravity. METHODS: Rats were injected intramuscularly with a radioactive tracer and then lightly anesthetized in order to facilitate their placement in the 45HDT position. They were then placed in the 45HDT position using a specially designed ramp (45HDT group) or prone position (control group) for an experimental time period of 1 h. During this period, the 99mTc-DTPA (technetium-labeled diethylenepentaacetate, MW=492 amu, physical half-life of 6.02 h) radioactive tracer clearance rate was determined by measuring gamma counts per minute. The kidneys were then fixed and sectioned for electron microscopy. A point counting method was used to quantitate intracellular spaces of the kidney proximal tubules. RESULTS: 45HDT animals show a significantly (p=0.0001) increased area in the interstitial space of the proximal tubules. CONCLUSIONS: There are significant changes in the kidneys during a 1 h exposure to a simulated microgravity environment that consist primarily of anatomical alterations in the kidney proximal tubules. The kidneys also appear to respond differently to the initial periods of head-down tilt.
