Dental economics and the aging population.

In 2011, the oldest segment of the baby boom generation will be 65 years of age, marking the beginning of an important demographic shift for dentistry. As seniors, boomers will continue to need dental care, more than previous cohorts of seniors. However, many may lack the means to fully finance their dental care. With the associations between oral and systemic health becoming clearer, dental practitioners will become increasingly involved in promoting their patients' overall health. This article reviews recent trends and projections in dental spending and how an aging population may impact clinical practice and dental business operations.

Considerations in value-based purchasing.

In health care (and in life) reimbursement drives behavioral change. If providers are reimbursed based on the quantity of services provided, it is likely that the quantity of services will increase. Likewise, as payment shifts towards reimbursement based on quality or value--then those metrics will be more closely evaluated and managed. The current Home Health P4P Demonstration gives the home care industry a good idea of the baseline metrics that will likely be included in any P4P program to be broadly implemented across home care in the future. What remains to be seen, however, is whether the methodology and structure of the demonstration will be associated with real cost savings, and if so, what the magnitude of savings is. These findings will surely impact the degree to which the current methodology and structure will be adjusted or revised prior to seeking full implementation. Until such findings are revealed, one can be sure savvy home care providers will be focusing on how to get a handle on what patient populations drive their performance on the risk-adjusted outcome measures included in the current P4P demonstration and exploring approaches to care to achieve continued improvement.

Turning challenge into opportunity: what home care needs to know about Medicare advantage.

With multiple payors having different rules, paperwork, and payment models, the challenge is that MA plans typically focus time and attention on the providers associated with the highest costs--hospitals and physicians. With little attention being paid to the home health providers, MA plans cost containment measures and operational practices create challenges for providers developing an overall treatment plan for a patient's episode of care.

Pressure ulcer prevalence and the role of negative pressure wound therapy in home health quality outcomes.

Home health agencies, challenged to demonstrate quality while containing costs, are motivated to find best practices for managing patient and wound care. The effects of different wound therapies on frequency of hospitalization and emergent care, two prominent quality measures, have not been studied. A retrospective study was conducted to determine the prevalence of Stage III and Stage IV pressure ulcers in the home health population and to quantify the impact of negative pressure wound therapy in reducing acute care hospitalizations and emergent care in general, and wound infection or deteriorating wound status in particular. Data from 1.94 million OASIS start-of-care assessments in 2003 and 2004 were evaluated to estimate pressure ulcer prevalence and a retrospective matched group analysis compared patients using (n = 60) and not using (n = 2,288) negative pressure wound therapy. In 2003, 6.9% and in 2004, 7% of patients had pressure ulcers at start of care. Of these, 23% were Stage III or Stage IV and 31% were "not healing." In the matched analysis group, it was found that compared to comparison group patients, those receiving negative pressure wound therapy experienced lower rates of hospitalization (35% versus 48%, P less than .05), hospitalization due to wound problems (5% versus 14%, P less than .01), and emergent care for wound problems (0% versus 8%, P = .01). To offset potential limitations in generalizability and increase practical application of these results, further research is needed with a larger, nationally representative sample to compare other quality outcomes as well as the cost of providing negative pressure wound therapy to other specific wound care modalities.