Variation in Costs Among Surgeons and Hospitals in Pediatric Tympanostomy Tube Placement
|
|
- Cathleen Green
- 5 years ago
- Views:
Transcription
1 The Laryngoscope VC 2015 The American Laryngological, Rhinological and Otological Society, Inc. Variation in Costs Among Surgeons and Hospitals in Pediatric Tympanostomy Tube Placement Phayvanh P. Sjogren, MD; Craig Gale, MS; Jacob Henrichsen, BS; Griffin Olsen, BS; Mark J. Ott, MD; Matthew Peters; Rajendu Srivastava, MD, FRC(C), MPH; Jeremy D. Meier, MD Objectives/Hypothesis: 1) Identify the major expenses for outpatient pediatric tympanostomy tube placement in a multihospital network. 2) Compare differences for variations in costs among hospitals and surgeons. Methods: An observational cohort study in a multihospital network using a standardized activity-based accounting system to determine hospital costs for tympanostomy tube placement from February 2011 to January Children aged 6 months to less than 3 years old who underwent same-day surgery (SDS) for tympanostomy tubes at 15 hospital facilities were included. Subjects with additional procedures were excluded. Hospital costs were subdivided into categories including operating room (OR), SDS preoperative, SDS postoperative, postanesthesia care unit, anesthesia, pharmacy, and OR supplies. Results: The study cohort included 5,623 patients undergoing tympanostomy tube placement by 67 surgeons. Mean cost per surgery was $769 6 $3. Significant variations (P < 0.001) in mean cost per procedure were identified by hospital (range $ $38 to $509 6 $11) and by surgeon (range $ $75 to $660 6 $11). Operating room and SDS preoperative were the greatest expenditures; each category accounted for over 30% of overall costs. Pharmacy costs and OR costs were some of the major drivers of cost variation among surgeons. Conclusion: This study demonstrates that OR and SDS preoperative costs accounted for the greatest expenditure in tympanostomy tube placement, and significant variation exists among surgeons and hospitals within a multihospital network. Further research is needed to elucidate factors accounting for such variation in cost and the overall impact on patient outcomes. Key Words: Pediatric, tympanostomy, tube, costs, ototopical treatment, variation. Level of Evidence: 4. Laryngoscope, 126: , 2016 From the Division of Otolaryngology Head and Neck Surgery (P.S., J.D.M.); the Division of Pediatric Inpatient Medicine, Department of Pediatrics (R.S.), University of Utah School of Medicine; the Primary Children s Hospital (R.S.), the Institute for Health Care Delivery Research (R.S.), Intermountain Healthcare Inc., Salt Lake City; and the Intermountain Healthcare, Surgical Services Clinical Program, Intermountain Medical Center (C.G., J.H., G.O., M.O., M.P.), Murray, Utah, U.S.A. Editor s Note: This Manuscript was accepted for publication October 12, Presented at the Triological Society 118th Annual Meeting at the Combined Sections Meeting in Boston, Massachusetts, U.S.A, April 24 25, Dr. Jeremy D. Meier received a Triological Society Career Development Award unrelated to this research. Dr. Rajendu Srivastava chairs the Pediatric Research in Inpatient Settings with several federally funded grants, none of which are related to this research. The authors have no other funding, financial relationships, or conflicts of interest to disclose. Send correspondence to Jeremy D. Meier, MD, Assistant Professor, University of Utah, Division of Otolaryngology Head and Neck Surgery, 50 North Medical Drive, Room 3C120, Salt Lake City, UT Jeremy.meier@imail.org DOI: /lary INTRODUCTION Acute otitis media is one of the most common illnesses of childhood and represents the most common indication for pediatric antibiotic therapy and clinic visits in the United States. 1 Recurrent infections, infections not resolved after antibiotic therapy, or those that result in persistent middle ear fluid benefit from ventilation tubes. Myringotomy with tube insertion is the most common ambulatory surgery in children aged less than 15 years old, with approximately 667 thousand cases performed each year in the United States. 2 Given the high prevalence of this disease, costs associated with otitis media have been under surveillance since the 1980s and continue to pose a major health care utilization concern. 3 Both direct and indirect costs of acute otitis media and chronic otitis media with effusion have been estimated to have an annual economic burden exceeding $5 billion. 4,5 In the climate of rising health care costs, recent guidelines for this commonly performed surgery were published by the American Academy of Otolaryngology Head and Neck Surgery Foundation. The updated recommendations focus on patient selection, surgical indications, and management of tympanostomy tubes in children. 6 However, the guidelines do not specifically address perioperative considerations, which directly drive surgical costs. A major priority of current health care reform is to transition from a volume-based to a value-based delivery system. More and more, reimbursement models are focusing on quality rather than the quantity of care delivered. 7 One approach includes bundled payment plans in which reimbursement is provided for the entire episode of care related to a specific diagnosis or problem. This repayment model could apply to common conditions such as otitis media or procedures such as tympanostomy tube placement. To anticipate 1935
2 future reform, it is imperative that otolaryngologists understand the costs for these common procedures and identify the drivers of variation in costs. Intermountain Healthcare (Intermountain; Murray, UT) is a nonprofit, integrated health care system that includes 22 hospitals ranging from tertiary care referral centers to community and rural hospitals in the Intermountain West. Intermountain houses the Enterprise Data Warehouse (EDW), a comprehensive database that contains administrative, financial, and clinical information. The financial data in the EDW are beneficial in that hospital costs, and not simply charges, are recorded. Charge data depend on payment agreements between hospitals and third-party payers without correlation to the actual cost of the operation. Alternatively, cost data represent a more accurate assessment of resources actually utilized. We have previously used this database to evaluate variation in adenotonsillectomy costs and complications among hospitals and surgeons within the tertiary children s hospital 8 and across the Intermountain system. 9 The purpose of this study is to identify the major expenses for outpatient pediatric tympanostomy tube placement in a multihospital network and to delineate areas of cost variation among hospitals and surgeons. MATERIALS AND METHODS The institutional review board at Intermountain Healthcare approved this study. The EDW was queried for encounters with International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) procedure code (myringotomy with insertion of tube) for patients aged 6 months to less than 3 years old between February 2011 and January There were a total of 15 hospital facilities included in the study (14 hospitals and 1 hospital outpatient surgery center). Eight additional hospitals within Intermountain were excluded because the cost accounting systems at these hospitals were missing at least some pertinent data related to this procedure. Subjects with additional ICD-9-CM procedure codes during the encounter or costs attributed to other services in the hospital (e.g., oncology, audiology) were excluded to ensure that patients undergoing tympanostomy tube placement alone were included in the analysis. To limit confounding factors secondary to medical complexity, only patients listed as same-day discharges were included in the study cohort. All operations were performed in a hospital operating room (OR) or the off-site hospital outpatient surgery center associated with the children s hospital. Hospital costs were subdivided into categories including OR, same-day services (SDS) preoperative registration and evaluation, SDS postoperative care, postanesthesia care unit (PACU), anesthesia (not including professional fees), and pharmacy costs. Mean total cost for the procedure and costs by subcategory were determined across the entire system. Mean costs per hospital and per surgeon were also calculated. In addition, mean total OR time was measured per hospital and surgeon. Analysis of variance was applied to determine statistical differences in costs between hospitals and surgeons. RESULTS A total of 67 surgeons performed tympanostomy tube placement on 5,801 patients at 15 hospital facilities. Patients (n 5 77) with additional activities such as 1936 Fig. 1. Breakdown of total costs per case by subcategory across the entire cohort. audiology, respiratory therapy, emergency department, or oncology clinic visits attached to the tympanostomy tube encounter were excluded. Subjects were also excluded if OR or pharmacy costs were incomplete (n 5 101), leading to a total of 5,623 patients in the final cohort. The mean cost per case was $ A breakdown of the costs by category is shown in Figure 1, demonstrating that OR and SDS preoperative services were the greatest expenditures. Each of these categories accounted for over 30% of the overall costs. Figure 2 depicts the mean cost per procedure by hospital (range $ $38 to $509 6 $11). Figure 3 depicts the mean cost per procedure by surgeon (range $ $75 to $660 6 $11). Significant variation in costs was identified among hospitals and surgeons (P < 0.001). Figure 4 depicts the variation in costs by each surgeon at each hospital. In Figure 4, 18 surgeons performed only one case at certain facilities; therefore, these 18 data points are omitted from the figure. The mean total OR time per case (n 5 5,801) was 13.8 minutes. This ranged from 8.9 minutes in one hospital (n 5 150) to 25.2 minutes in another hospital (n 5 56), and from 8.9 minutes in one surgeon (n 5 146) to 35.5 minutes in another surgeon (n 5 2). Figure 5 depicts the breakdown of OR time per case by surgeon at each hospital. Table I shows the coefficient of variation for different subcategories of costs across the entire cohort. This table also shows the range of mean subcategory costs per surgeon at the pediatric outpatient surgery center. DISCUSSION Variation in health care delivery exists at the provider, hospital, and regional level. 10 Some types of variation are inevitable; however, the variation is deemed unwarranted when not explained by the type or severity of illness, patient preference, or dictates of evidencebased medicine. 11 This unwarranted variation can increase economic burden by creating waste without improvement in patient outcomes. Despite the robust number of tympanostomy tube procedures in the United States, there remains a paucity of data scrutinizing
3 Fig. 2. Mean procedure costs per hospital. variations in this practice. Few databases are able to successfully capture the information regarding potential unwarranted variation in costs. This study was able to incorporate such cost analyses using the Intermountain EDW data. Significant variation in pediatric tympanostomy tube placement was identified not only among surgeons but also among hospitals. The results from this study demonstrate significant variation among facilities in costs for tympanostomy tube placement in children. There is more than a twofold difference in monetary resources utilized between the most and least expensive hospitals for the same procedure. Each hospital within the Intermountain system uses the same cost-accounting system. However, several factors may explain cost discrepancies between hospitals. Some variation in expenses could be attributable to differences in overhead costs between hospitals. Equipment and services in the OR vary at different institutions, leading to a discrepancy in cost per minute in the OR. Additionally, time spent in the OR or preoperative and postoperative areas could differ between hospitals, accounting for some additional variation in costs. In a truly capitated health system or bundled payment model, incentives may drive common, simple procedures such as tympanostomy tube placement to less expensive facilities. This would be an onus for more costly hospitals to identify innovative approaches to reduce the costs for these common procedures in order to remain competitive. This study found that a significant portion of the costs for outpatient tympanostomy tube placement in hospitals was accrued in the preoperative area (31%) and postoperative recovery area (18%). The OR only accounted for 34% of costs, whereas the OR often assumes a greater proportion of the overall costs of care for outpatient procedures. Many children after tube placement bypass recovery in the PACU, which accounted for 5% of costs because most children did not use the PACU. Costs for the preoperative and postoperative areas accrue from the nursing and hospital space that are used and are allocated per unit of time. Costs in the preoperative area also include staffing and space for patient registration, initial intake and recording of vitals, and preoperative teaching. In the hospital setting, some of these processes may be streamlined and targeted to reduce costs. A few factors may better explain why OR costs accounted for only one-third of the total costs. First, tympanostomy tube placement is a very brief procedure. Therefore, time in the OR is much shorter compared to Fig. 3. Mean procedure costs by surgeon with breakdown by category. 1937
4 TABLE I. Coefficient of Variation for Different Subcategories of Costs Across the Entire Cohort and the Range of Mean Subcategory Costs Per Surgeon at the Pediatric Outpatient Surgery Center. Subcategory Coefficient of Variation Range of Costs (by surgeon) Fig. 4. Mean total cost for each facility (bar) with the mean cost for each surgeon in that facility (dot). time in the preoperative and postoperative areas. Second, this study evaluated costs and not charges. Charges per minute in the OR often are quite inflated and do not reflect the true cost of care. Finally, the relatively high costs for preoperative care may reflect the increased costs for tympanostomy tubes placed in a hospital setting compared to a surgical center. The patients in this cohort often had the same registration, intake, and preoperative assessment as patients presenting for much more complicated procedures. Identifying strategies to streamline this process in this relatively healthy cohort could lead to significant reduction in costs. For example, in our children s hospital, all children undergoing surgery have a preoperative history and physical exam performed by a nurse practitioner. Pilot studies skipping this step in the preoperative process are currently underway. In addition to cost differences among hospitals, the results of the study also underscore variation among individual surgeons. Some of this variation is secondary to underlying differences between hospitals related to the reasons discussed above and outside the surgeons control. However, Figure 4 demonstrates that even within the same facility there are robust differences in the cost of the procedure by each otolaryngologist. The greatest sources of variation directly linked to surgeon practices were operative time and pharmacy costs. Although faster operations will cost less, safety risks and potential complications with quicker surgeries are Fig. 5. Mean operating room time for each facility (bar) and the mean time for each surgeon in that facility (dot) Total cost.251 $662 $902 Pharmacy.773 $27 $135 Supply costs.686 $18 $44 Postanesthesia care unit.670 $24 $44 Postoperative SDS.616 $124 $149 Anesthesia.561 $0 $27 OR.474 $200 $349 Preoperative SDS.200 $204 $247 SDS 5 same-day surgery. unknown. This study did not evaluate whether operative time correlated with outcomes or complications, but this could be explored in future studies. An ideal operative time that provides the fewest complications but remains efficient could be determined in the future. Ototopical drops are often prescribed to decrease the risk of posttympanostomy otorrhea and ventilation tube occlusion. The majority of studies have demonstrated a significant reduction in posttympanostomy otorrhea, with application of ototopical therapy compared with no treatment. 12 However, results are debatable when comparing types and duration of topical therapy. Roland et al. showed a 1.1 day reduction in time to cessation of otorrhea with ciprofloxacin plus dexamethasone (Alcon Laboratories, Fort Worth, TX) compared to ciprofloxacin (Alcon Laboratories, Fort Worth, TX). 13 However, at 2 weeks there was no significant difference between the two groups in either clinical response or microbial eradication. 13 Conversely, other studies comparing topical antibiotics alone versus topical antibiotic with steroids demonstrated that the risk ratio at 2 to 3 weeks was not significant. 14,15 Furthermore, some may contend that other less-expensive topical therapies can reduce otorrhea rates, such as middle ear irrigation with saline immediately after tube insertion. Kocaturk et al. showed decreased prevalence of otorrhea at 2 weeks from 30% in control children to 16% treated with saline irrigation. The same study showed no statistically significant difference between the saline group and children treated with a prolonged application of ofloxacin. 16 Given the conflicting results from multiple studies, no single ototopical therapy has proven superior. Our results identify pharmacy costs as a potential target to reduce expenditures. In our cohort, ciprofloxacin plus dexamethasone otic suspension (Alcon Laboratories, Fort Worth, TX), ofloxacin otic (Bausch & Lomb, Tampa, FL), or sulfacetamide sodium plus prednisolone sodium phosphate (Bausch & Lomb, Tampa, FL) are typically administered and prescribed following surgery. Using Ciprodex drops can directly increase the costs of the procedure by 10% to 15%. The duty to cut unnecessary spending falls not only on the health care system as a whole but also places the individual physician accountable. Surgeons can decrease medical care costs and waste if
5 they are cognizant of options that directly impact the cost of services provided. 17 Additional studies delineating patient outcomes relative to cost reduction are needed. This study has several strengths. The EDW costbased accounting system records hospital and supply costs and thus more accurately depicts resource utilization. Economic analyses utilizing charge as a proxy for cost can be erroneous. Charges are often several magnitudes higher than actual facility costs, thereby overestimating true expenses. 18 In addition, the large sample size increases the power of our statistical analysis and the cross-sectional cohort contains data on procedures performed by multiple otolaryngologists. The study is not limited to an academic tertiary setting but is applicable to private and hospital-employed surgeons. Although the Intermountain cost data in this study will naturally have regional differences to other hospitals in the United States, we expect that most health systems would have similar variation to the 15 hospitals in our study that span rural, community, and urban centers. As such, the results are an excellent representation of care for multiple centers with differing capacities across the U.S. medical system. This study delineates how hospitals account for costs for tympanostomy tubes and identify areas that system and individual providers could target to decrease costs. Choosing less-expensive ototopical drops, when appropriate, could decrease costs by up to 15% in some cases. More efficient use of operative time may also decrease costs for some surgeons. Streamlining preoperative and postoperative system processes within individual hospitals could also reduce the cost of care. Despite these strengths, the use of an administrative database has inherent limitations. We cannot overcome the biases of a retrospective observational study and electronic database, which are limited by accurate coding. There may be discrepancies in how costs are accounted for across facilities. Not all hospitals within the Intermountain system were included in the study because some did not include pharmacy costs. This study only contains costs to the hospital regardless of thirdparty payers or insurance coverage. Therefore, differences in charges or pricing for ototopical drops dependent on patient s insurance coverage are not impacted by our results. In our system, surgeons typically use drops intraoperatively and are given an outpatient prescription, which is then filled at the hospital. In cases when drops were used, we determined the cost of the bottle to the hospital and did not include any outpatient pharmacy charges. In addition, residents were involved in a portion of the procedures performed in one of the hospitals by five of the surgeons. Surgeons in training could likely have increased the operative time and therefore the costs in some cases. However, we could not delineate those cases, and differences remained among surgeons in the absence of resident involvement at the other 14 hospitals. Lastly, we were unable to measure patient-reported outcomes or complications associated with these procedures. Future investigations are warranted to evaluate the relationship between procedure costs and outcomes. A better understanding of how operative time and choice of ototopical drops impact postoperative tympanostomy tube otorrhea, occlusion, or early extrusion will be necessary to identify care that will deliver the best value to the patient. CONCLUSION This study identified significant variation in cost for outpatient tympanostomy tube placement among hospitals and surgeons. A better understanding of such discrepancies will motivate otolaryngologists to adjust their practices to promote cost savings. At the hospital level, an activity-based cost database can identify sources of variation and prospective strategies to decrease waste. Further research is needed to elucidate factors accounting for these variations in cost and physician practices and the overall impact on patient outcomes. BIBLIOGRAPHY 1. Sidell D, Shapiro NL, Bhattacharyya N. Demographic influences on antibiotic prescribing for pediatric acute otitis media. Otolaryngol Head Neck Surg 2012;146: Cullen KA, Hall MJ, Golosinskiy A. Ambulatory surgery in the United States, Natl Health Stat Report 2009: Ahmed S, Shapiro NL, Bhattacharyya N. Incremental health care utilization and costs for acute otitis media in children. Laryngoscope 2014;124: Alsarraf R, Jung CJ, Perkins J, Crowley C, Alsarraf NW, Gates GA. Measuring the indirect and direct costs of acute otitis media. Arch Otolaryngol Head Neck Surg 1999;125: Gates GA. Cost-effectiveness considerations in otitis media treatment. Otolaryngol Head Neck Surg 1996;114: Rosenfeld RM, Schwartz SR, Pynnonen MA, et al. Clinical practice guideline: tympanostomy tubes in children. Otolaryngol Head Neck Surg 2013;149(suppl 1):S1 S Burwell SM. Setting value-based payment goals HHS efforts to improve U.S. health care. N Engl J Med 2015;372: Meier JD, Duval M, Wilkes J, et al. Surgeon dependent variation in adenotonsillectomy costs in children. Otolaryngol Head Neck Surg 2014;150: Meier JD, Zhang Y, Greene TH, Curtis JL, Srivastava R. Variation in pediatric outpatient adenotonsillectomy costs in a multihospital network. Laryngoscope 2015;125: doi: /lary Goodman DC. Unwarranted variation in pediatric medical care. Pediatr Clin North Am 2009;56: Wennberg JE. Unwarranted variations in healthcare delivery: implications for academic medical centres. BMJ 2002;325: Schilder AG, Burton MJ, Shin JJ, Rosenfeld RM. Extracts from the Cochrane Library: interventions for the prevention of postoperative ear discharge after insertion of ventilation tubes (grommets) in children. Otolaryngol Head Neck Surg 2013;149: Roland PS, Anon JB, Moe RD, et al. Topical ciprofloxacin/dexamethasone is superior to ciprofloxacin alone in pediatric patients with acute otitis media and otorrhea through tympanostomy tubes. Laryngoscope 2003; 113: Morpeth JF, Bent JP, Watson T. A comparison of cortisporin and ciprofloxacin otic drops as prophylaxis against post-tympanostomy otorrhea. Int J Pediatr Otorhinolaryngol 2001;61: Poetker DM, Lindstrom DR, Patel NJ, et al. Ofloxacin otic drops vs neomycin-polymyxin B otic drops as prophylaxis against early postoperative tympanostomy tube otorrhea. Arch Otolaryngol Head Neck Surg 2006;132: Kocaturk S, Yardimci S, Yildirim A, Incesulu A. Preventive therapy for postoperative purulent otorrhea after ventilation tube insertion. Am J Otolaryngol 2005;26: Brook RH. The role of physicians in controlling medical care costs and reducing waste. JAMA 2011;306: Smith KA, Rudmik L. Cost collection and analysis for health economic evaluation. Otolaryngol Head Neck Surg 2013;149:
Tympanostomy tubes for otitis media: Quality-of-life improvement for children and parents
MUI, RASGON, ORIGINAL HILSINGER, ARTICLELEWIS, LACTAO Tympanostomy tubes for otitis media: Quality-of-life improvement for children and parents Stanley Mui, MD; Barry M. Rasgon, MD; Raymond L. Hilsinger,
More informationThe introduction of the first freestanding ambulatory
Epidemiology of Ambulatory Anesthesia for Children in the United States: and 1996 Jennifer A. Rabbitts, MB, ChB,* Cornelius B. Groenewald, MB, ChB,* James P. Moriarty, MSc, and Randall Flick, MD, MPH*
More informationORIGINAL ARTICLE. Variation in Surgical Time-out and Site Marking Within Pediatric Otolaryngology
ORIGINAL ARTICLE Variation in Surgical Time-out and Site Within Pediatric Otolaryngology Rahul K. Shah, MD; Ellis Arjmand, MD; David W. Roberson, MD; Ellen Deutsch, MD; Craig Derkay, MD Objective: To determine
More informationAmerican Health Lawyers Association Institute on Medicare and Medicaid Payment Issues. History of the Physician Fee Schedule
American Health Lawyers Association Institute on Medicare and Medicaid Payment Issues March 20-22, 2013 Baltimore, Maryland Sidney S. Welch, Esq. 1 History of the Physician Fee Schedule Prior to 1992,
More informationSTANDARDIZED PROCEDURE MYRINGOTOMY (Adult, Peds)
I. Definition Myringotomy is creation of a small incision into the tympanic membrane (TM) under otomicroscopic visualization with a speculum in the external auditory canal (EAC). After the TM has been
More informationThe Pain or the Gain?
The Pain or the Gain? Comprehensive Care Joint Replacement (CJR) Model DRG 469 (Major joint replacement with major complications) DRG 470 (Major joint without major complications or comorbidities) Actual
More informationCost Effectiveness of Physician Anesthesia J.P. Abenstein, M.S.E.E., M.D. Mayo Clinic Rochester, MN
Mayo Clinic Rochester, MN Introduction The question of whether anesthesiologists are cost-effective providers of anesthesia services remains an open question in the minds of some of our medical colleagues,
More informationDistribution of Post-Acute Care under CJR Model of Lower Extremity Joint Replacements for MS-DRG 470
Distribution of Post-Acute Care under CJR Model of Lower Extremity Joint Replacements for MS-DRG 470 Introduction The goal of the Medicare Comprehensive Care for Joint Replacement (CJR) payment model is
More informationWhose Experience Is Measured?: A Pilot Study of Patient Satisfaction Demographics in Pediatric Otolaryngology
The Laryngoscope VC 2013 The American Laryngological, Rhinological and Otological Society, Inc. Whose Experience Is Measured?: A Pilot Study of Patient Satisfaction Demographics in Pediatric Otolaryngology
More informationA strategy for building a value-based care program
3M Health Information Systems A strategy for building a value-based care program How data can help you shift to value from fee-for-service payment What is value-based care? Value-based care is any structure
More informationJULY 2012 RE-IMAGINING CARE DELIVERY: PUSHING THE BOUNDARIES OF THE HOSPITALIST MODEL IN THE INPATIENT SETTING
JULY 2012 RE-IMAGINING CARE DELIVERY: PUSHING THE BOUNDARIES OF THE HOSPITALIST MODEL IN THE INPATIENT SETTING About The Chartis Group The Chartis Group is an advisory services firm that provides management
More informationDepartment of Anesthesiology and Pediatrics, Duke University School of Medicine, Durham, NC, USA
JEPM Vol XVII, Issue III, July-December 2015 1 Original Article 1 Assistant Professor, Department of Anesthesiology and Pediatrics, Duke University School of Medicine, Durham, NC, USA 2 Resident Physician,
More informationFAQ for Coding Encounters in ICD 10 CM
FAQ for Coding Encounters in ICD 10 CM Topics: Encounter for Routine Health Exams Encounter for Vaccines Follow Up Encounters Coding for Injuries Encounter for Suture Removal External Cause Codes Tobacco
More informationFrequently Asked Questions (FAQ) The Harvard Pilgrim Independence Plan SM
Frequently Asked Questions (FAQ) The Harvard Pilgrim Independence Plan SM Plan Year: July 2010 June 2011 Background The Harvard Pilgrim Independence Plan was developed in 2006 for the Commonwealth of Massachusetts
More informationChallenges of Sustaining Momentum in Quality Improvement: Lessons from a Multidisciplinary Postoperative Pulmonary Care Program
Challenges of Sustaining Momentum in Quality Improvement: Lessons from a Multidisciplinary Postoperative Pulmonary Care Program Michael R Cassidy, MD Pamela Rosenkranz, RN, BSN, MEd, and David McAneny
More informationORIGINAL ARTICLE. Evaluating Popular Media and Internet-Based Hospital Quality Ratings for Cancer Surgery
ORIGINAL ARTICLE Evaluating Popular Media and Internet-Based Hospital Quality Ratings for Cancer Surgery Nicholas H. Osborne, MD; Amir A. Ghaferi, MD; Lauren H. Nicholas, PhD; Justin B. Dimick; MD MPH
More informationRisk Adjustment Methods in Value-Based Reimbursement Strategies
Paper 10621-2016 Risk Adjustment Methods in Value-Based Reimbursement Strategies ABSTRACT Daryl Wansink, PhD, Conifer Health Solutions, Inc. With the move to value-based benefit and reimbursement models,
More informationEfficacy of Tympanostomy Tubes for Children with Recurrent Acute Otitis Media Randomization Phase
CONSENT FOR A CHILD TO BE A SUBJECT IN MEDICAL RESEARCH AND AUTHORIZATION TO PERMIT THE USE AND SHARING OF IDENTIFIABLE MEDICAL INFORMATION FOR RESEARCH PURPOSES TITLE Efficacy of Tympanostomy Tubes for
More informationManagement of the Surgical Patient Preoperative, Intraoperative and Postoperative
NURS 143 Nursing in Health Alterations II Management of the Surgical Patient Preoperative, Intraoperative and Postoperative Upon completion of the O.R., PACU, or SDS experience, the student will be able
More informationObservation Coding and Billing Compliance Montana Hospital Association
Observation Coding and Billing Compliance Montana Hospital Association Sue Roehl, RHIT, CCS sroehl@eidebaill.com 701-476-8770 IP versus Observation considerations Severity of patient s signs and symptoms
More informationNew research: Change peripheral intravenous catheters only as clinically
Content page New research: Change peripheral intravenous catheters only as clinically indicated, not routinely. The results of a nurse led and nationally funded multicentre, randomised equivalence trial
More informationPerformance Measurement of a Pharmacist-Directed Anticoagulation Management Service
Hospital Pharmacy Volume 36, Number 11, pp 1164 1169 2001 Facts and Comparisons PEER-REVIEWED ARTICLE Performance Measurement of a Pharmacist-Directed Anticoagulation Management Service Jon C. Schommer,
More informationManual for costing HIV facilities and services
UNAIDS REPORT I 2011 Manual for costing HIV facilities and services UNAIDS Programmatic Branch UNAIDS 20 Avenue Appia CH-1211 Geneva 27 Switzerland Acknowledgement We would like to thank the Centers for
More informationUnderstanding the Implications of Total Cost of Care in the Maryland Market
Understanding the Implications of Total Cost of Care in the Maryland Market January 29, 2016 Joshua Campbell Director KPMG LLP Matthew Beitman Sr. Associate KPMG LLP The concept of total cost of care is
More informationPaying for Outcomes not Performance
Paying for Outcomes not Performance 1 3M. All Rights Reserved. Norbert Goldfield, M.D. Medical Director 3M Health Information Systems, Inc. #Health Information Systems- Clinical Research Group Created
More informationChapter VII. Health Data Warehouse
Broward County Health Plan Chapter VII Health Data Warehouse CHAPTER VII: THE HEALTH DATA WAREHOUSE Table of Contents INTRODUCTION... 3 ICD-9-CM to ICD-10-CM TRANSITION... 3 PREVENTION QUALITY INDICATORS...
More informationTHE USE OF SIMULATION TO DETERMINE MAXIMUM CAPACITY IN THE SURGICAL SUITE OPERATING ROOM. Sarah M. Ballard Michael E. Kuhl
Proceedings of the 2006 Winter Simulation Conference L. F. Perrone, F. P. Wieland, J. Liu, B. G. Lawson, D. M. Nicol, and R. M. Fujimoto, eds. THE USE OF SIMULATION TO DETERMINE MAXIMUM CAPACITY IN THE
More informationGeographic Variation in Medicare Spending. Yvonne Jonk, PhD
in Medicare Spending Yvonne Jonk, PhD Why are we concerned about geographic variation in Medicare spending? Does increased spending imply better health outcomes? How do we justify variation in Medicare
More informationBrittany Turner, 2015 PharmD Candidate 1 Justin Campbell, PharmD 2 Katie McKinney, PharmD, MS, BCPS 2
Discharge Medication Concierge Program: A pilot project in heart failure to reduce readmission rates, improve patient satisfaction, and increase pharmacy business metrics Brittany Turner, 2015 PharmD Candidate
More informationExpert Rev. Pharmacoeconomics Outcomes Res. 2(1), (2002)
Expert Rev. Pharmacoeconomics Outcomes Res. 2(1), 29-33 (2002) Microcosting versus DRGs in the provision of cost estimates for use in pharmacoeconomic evaluation Adrienne Heerey,Bernie McGowan, Mairin
More informationBenefit Criteria for Outpatient Observation Services to Change for Texas Medicaid
Benefit Criteria for Outpatient Observation Services to Change for Texas Medicaid Information posted on October 8, 2010 Effective for dates of service on or after December 1, 2010, the benefit criteria
More informationCase-mix Analysis Across Patient Populations and Boundaries: A Refined Classification System
Case-mix Analysis Across Patient Populations and Boundaries: A Refined Classification System Designed Specifically for International Quality and Performance Use A white paper by: Marc Berlinguet, MD, MPH
More informationMedication Management: Is It in Your Toolbox?
Medication Management: Is It in Your Toolbox? Brian K. Esterly, MBA, SVP, Corporate Development, excellerx, Inc. O: 215.282.1676, besterly@excellerx.com What has been your Medication Management experience?
More informationBasic Utilization and Case Management
& CHAPTER 7 Basic Utilization and Case Management I Bartlett CHAPTER Learning, STUDY LLC REVIEW 1. Goal of utilization management is to see that each member receives the appropriate level of care at an
More informationDomiciliary non-invasive ventilation for recurrent acidotic exacerbations of COPD: an economic analysis Tuggey J M, Plant P K, Elliott M W
Domiciliary non-invasive ventilation for recurrent acidotic exacerbations of COPD: an economic analysis Tuggey J M, Plant P K, Elliott M W Record Status This is a critical abstract of an economic evaluation
More informationValue based care: A system overhaul
Value based care: A system overhaul Lee A. Fleisher, M.D. Robert D. Dripps Professor and Chair of Anesthesiology Perelman School of Medicine at the University of Pennsylvania Email: lee.fleisher@uphs.upenn.edu
More informationInnovation and Diagnosis Related Groups (DRGs)
Innovation and Diagnosis Related Groups (DRGs) Kenneth R. White, PhD, FACHE Professor of Health Administration Department of Health Administration Virginia Commonwealth University Richmond, Virginia 23298
More informationA Jardine, R Moorthy, G Watters Date of review: June 2022
ENT UK OUTPATIENTS REVIEW AND RECOMMENDATIONS A Jardine, R Moorthy, G Watters Date of review: June 2022 BACKGROUND ENT UK have published guidelines with indicative numbers of s to be seen in Out Clinics
More informationHealth Care Quality Indicators in the Irish Health System:
Health Care Quality Indicators in the Irish Health System Examining the Potential of Hospital Discharge Data using the Hospital Inpatient Enquiry System - i - Health Care Quality Indicators in the Irish
More informationVolume to Value Transition in the USA
Volume to Value Transition in the USA Lee A. Fleisher, M.D. Robert D. Dripps Professor and Chair of Anesthesiology Perelman School of Medicine at the University of Pennsylvania Email: lee.fleisher@uphs.upenn.edu
More information3M Health Information Systems Should physicians assign their own codes?
3M Health Information Systems Should physicians assign their own codes? The practical guide to striking a coding balance It started with the EHR boom The adoption of electronic health records (EHR) significantly
More informationTotal Joint Partnership Program Identifies Areas to Improve Care and Decrease Costs Joseph Tomaro, PhD
WHITE PAPER Accelero Health Partners, 2013 Total Joint Partnership Program Identifies Areas to Improve Care and Decrease Costs Joseph Tomaro, PhD ABSTRACT The volume of total hip and knee replacements
More informationQuestions and Answers on the CMS Comprehensive Care for Joint Replacement Model
Questions and Answers on the CMS Comprehensive Care for Joint Replacement Model MEGGAN BUSHEE, ESQ. 704.343.2360 mbushee@mcguirewoods.com 201 North Tryon Street, Suite 3000 Charlotte, North Carolina 28202-2146
More informationUNITED STATES HEALTH CARE REFORM: EARLY LESSONS FROM ACCOUNTABLE CARE ORGANIZATIONS
UNITED STATES HEALTH CARE REFORM: EARLY LESSONS FROM ACCOUNTABLE CARE ORGANIZATIONS Stephen M. Shortell, Ph.D., M.P.H, M.B.A. Blue Cross of California Distinguished Professor of Health Policy and Management
More informationGlobal Surgery Package
Private Property of Florida Blue. This payment policy is Copyright 2017 Florida Blue. All Rights Reserved. You may not copy or use this document or disclose its contents without the express written permission
More informationReimbursement for Non-Invasive Respiratory Support in Hospital Inpatient, Emergency Department and Other Outpatient Settings 1
2400 Beacon St., #203, Chestnut Hill, MA 02467 617-645-8452 Reimbursement for Non-Invasive Respiratory Support in Hospital Inpatient, Emergency Department and Other Outpatient Settings 1 The purpose of
More information3M Health Information Systems. 3M Clinical Risk Groups: Measuring risk, managing care
3M Health Information Systems 3M Clinical Risk Groups: Measuring risk, managing care 3M Clinical Risk Groups: Measuring risk, managing care Overview The 3M Clinical Risk Groups (CRGs) are a population
More informationTransitions of Care from a Community Perspective
Transitions of Care from a Community Perspective ACMA Utah Chapter 2nd Annual Education Session Dr. Larry Garrett, PhD, MPH, BSN Sr. Project Manager, HealthInsight Presenting with the 5 I s Interactive
More informationPayment Reforms to Improve Care for Patients with Serious Illness
Payment Reforms to Improve Care for Patients with Serious Illness Discussion Draft March 2017 Payment Reforms to Improve Care for Patients with Serious Illness Page 2 PAYMENT REFORMS TO IMPROVE CARE FOR
More informationGOALS AND OBJECTIVES
GOALS AND OBJECTIVES The goals of the Division of Otolaryngology Head and Neck Surgery are: 1. To provide the highest-quality patient care 2. To provide comprehensive education of residents and medical
More informationCreating a Patient-Centered Payment System to Support Higher-Quality, More Affordable Health Care. Harold D. Miller
Creating a Patient-Centered Payment System to Support Higher-Quality, More Affordable Health Care Harold D. Miller First Edition October 2017 CONTENTS EXECUTIVE SUMMARY... i I. THE QUEST TO PAY FOR VALUE
More informationPrepared for North Gunther Hospital Medicare ID August 06, 2012
Prepared for North Gunther Hospital Medicare ID 000001 August 06, 2012 TABLE OF CONTENTS Introduction: Benchmarking Your Hospital 3 Section 1: Hospital Operating Costs 5 Section 2: Margins 10 Section 3:
More informationPrior to implementation of the episode groups for use in resource measurement under MACRA, CMS should:
Via Electronic Submission (www.regulations.gov) March 1, 2016 Andrew M. Slavitt Acting Administrator Centers for Medicare and Medicaid Services 7500 Security Boulevard Baltimore, MD episodegroups@cms.hhs.gov
More informationHealth technology The study examined the use of laparoscopic nephrectomy (LapDN) for living donors.
Laparoscopic vs open donor nephrectomy: a cost-utility analysis Pace K T, Dyer S J, Phan V, Stewart R J, Honey R J, Poulin E C, Schlachta C N, Mamazza J Record Status This is a critical abstract of an
More informationRe: Rewarding Provider Performance: Aligning Incentives in Medicare
September 25, 2006 Institute of Medicine 500 Fifth Street NW Washington DC 20001 Re: Rewarding Provider Performance: Aligning Incentives in Medicare The American College of Physicians (ACP), representing
More informationImproving Hospital Performance Through Clinical Integration
white paper Improving Hospital Performance Through Clinical Integration Rohit Uppal, MD President of Acute Hospital Medicine, TeamHealth In the typical hospital, most clinical service lines operate as
More informationRE: Medicare Program; Request for Information Regarding the Physician Self-Referral Law
1055 N. Fairfax Street, Suite 204, Alexandria, VA 22314, TEL (703) 299-2410, (800) 517-1167 FAX (703) 299-2411 WEBSITE www.ppsapta.org August 24, 2018 Seema Verma, MPH Administrator Centers for Medicare
More informationSeptember 6, RE: CY 2017 Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems Proposed Rule
September 6, 2016 VIA E-MAIL FILING Centers for Medicare & Medicaid Services Department of Health and Human Services Attention: CMS-1656-P P.O. Box 8013 Baltimore, MD 21244-1850 RE: CY 2017 Hospital Outpatient
More informationThe Centers for Medicare & Medicaid Services (CMS) have
RESEARCH BRIEF Impact of Pharmacy Intervention on Prior Authorization Success and Efficiency at a University Medical Center Timothy Cutler, PharmD, CGP; Yifan She, PharmD; Jason Barca, PharmD; Shawn Lester,
More informationTOTAL KNEE REPLACEMENT BASKET OF CARE SUBCOMMITTEE Report to: Minnesota Department of Health. June 22, 2009
This document is made available electronically by the Minnesota Legislative Reference Library as part of an ongoing digital archiving project. http://www.leg.state.mn.us/lrl/lrl.asp TOTAL KNEE REPLACEMENT
More informationMedicare, Managed Care & Emerging Trends
Medicare, Managed Care & Emerging Trends LeadingAge Michigan 2015 Annual Leadership Institute August 12, 2015 Jon Lanczak, Manager Beth Sullivan, Senior Manager Plante Moran, PLLC Overall Theme Healthcare
More informationDelayed discharges and unplanned admissions from the Day Care Unit at Mater Dei Hospital, Malta
Delayed discharges and unplanned admissions from the Day Care Unit at Mater Dei Hospital, Malta Abstract Introduction: Day care units are playing an increasingly important role in healthcare provision,
More informationHealthcare Financial Management Association October 13 th, 2016 Introduction to Accountable Care Organizations and Clinically Integrated Networks
Healthcare Financial Management Association October 13 th, 2016 Introduction to Accountable Care Organizations and Clinically Integrated Networks Agenda Define ACO, CIN, and Coordinated Care Review ACO/CIN
More informationChronic Disease Management: Breakthrough Opportunities for Improving the Health And Productivity of Iowans
Chronic Disease Management: Breakthrough Opportunities for Improving the Health And Productivity of Iowans A Report of the Iowa Chronic Care Consortium February 2003 Background The Iowa Chronic Care Consortium
More informationCertification of Health Care Provider (Family and Medical Leave Act of 1993)
Certification of Health Care Provider (Family and Medical Leave Act of 1993) U.S. Department of Labor Employment Standards Administration Wage and Hour Division (When completed, this form goes to the employee,
More informationOutpatient Hospital Facilities
Outpatient Hospital Facilities Chapter 6 Chapter Outline Introduce students to 1. Different outpatient facilities 2. Different departments involved in the reimbursement process 3. The Chargemaster 4. Terminology
More informationDivision of Pediatric Surgery, Department of Surgery, University Of Wisconsin School of Medicine and Public Health
Surgeon-Directed Surgical Wound Classification During a Structured Operative Debrief Improves Accuracy of Wound Classification for Common Pediatric Surgery Procedures University Of Wisconsin Hospital And
More informationPerioperative management of the higher risk surgical patient with an acute surgical abdomen undergoing emergency surgery
CLINICAL GUIDELINE Perioperative management of the higher risk surgical patient with an acute surgical abdomen undergoing emergency surgery CG10214-2 For use in (clinical areas): For use by (staff groups):
More informationResearch Design: Other Examples. Lynda Burton, ScD Johns Hopkins University
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike License. Your use of this material constitutes acceptance of that license and the conditions of use of materials on this
More informationEmerging Outpatient CDI Drivers and Technologies
7th Annual Association for Clinical Documentation Improvement Specialists Conference Emerging Outpatient CDI Drivers and Technologies Elaine King, MHS, RHIA, CHP, CHDA, CDIP, FAHIMA Outpatient Payment
More informationMoving the Dial on Quality
Moving the Dial on Quality Washington State Medical Oncology Society November 1, 2013 Nancy L. Fisher, MD, MPH CMO, Region X Centers for Medicare and Medicaid Serving Alaska, Idaho, Oregon, Washington
More informationPRE OPERATIVE MANAGEMENT FOR PEDIATRIC HOSPITALISTS
Before the Operating Room: PRE OPERATIVE MANAGEMENT FOR PEDIATRIC HOSPITALISTS Presenters: Anjna Melwani, MD Sonaly McClymont, MD David Rappaport, MD Sarah Denniston, MD David Pressel, MD Amy Vinson, MD
More informationSTATEMENT ON THE ANESTHESIA CARE TEAM
Committee of Origin: Anesthesia Care Team (Approved by the ASA House of Delegates on October 18, 2006, and last amended on October 21, 2009) Anesthesiology is the practice of medicine including, but not
More informationPossible Denominator Codes Applicable to OMS * Le Fort Fractures 21346, 21347, 21348, 21422, 21423, 21432, 21433, 21435, 21436
Individual PQRS s Eligible OMS #20: #22: Perioperative Care: Timing of Antibiotic Prophylaxis Ordering Physician. Percentage of surgical patients aged 18 years and older undergoing procedures with the
More informationEmpire BlueCross BlueShield Professional Reimbursement Policy
Subject: Global Surgery NY Policy: 0012 Effective: 02/01/2014 05/31/2014 Coverage is subject to the terms, conditions, and limitations of an individual member s programs or products and policy criteria
More informationComments on Request for Information on Specialty Practitioner Payment Model Opportunities
American Cancer Society Cancer Action Network 555 11 th Street, NW Suite 300 Washington, DC 20004 202.661.5700 Dr. Patrick Conway, MD, MSc Acting Director Center for Medicare & Medicaid Innovation Centers
More informationUPDATE ON MEANINGFUL USE. HITECH Stimulus Act of 2009: CSC Point of View
HITECH Stimulus Act of 2009: CSC Point of View UPDATE ON MEANINGFUL USE Introduction The HITECH provisions of the American Recovery and Reinvestment Act of 2009 provide a commanding $36 billion dollars
More informationA Primer on Activity-Based Funding
A Primer on Activity-Based Funding Introduction and Background Canada is ranked sixth among the richest countries in the world in terms of the proportion of gross domestic product (GDP) spent on health
More informationENVIRONMENT Preoperative evaluation clinic. Preoperative evaluation clinic. Preoperative evaluation clinic. clinic. clinic. Preoperative evaluation
Goals and Objectives, Preoperative Evaluation Clinic Rotation, CA-1 and CA-2 year UCSD DEPARTMENT OF ANESTHESIOLOGY PREOPERATIVE EVALUATION CLINIC ROTATION GOALS AND OBJECTIVES, CA-1 and CA-2 YEAR PATIENT
More informationThe Reasons for Cancellations of Elective Pediatric Surgery Cases at Queen Rania Al-Abdullah Children Hospital
The for Cancellations of Elective Pediatric Surgery Cases at Queen Rania Al-Abdullah Children Hospital Zahi Almajali MD*, Emil Batarseh MD*, Mohd Daaja MD**, Eyad Safadi MD^, Basem Elnabulsi MD** ABSTRACT
More informationMeasuring Harm. Objectives and Overview
Patient Safety Research Introductory Course Session 3 Measuring Harm Albert W Wu, MD, MPH Former Senior Adviser, WHO Professor of Health Policy & Management, Johns Hopkins Bloomberg School of Public Health
More informationPatient Safety Research Introductory Course Session 3. Measuring Harm
Patient Safety Research Introductory Course Session 3 Measuring Harm Albert W Wu, MD, MPH Former Senior Adviser, WHO Professor of Health Policy & Management, Johns Hopkins Bloomberg School of Public Health
More informationNQF-ENDORSED VOLUNTARY CONSENSUS STANDARDS FOR HOSPITAL CARE. Measure Information Form
Last Updated: Version 3.2 NQF-ENORSE VOLUNTARY CONSENSUS STANARS FOR HOSPITAL CARE Measure Information Form Measure Set: Surgical Care Improvement Project (SCIP) Set Measure I#: SCIP- Performance Measure
More informationDefinitions/Glossary of Terms
Definitions/Glossary of Terms Submitted by: Evelyn Gallego, MBA EgH Consulting Owner, Health IT Consultant Bethesda, MD Date Posted: 8/30/2010 The following glossary is based on the Health Care Quality
More informationEvaluation and Management
Evaluation and Management CPT CPT copyright 2011 American Medical Association. All rights reserved. Fee schedules, relative value units, conversion factors and/or related components are not assigned by
More informationCommunity Performance Report
: Wenatchee Current Year: Q1 217 through Q4 217 Qualis Health Communities for Safer Transitions of Care Performance Report : Wenatchee Includes Data Through: Q4 217 Report Created: May 3, 218 Purpose of
More informationImproving Patient Satisfaction in the Orthopaedic Trauma Population
ORIGINAL ARTICLE Improving Patient Satisfaction in the Orthopaedic Trauma Population Brent J. Morris, MD,* Justin E. Richards, MD, Kristin R. Archer, PhD, Melissa Lasater, MSN, ACNP, Denise Rabalais, BA,
More informationINCENTIVE OFDRG S? MARTTI VIRTANEN NORDIC CASEMIX CONFERENCE
INCENTIVE OFDRG S? MARTTI VIRTANEN NORDIC CASEMIX CONFERENCE 3.6.2010 DIAGNOSIS RELATED GROUPS Grouping of patients/episodes of care based on diagnoses, interventions, age, sex, mode of discharge (and
More informationObjectives. Prevalence of Non-Adherence. Medications and Care Transitions. The Cost of Readmissions. The Pharmacist s Role in Improving Care 4/22/2015
MEDS TO BEDS: DELIVERING REDUCED READMISSIONS, LOWER COSTS, AND IMPROVED QUALITY Laura S. Carr PharmD, Senior Attending Pharmacist, Transitional Care Massachusetts General Hospital Ed Cohen, PharmD, FAPhA
More informationPiloting Bundled Medicare Payments for Hospital and Post-Hospital Care /
Piloting Bundled Medicare Payments for Hospital and Post-Hospital Care / A Study of Two Conditions Raises Key Policy Design Considerations March 2010 Policymakers are exploring many different models for
More informationVJ Periyakoil Productions presents
VJ Periyakoil Productions presents Oscar thecare Cat: Advance Lessons Learned Planning Joan M. Teno, MD, MS Professor of Community Health Warrant Alpert School of Medicine at Brown University VJ Periyakoil,
More informationWhen the Best Surprise is No Surprise
PROVIDER ENGAGEMENT When the Best Surprise is No Surprise Managing Margins and Efficiency in Outpatient Surgery Sarah Wald Dedicated Advisor Impetus for Outpatient Expansion 2 Continued Outpatient Volume
More informationTransitions of Care. Objectives 1/6/2016. Roman Digilio, PharmD PGY1 Resident West Kendall Baptist Hospital. The author has nothing to disclose.
Transitions of Care Roman Digilio, PharmD PGY1 Resident West Kendall Baptist Hospital 1 The author has nothing to disclose. 2 Objectives Discuss current healthcare trends and the need for pharmacists in
More informationJoint Statement on Ambulance Reform
Joint Statement on Ambulance Reform Policymakers Should Examine Short- and Intermediate-Term Policies to Promote Innovation in the Delivery of Emergency and Non- Emergency Care Provided by Ambulance Services
More informationThe spoke before the hub
Jones Lang LaSalle February Series: Ambulatory Care The spoke before the hub Turning the healthcare delivery model upside down For decades, the model for delivering healthcare in the U.S. has been slowly
More informationReimbursement guide. IODOSORB/IODOFLEX are Cadexomer Iodine-based products, available in two forms gel or pad.
Reimbursement guide IODOSORB/IODOFLEX are Cadexomer Iodine-based products, available in two forms gel or pad. IODOSORB/IODOFLEX remove barriers to healing by its dual action antimicrobial and desloughing
More informationHow to Win Under Bundled Payments
How to Win Under Bundled Payments Donald E. Fry, M.D., F.A.C.S. Executive Vice-President, Clinical Outcomes MPA Healthcare Solutions Chicago, Illinois Adjunct Professor of Surgery Northwestern University
More informationComparison of ACP Policy and IOM Report Graduate Medical Education That Meets the Nation's Health Needs
IOM Recommendation Recommendation 1: Maintain Medicare graduate medical education (GME) support at the current aggregate amount (i.e., the total of indirect medical education and direct graduate medical
More informationOptima Health Provider Manual
Optima Health Provider Manual Supplemental Information For Ohio Facilities and Ancillaries This supplement of the Optima Health Ohio Provider Manual provides information of specific interest to Participating
More informationThe dawn of hospital pay for quality has arrived. Hospitals have been reporting
Value-based purchasing SCIP measures to weigh in Medicare pay starting in 2013 The dawn of hospital pay for quality has arrived. Hospitals have been reporting Surgical Care Improvement Project (SCIP) measures
More information