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https://www.readbyqxmd.com/read/27677890/review-of-knee-arthroscopic-practice-and-coding-at-a-major-metropolitan-centre
#1
James P Lisik, Michelle M Dowsey, Joshua Petterwood, Peter F M Choong
BACKGROUND: Arthroscopic knee surgery has been a topic of significant controversy in recent orthopaedic literature. Multiple studies have used administrative (Victorian Admitted Episodes Dataset and Centre for Health Record Linkage) data to identify trends in practice. This study explored the usage and reporting of arthroscopic knee surgery by conducting a detailed audit at a major Victorian public hospital. METHODS: A database of orthopaedic procedures at St Vincent's Hospital Melbourne was used to retrospectively identify cases of knee arthroscopy from 1 December 2011 to 1 April 2014...
September 27, 2016: ANZ Journal of Surgery
https://www.readbyqxmd.com/read/27622233/the-uptake-of-aboriginal-and-torres-strait-islander-health-assessments-fails-to-improve-in-some-areas
#2
Heike Sch├╝tze, Lisa Jackson Pulver, Mark Harris
BACKGROUND: The Medicare-rebated Health Assessment for Aboriginal and Torres Strait Islander People (Medicare Benefits Schedule [MBS] item number 715) has been progressively implemented across Australia since 1999. OBJECTIVE: This paper explores some of the reasons why the uptake of Health Assessment for Aboriginal and Torres Strait Islander People remains low in some metropolitan general practices. METHODS: Semi-structured interviews and self-complete mail surveys with 31 general practice staff and practitioners were combined with an audit of practice systems and patient medical records in seven general practices in Sydney...
June 2016: Australian Family Physician
https://www.readbyqxmd.com/read/27265921/the-use-of-an-indwelling-catheter-protocol-to-reduce-rates-of-postoperative-urinary-tract-infections
#3
Affan Umer, David S Shapiro, Chris Hughes, Cynthia Ross-Richardson, Scott Ellner
BACKGROUND: Catheter-associated urinary tract infections (CAUTI) have been associated with increases in morbidity and mortality as well as increased costs of hospitalization. At our institution, we implemented a protocol for indwelling catheter use, maintenance, and removal based on Center for Medicare and Medicaid Services (CMS) guidelines, in efforts to reduce CAUTI rates. METHODS: A hospital committee of quality stewards focused on several measures which included staff education, modification of existing systems to ensure compliance, and auditing of patient care areas for catheter utilization before implementation of the protocol...
April 2016: Connecticut Medicine
https://www.readbyqxmd.com/read/27178368/decade-long-trends-in-liver-transplant-waitlist-removal-due-to-illness-severity-the-impact-of-centers-for-medicare-and-medicaid-services-policy
#4
Natasha H Dolgin, Babak Movahedi, Paulo N A Martins, Robert Goldberg, Kate L Lapane, Frederick A Anderson, Adel Bozorgzadeh
BACKGROUND: The central tenet of liver transplant organ allocation is to prioritize the sickest patients first. However, a 2007 Centers for Medicare and Medicaid Services regulatory policy, Conditions of Participation (COP), which mandates publically reported transplant center performance assessment and outcomes-based auditing, critically altered waitlist management and clinical decision making. We examine the extent to which COP implementation is associated with increased removal of the "sickest" patients from the liver transplant waitlist...
June 2016: Journal of the American College of Surgeons
https://www.readbyqxmd.com/read/26964415/cms-gives-the-ra-program-a-makeover-with-more-changes-in-store
#5
(no author information available yet)
CMS has made changes in the scope of work for the Recovery Auditor program and has proposed a number of other changes to be implemented when new RA contracts are issued. CMS has restricted the number of additional documentation requests, has shortened the "look-back" period for patient status reviews, and announced penalties for RAs with high error rates. The new contracts shorten the time RAs have to complete complex reviews, requires RAs to wait 30 days before referring cases to the Medicare Administrative Contractors, and postpones contingency payments to RAs until after the second level of appeals...
March 2016: Hospital Case Management: the Monthly Update on Hospital-based Care Planning and Critical Paths
https://www.readbyqxmd.com/read/26964413/financial-stakes-rising-as-auditors-set-their-sights-on-providers
#6
(no author information available yet)
The Centers for Medicare & Medicaid Services (CMS) is continuing to tweak its various audit programs, and the changes make it imperative that case managers stay current so they can educate the rest of the staff. Hospitals have got to get patient status right up front, and that means case managers should review every patient who comes in from every point of access. Hospitals should eliminate the silos within their various departments and outside the hospital walls with post-acute providers so everyone can work together for better patient care...
March 2016: Hospital Case Management: the Monthly Update on Hospital-based Care Planning and Critical Paths
https://www.readbyqxmd.com/read/26927625/indirect-standardization-matching-assessing-specific-advantage-and-risk-synergy
#7
Jeffrey H Silber, Paul R Rosenbaum, Richard N Ross, Justin M Ludwig, Wei Wang, Bijan A Niknam, Alexander S Hill, Orit Even-Shoshan, Rachel R Kelz, Lee A Fleisher
OBJECTIVE: To develop a method to allow a hospital to compare its performance using its entire patient population to the outcomes of very similar patients treated elsewhere. DATA SOURCES/SETTING: Medicare claims in orthopedics and common general, gynecologic, and urologic surgery from Illinois, New York, and Texas from 2004 to 2006. STUDY DESIGN: Using two example "focal" hospitals, each hospital's patients were matched to 10 very similar patients selected from 619 other hospitals...
February 29, 2016: Health Services Research
https://www.readbyqxmd.com/read/26856028/responding-to-audits-managed-care-medicare-and-medicaid-oh-my
#8
Neville M Bilimoria
No abstract text is available yet for this article.
November 2015: Journal of Medical Practice Management: MPM
https://www.readbyqxmd.com/read/26738222/a-retrospective-audit-of-population-service-access-trends-for-cleft-lip-and-cleft-palate-patients
#9
L N Woincham, E Kruger, M Tennant
UNLABELLED: Population prevalence of orofacial clefts (OFCs) is well documented but the service utilisation patterns of these patients have received limited consideration. OBJECTIVE: To analyse 10-year trends in the utilisation of subsidised OFC related services in Australia. DESIGN: Retrospective audit of service utilisation and claims datasets. METHODS: Using state-wide hospital admission data, all persons treated for Cleft Palate Only (CPO) and Cleft Lip Only (CLO) as their primary diagnosis from 1999 to 2009 in Western Australia were included in the data frameset...
December 2015: Community Dental Health
https://www.readbyqxmd.com/read/26677536/medicare-and-medicaid-audits
#10
Sarah Kurusz
No abstract text is available yet for this article.
November 2015: Bulletin of the American College of Surgeons
https://www.readbyqxmd.com/read/26644137/unhealthy-alcohol-use-in-older-adults-association-with-readmissions-and-emergency-department-use-in-the-30-days-after-hospital-discharge
#11
Laura J Chavez, Chuan-Fen Liu, Nathan Tefft, Paul L Hebert, Brendan J Clark, Anna D Rubinsky, Gwen T Lapham, Katharine A Bradley
BACKGROUND: Unhealthy alcohol use could impair recovery of older patients after medical or surgical hospitalizations. However, no prior research has evaluated whether older patients who screen positive for unhealthy alcohol use are at increased risk of readmissions or emergency department (ED) visits within 30 days after discharge. This study examined the association between AUDIT-C alcohol screening results and 30-day readmissions or ED visits. METHODS: Veterans Affairs (VA) patients age 65 years or older, were eligible if they were hospitalized for a medical or surgical condition (2/1/2009-10/1/2011) and had an AUDIT-C score documented in their VA electronic medical record in the year before they were hospitalized...
January 1, 2016: Drug and Alcohol Dependence
https://www.readbyqxmd.com/read/26294267/operating-profitability-of-for-profit-and-not-for-profit-florida-community-hospitals-during-medicare-policy-changes-2000-to-2010
#12
Barbara Langland-Orban, John T Large, Alan M Sear, Hanze Zhang, Nanhua Zhang
Medicare Advantage was implemented in 2004 and the Recovery Audit Contractor (RAC) program was implemented in Florida during 2005. Both increase surveillance of medical necessity and deny payments for improper admissions. The purpose of the present study was to determine their potential impact on for-profit (FP) and not-for-profit (NFP) hospital operating margins in Florida. FP hospitals were expected to be more adversely affected as admissions growth has been one strategy to improve stock performance, which is not a consideration at NFPs...
2015: Inquiry: a Journal of Medical Care Organization, Provision and Financing
https://www.readbyqxmd.com/read/26189318/inpatient-vs-observation-will-it-ever-be-clear
#13
(no author information available yet)
Hospitals are still struggling with whether patients should be admitted or receive observation services despite efforts by the Centers for Medicare & Medicaid Services to clear up the confusion and conduct Probe and Educate audits. The two-midnight rule bases patient status on time in the hospital rather than clinical criteria, but case managers should still use decision-support software to determine if patients meet medical necessity criteria for an inpatient stay. Take a proactive approach and educate physicians up front about the level of detail the documentation should include to reflect the patient's conditions and intensity of service, and give them prompts in the medical record about what they should include...
August 2015: Hospital Case Management: the Monthly Update on Hospital-based Care Planning and Critical Paths
https://www.readbyqxmd.com/read/26119695/availability-of-new-medicaid-patient-appointments-and-the-role-of-rural-health-clinics
#14
Michael R Richards, Brendan Saloner, Genevieve M Kenney, Karin V Rhodes, Daniel Polsky
OBJECTIVE: To examine the willingness to accept new Medicaid patients among certified rural health clinics (RHCs) and other nonsafety net rural providers. DATA SOURCES: Experimental (audit) data from a 10-state study of primary care practices, county-level information from the Area Health Resource File, and RHC information from the Center for Medicare and Medicaid Services. STUDY DESIGN: We generate appointment rates for rural and nonrural areas by patient-payer type (private, Medicaid, self-pay) to then motivate our focus on within-rural variation by clinic type (RHC vs...
April 2016: Health Services Research
https://www.readbyqxmd.com/read/26092305/reforming-maternity-services-in-australia-outcomes-of-a-private-practice-midwifery-service
#15
E Wilkes, J Gamble, Ghazala Adam, D K Creedy
BACKGROUND AND AIMS: recent legislative changes in Australia have enabled eligible midwives to provide private primary maternity care with fee rebates through Medicare. This paper (1) discusses these changes affecting midwifery practice; (2) describes Australia's first private midwifery service with visiting rights to hospital for labour and birth care since Medicare funding for midwives was introduced in 2010; and (3) compares outcomes with National Core Maternity Indicators. METHODS: an audit of all client records (n=323) for the survey period from September 2012 to February 2014 was undertaken...
October 2015: Midwifery
https://www.readbyqxmd.com/read/25995304/predictors-of-payer-mix-and-financial-performance-among-safety-net-hospitals-prior-to-the-affordable-care-act
#16
Benjamin D Sommers, Juliana Stone, Nancy Kane
The objective of this study was to use audited hospital financial statements to identify predictors of payer mix and financial performance in safety net hospitals prior to the Affordable Care Act. We analyzed the 2010 financial statements of 98 large, urban safety net hospital systems in 34 states, supplemented with data on population demographics, hospital features, and state policies. We used multivariate regression to identify independent predictors of three outcomes: 1) Medicaid-reliant payer mix (hospitals for which at least 25% of hospital days are paid for by Medicaid); 2) safety net revenue-to-cost ratio (Medicaid and Medicare Disproportionate Share Hospital payments and local government transfers, divided by charity care costs and Medicaid payment shortfall); and 3) operating margin...
2016: International Journal of Health Services: Planning, Administration, Evaluation
https://www.readbyqxmd.com/read/25938355/is-vitamin-d-testing-at-a-tertiary-referral-hospital-consistent-with-guideline-recommendations
#17
Katherine Norton, Samuel D Vasikaran, Gerard T Chew, Paul Glendenning
To determine if 25 hydroxyvitamin D (25OHD) testing at our tertiary referral hospital is consistent with guideline recommendations concerning the clinical indications for testing, the timing of repeat testing and utilisation of the test result, we conducted a retrospective audit of electronic laboratory and patient case records. We included adult inpatients and outpatients who had serum 25OHD measured during a randomly selected one-week audit period and who had patient case records available for detailed review...
June 2015: Pathology
https://www.readbyqxmd.com/read/25933614/mispricing-in-the-medicare-advantage-risk-adjustment-model
#18
Jing Chen, Randall P Ellis, Katherine H Toro, Arlene S Ash
The Centers for Medicare and Medicaid Services (CMS) implemented hierarchical condition category (HCC) models in 2004 to adjust payments to Medicare Advantage (MA) plans to reflect enrollees' expected health care costs. We use Verisk Health's diagnostic cost group (DxCG) Medicare models, refined "descendants" of the same HCC framework with 189 comprehensive clinical categories available to CMS in 2004, to reveal 2 mispricing errors resulting from CMS' implementation. One comes from ignoring all diagnostic information for "new enrollees" (those with less than 12 months of prior claims)...
2015: Inquiry: a Journal of Medical Care Organization, Provision and Financing
https://www.readbyqxmd.com/read/25842707/the-racs-are-back-auditors-to-start-performing-complex-reviews
#19
(no author information available yet)
The Recovery Auditor program is cranking back up again after almost a year's hiatus, but despite the Centers for Medicare & Medicaid Services' plans to improve the program and issue new contracts, the audits will be conducted by the same auditors under the same rules. Auditors are likely to target short stays and other weak areas the Medicare Administrative Contractors identified during Probe and Educate, according to Elizabeth Lamkin, MHA, chief executive officer and partner in PACE Healthcare Consulting, LLC, based in Beaufort County, SC...
April 2015: Hospital Case Management: the Monthly Update on Hospital-based Care Planning and Critical Paths
https://www.readbyqxmd.com/read/25821191/pressure-ulcers-in-the-icu-patient-an-update-on-prevention-and-treatment
#20
Anna E Krupp, Jill Monfre
The occurrence of hospital-acquired pressure ulcers (HAPU) is a recognized metric of quality of care by the Centers for Medicare and Medicaid Services (CMS) and the Agency for Healthcare Research and Quality. Pressure ulcer (PU) prevention and treatment have become a priority for many facilities as the reimbursement for hospital-acquired PUs has been significantly restricted by regulations implemented by CMS in 2008. Intensive care unit (ICU) patients are at higher risk for PU development due to comorbidities and life-saving treatment modalities in this environment...
March 2015: Current Infectious Disease Reports
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