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https://www.readbyqxmd.com/read/29622136/american-college-of-radiology-accreditation-performance-metrics-reimbursement-and-economic-considerations-in-breast-mr-imaging
#1
REVIEW
Matthew F Covington, Catherine A Young, Catherine M Appleton
Accreditation through the American College of Radiology (ACR) Breast Magnetic Resonance Imaging Accreditation Program is necessary to qualify for reimbursement from Medicare and many private insurers and provides facilities with peer review on image acquisition and clinical quality. Adherence to ACR quality control and technical practice parameter guidelines for breast MR imaging and performance of a medical outcomes audit program will maintain high-quality imaging and facilitate accreditation. Economic factors likely to influence the practice of breast MR imaging include cost-effectiveness, competition with lower-cost breast-imaging modalities, and price transparency, all of which may lower the cost of MR imaging and allow for greater utilization...
May 2018: Magnetic Resonance Imaging Clinics of North America
https://www.readbyqxmd.com/read/29582674/current-procedural-terminology-coding-for-surgical-pathology-a-review-and-one-academic-center-s-experience-with-pathologist-verified-coding
#2
Audrey Deeken-Draisey, Allison Ritchie, Guang-Yu Yang, Margaret Quinn, Linda M Ernst, Ajda Guttormsen, Gyongyi Ella Simionov, Kruti P Maniar
CONTEXT: - The Current Procedural Terminology (CPT) system is a standardized numerical coding system for reporting medical procedures and services, and is the basis for reimbursement of health care providers by Medicare and other third-party payers. Accurate CPT coding is therefore crucial for appropriate compensation as well as for compliance with Medicare policies, and erroneous coding may result in loss of revenues and/or significant monetary penalties for a hospital or practice. OBJECTIVE: - To provide a review of the history, current state, and basic principles of CPT coding, in particular as it applies to the practice of surgical pathology, and to present our experience with initiating a new system of pathologist involvement in the review and verification of CPT codes, including the most common codes that require modification in our practice at the time of sign-out or post-sign-out auditing...
March 27, 2018: Archives of Pathology & Laboratory Medicine
https://www.readbyqxmd.com/read/29519243/non-aids-complexity-amongst-patients-living-with-hiv-in-sydney-risk-factors-and-health-outcomes
#3
Derek J Chan, Virginia Furner, Don E Smith, Mithilesh Dronavalli, Rohan I Bopage, Jeffrey J Post, Anjali K Bhardwaj
OBJECTIVE: To assess the prevalence of non-AIDS co-morbidities (NACs) and predictors of adverse health outcomes amongst people living with HIV in order to identify health needs and potential gaps in patient management. DESIGN: Retrospective, non-consecutive medical record audit of patients attending a publicly funded HIV clinic in metropolitan Sydney analysed for predictors of adverse health outcomes. We developed a scoring system based on the validated Charlson score method for NACs, mental health and social issues and confounders were selected using directed acyclic graph theory under the principles of causal inference...
March 8, 2018: AIDS Research and Therapy
https://www.readbyqxmd.com/read/29444552/optometry-facilitated-teleophthalmology-an-audit-of-the-first-year-in-western-australia
#4
Stephen E Bartnik, Stephen P Copeland, Angela J Aicken, Angus W Turner
BACKGROUND: Lions Outback Vision has run a state-wide teleophthalmology service since 2011. In September 2015 the Australian federal government introduced a Medicare reimbursement for optometry-facilitated teleophthalmology consultations under specific circumstances. This audit demonstrates the first 12 months experience with this scheme. We aim to provide practical insights for others looking to embed a telemedicine program as part of delivering outreach clinical services. METHODS: A 12-month retrospective audit was performed between September 2015 and August 2016, inclusive...
February 14, 2018: Clinical & Experimental Optometry: Journal of the Australian Optometrical Association
https://www.readbyqxmd.com/read/29399974/early-repeat-computed-tomographic-imaging-in-transferred-trauma-and-neurosurgical-patients-incidence-indications-and-impact
#5
Penni Blazak, Craig Hacking, Jeffrey Presneill, Michael Reade
INTRODUCTION: Computed tomographic (CT) imaging is widely available in Australian rural and remote hospitals and is often performed prior to patient transfer to definitive tertiary hospital care. We hypothesised that critically ill trauma and neurosurgical patients might have CT scans repeated after interhospital transfer and that the utility of this practice might be low in relation to the additional financial cost and radiation exposure. METHODS: We conducted a retrospective review of clinical records to determine the proportion of trauma and neurosurgical patients transferred to our tertiary ICU from other hospitals between 1 June 2013 and 30 June 2014 who underwent a repeat CT scan...
February 5, 2018: Journal of Medical Imaging and Radiation Oncology
https://www.readbyqxmd.com/read/29380345/an-evaluation-of-routine-antenatal-depression-screening-and-psychosocial-assessment-in-a-regional-private-maternity-setting-in-australia
#6
Harish Kalra, Nicole Reilly, Marie-Paule Austin
BACKGROUND: There is limited information relating to routine depression screening and psychosocial assessment programs in private maternity settings in Australia. AIMS: To describe the psychosocial profile of a sample of private maternity patients who participated in a depression screening and psychosocial risk assessment program as part of routine antenatal care, and to explore women's experience of receiving this component of pregnancy care. MATERIALS AND METHODS: We conducted a retrospective medical records audit of 455 consecutive women having a routine psychosocial assessment and referral...
January 30, 2018: Australian & New Zealand Journal of Obstetrics & Gynaecology
https://www.readbyqxmd.com/read/28944526/state-medicaid-fees-and-access-to-primary-care-physicians
#7
Rajiv Sharma, Sarah Tinkler, Arnab Mitra, Sudeshna Pal, Raven Susu-Mago, Miron Stano
Medicaid and uninsured patients are disadvantaged in access to care and are disproportionately Black and Hispanic. Using a national audit of primary care physicians, we examine the relationship between state Medicaid fees for primary care services and access for Medicaid, Medicare, uninsured, and privately insured patients who differ by race/ethnicity and sex. We found that states with higher Medicaid fees had higher probabilities of appointment offers and shorter wait times for Medicaid patients, and lower probabilities of appointment offers and longer wait times for uninsured patients...
September 24, 2017: Health Economics
https://www.readbyqxmd.com/read/28697295/using-electronic-medical-records-to-assess-the-rate-of-treatment-for-osteoporosis-in-australia
#8
Megan Elliott-Rudder, Catherine Harding, Joseph McGirr, Alexa Seal, Louis Pilotto
BACKGROUND: Despite available Medicare Benefits Schedule subsidies, it has been suggested that screening and treatment for osteoporosis are under-accessed in Australia, particularly in patients ≥70 years. This study describes the rate of osteoporosis treatment in those aged ≥70 years in regional New South Wales as identified in the electronic medical records (EMR) of 11 general practices. METHODS: EMR data were extracted using a Canning Tool adaptation. The prevalence of osteoporosis, fracture and bone-active medication prescriptions were described, and associations examined...
2017: Australian Family Physician
https://www.readbyqxmd.com/read/28467733/is-it-time-to-abandon-hospital-accreditation
#9
John R Griffith
Hospitals contracting with the Centers for Medicare & Medicaid Services (CMS) must comply with Conditions of Participation (CoP), enforced by 4 certified independent accrediting organizations (AOs) or individual state survey. Recent work documents that the system fails to achieve consistent clinical outcomes, allowing several-fold variation in mortality and patient safety. Other publicly reported evidence shows weaker clinical performance by state-surveyed hospitals, inexplicable variation in individual state surveys, and recurring disagreement between initial and audit surveyors...
January 2018: American Journal of Medical Quality: the Official Journal of the American College of Medical Quality
https://www.readbyqxmd.com/read/28411297/hospitalizations-with-observation-services-and-the-medicare-part-a-complex-appeals-process-at-three-academic-medical-centers
#10
Ann M Sheehy, Jeannine Z Engel, Charles F S Locke, Daniel J Weissburg, Kevin Eldridge, Bartho Caponi, Amy Deutschendorf
Hospitalists and other providers must classify hospitalized patients as inpatient or outpatient, the latter of which includes all observation stays. These orders direct hospital billing and payment, as well as patient out-of-pocket expenses. The Centers for Medicare & Medicaid Services (CMS) audits hospital billing for Medicare beneficiaries, historically through the Recovery Audit program. A recent U.S. Government Accountability Office (GAO) report identified problems in the hospital appeals process of Recovery Audit program audits to which CMS proposed reforms...
April 2017: Journal of Hospital Medicine: An Official Publication of the Society of Hospital Medicine
https://www.readbyqxmd.com/read/28375590/medicaid-program-disproportionate-share-hospital-payments-treatment-of-third-party-payers-in-calculating-uncompensated-care-costs-final-rule
#11
(no author information available yet)
This final rule addresses the hospital-specific limitation on Medicaid disproportionate share hospital (DSH) payments under section 1923(g)(1)(A) of the Social Security Act (Act), and the application of such limitation in the annual DSH audits required under section 1923(j) of the Act, by clarifying that the hospital-specific DSH limit is based only on uncompensated care costs. Specifically, this rule makes explicit in the text of the regulation, an existing interpretation that uncompensated care costs include only those costs for Medicaid eligible individuals that remain after accounting for payments made to hospitals by or on behalf of Medicaid eligible individuals, including Medicare and other third party payments that compensate the hospitals for care furnished to such individuals...
April 3, 2017: Federal Register
https://www.readbyqxmd.com/read/28323079/factors-driving-live-discharge-from-hospice-provider-perspectives
#12
Rachel Dolin, Laura C Hanson, Sarah F Rosenblum, Sally C Stearns, George M Holmes, Pam Silberman
CONTEXT: The proportion of patients disenrolling from hospice before death has increased over the decade with significant variations across hospice types and regions. Such trends have raised concerns about live disenrollment's effect on care quality. Live disenrollment may be driven by factors other than patient preference and may create discontinuities in care, disrupting ongoing patient-provider relationships. Researchers have not explored when and how providers make this decision with patients...
June 2017: Journal of Pain and Symptom Management
https://www.readbyqxmd.com/read/28143604/what-factors-contribute-to-the-continued-low-rates-of-indigenous-status-identification-in-urban-general-practice-a-mixed-methods-multiple-site-case-study
#13
MULTICENTER STUDY
Heike Schütze, Lisa Jackson Pulver, Mark Harris
BACKGROUND: Indigenous peoples experience worse health and die at younger ages than their non-indigenous counterparts. Ethnicity data enables health services to identify inequalities experienced by minority populations and to implement and monitor services specifically targeting them. Despite significant Government intervention, Australia's Indigenous peoples, the Aboriginal and Torres Strait Islander peoples, continue to be under identified in data sets. We explored the barriers to Indigenous status identification in urban general practice in two areas in Sydney...
January 31, 2017: BMC Health Services Research
https://www.readbyqxmd.com/read/28027164/meeting-the-needs-for-radiation-protection-diagnostic-imaging
#14
Donald P Frush
Radiation and potential risk during medical imaging is one of the foremost issues for the imaging community. Because of this, there are growing demands for accountability, including appropriate use of ionizing radiation in diagnostic and image-guided procedures. Factors contributing to this include increasing use of medical imaging; increased scrutiny (from awareness to alarm) by patients/caregivers and the public over radiation risk; and mounting calls for accountability from regulatory, accrediting, healthcare coverage (e...
February 2017: Health Physics
https://www.readbyqxmd.com/read/27925425/preventing-acute-care-associated-venous-thromboembolism-in-adult-and-pediatric-patients-across-a-large-healthcare-system
#15
Timothy I Morgenthaler, Vilmarie Rodriguez
BACKGROUND: Although effective methods for venous thromboembolism prophylaxis (VTE-P) have been known for decades, reliable implementation has been challenging. OBJECTIVE: Develop reliable VTE-P systems for adult and for pediatric patients to reduce preventable venous thromboembolism (VTE). DESIGN: We used a discovery and diffusion system to first develop an effective system in 1 hospital location, and then spread the principle best practices across the entire 22-hospital system...
December 2016: Journal of Hospital Medicine: An Official Publication of the Society of Hospital Medicine
https://www.readbyqxmd.com/read/27677890/review-of-knee-arthroscopic-practice-and-coding-at-a-major-metropolitan-centre
#16
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...
May 2017: 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
#17
Heike Schütze, 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
#18
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
#19
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
#20
(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
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