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https://www.readbyqxmd.com/read/27906530/medicare-program-hospital-outpatient-prospective-payment-and-ambulatory-surgical-center-payment-systems-and-quality-reporting-programs-organ-procurement-organization-reporting-and-communication-transplant-outcome-measures-and-documentation-requirements-electronic
#1
(no author information available yet)
This final rule with comment period revises the Medicare hospital outpatient prospective payment system (OPPS) and the Medicare ambulatory surgical center (ASC) payment system for CY 2017 to implement applicable statutory requirements and changes arising from our continuing experience with these systems. In this final rule with comment period, we describe the changes to the amounts and factors used to determine the payment rates for Medicare services paid under the OPPS and those paid under the ASC payment system...
November 14, 2016: Federal Register
https://www.readbyqxmd.com/read/27890310/same-day-total-hip-arthroplasty-performed-at-an-ambulatory-surgical-center-90-day-complication-rate-on-549-patients
#2
Gregg R Klein, Jason M Posner, Harlan B Levine, Mark A Hartzband
BACKGROUND: There is an increasing interest in outpatient total hip arthroplasty (THA), as there are perceived benefits to the patient, insurer, and overall healthcare system. However, the safety of outpatient total joint arthroplasty has not been studied. METHODS: Five hundred forty-nine patients who underwent mini-posterior THA at a freestanding independent ambulatory surgical center (ASC) were reviewed. All patients were discharged to home on the day of surgery...
October 20, 2016: Journal of Arthroplasty
https://www.readbyqxmd.com/read/27890061/preoperative-screening-for-sleep-disordered-breathing-in-children-a-systematic-literature-review
#3
Erin E Bauer, Rebecca Lee, Yasmine N Campbell
Clinicians frequently underestimate or do not assess sleep-disordered breathing (SDB) in children in ambulatory surgical centers. Identifying the disorder and obtaining information relevant to anesthesia management can be assisted by the use of a standard questionnaire during preoperative assessment. We wanted to determine whether a preoperative screening tool increases clinician awareness of SDB in children and leads to a decrease in perioperative respiratory adverse events. We reviewed 21 articles to identify reliable screening tools for pediatric SDB in ambulatory surgical centers and selected six articles for the review...
December 2016: AORN Journal
https://www.readbyqxmd.com/read/27871578/children-with-heart-disease-risk-stratification-for-non-cardiac-surgery
#4
Angela K Saettele, Jacob L Christensen, Kelly L Chilson, David J Murray
STUDY OBJECTIVE: Children with congenital or acquired heart disease have an increased risk of anesthesia related morbidity and mortality. The child's anesthetic risk is related to the severity of their underlying cardiac disease, associated comorbidities, and surgical procedure. The goal of this project was to determine the ease of use of a preoperative risk stratification tool for assigning pediatric cardiac staff and to determine the relative frequency that children with low, moderate, and high risk cardiac disease present for non-cardiac surgery at a tertiary pediatric hospital...
December 2016: Journal of Clinical Anesthesia
https://www.readbyqxmd.com/read/27871557/effect-of-adjunctive-dexmedetomidine-on-postoperative-intravenous-opioid-administration-in-patients-undergoing-thyroidectomy-in-an-ambulatory-setting
#5
Kristin Long, Joseph Ruiz, Spencer Kee, Alicia Kowalski, Farzin Goravanchi, Jeff Cerny, Katy French, Mike Hernandez, Nancy Perrier, Elizabeth Rebello
STUDY OBJECTIVE: Two of the most feared complications for patients undergoing thyroid surgery are pain and postoperative nausea and vomiting. Thyroidectomy is considered high risk for postoperative nausea and vomiting, and recent studies have looked at adjuncts to treat pain, limit narcotic use, "fast-track" the surgical process, and enhance recovery without compromising the patient's safety. One such perioperative medication of interest is dexmedetomidine (Dex), a centrally acting α-2 agonist that has been associated with reducing pain and postoperative opioid consumption...
December 2016: Journal of Clinical Anesthesia
https://www.readbyqxmd.com/read/27871521/functional-outcome-and-cost-effectiveness-of-outpatient-vs-inpatient-care-for-complex-hind-foot-and-ankle-surgery-a-retrospective-cohort-study
#6
Justin Oh, Anahi Perlas, Johnny Lau, Rajiv Gandhi, Vincent W S Chan
STUDY OBJECTIVE: To compare the postoperative functional outcome and the total cost associated with outpatient vs inpatient care following complex hind-foot and ankle surgery. DESIGN: Retrospective, cohort study. SETTING: Tertiary care center. PATIENTS: Forty patients, American Society of Anesthesiologists 1-3, of either sex undergoing elective complex hind-foot and ankle surgery (fusion, osteotomy, or multiple ligament repair)...
December 2016: Journal of Clinical Anesthesia
https://www.readbyqxmd.com/read/27870667/the-role-of-dedicated-musculoskeletal-urgent-care-centers-in-reducing-cost-and-improving-access-to-orthopaedic-care
#7
Travis J Anderson, Peter L Althausen
OBJECTIVES: Over the past few years, the United States has seen the rapid growth of dedicated musculoskeletal urgent care centers owned and operated by individual orthopaedic practices. In June of 2014, our practice opened the first dedicated orthopaedic urgent care in the region staffed by physician assistants and supervised by orthopaedic surgeons. Our hypothesis is that such centers can safely improve orthopaedic care for ambulatory orthopaedic injuries, decrease volume for overburdened emergency departments (EDs), reduce wait times and significantly decrease the cost of care while improving access to orthopaedic specialists...
December 2016: Journal of Orthopaedic Trauma
https://www.readbyqxmd.com/read/27852902/overlapping-surgery-in-the-ambulatory-orthopaedic-setting
#8
Alan L Zhang, David C Sing, Debbie Y Dang, C Benjamin Ma, Dennis Black, Thomas P Vail, Brian T Feeley
BACKGROUND: The practice of a surgeon performing procedures in two operating rooms during overlapping time frames has been described as concurrent surgery if critical portions occur simultaneously, or overlapping surgery if they do not. Although recent media reports have focused on the potential adverse effects of these practices, to our knowledge, there has been no previous research investigating outcomes of overlapping procedures in orthopaedic surgery. METHODS: A retrospective review of an institutional clinical database from 2012 to 2015 was utilized to collect data from all surgical cases (including sports medicine, hand, and foot and ankle) performed at an ambulatory orthopaedic surgery center...
November 16, 2016: Journal of Bone and Joint Surgery. American Volume
https://www.readbyqxmd.com/read/27843687/cervical-spine-surgery-performed-in-ambulatory-surgical-centers-are-patients-being-put-at-increased-risk
#9
Nancy E Epstein
BACKGROUND: Spine surgeons are being increasingly encouraged to perform cervical operations in outpatient ambulatory surgical centers (ASC). However, some studies/data coming out of these centers are provided by spine surgeons who are part or full owners/shareholders. In Florida, for example, there was a 50% increase in ASC (5349) established between 2000-2007; physicians had a stake (invested) in 83%, and outright owned 43% of ASC. Data regarding "excessive" surgery by ASC surgeon-owners from Idaho followed shortly thereafter...
2016: Surgical Neurology International
https://www.readbyqxmd.com/read/27819001/interspinous-process-decompression-expanding-treatment-options-for-lumbar-spinal-stenosis
#10
Pierce D Nunley, A Nick Shamie, Scott L Blumenthal, Douglas Orndorff, Jon E Block, Fred H Geisler
Interspinous process decompression is a minimally invasive implantation procedure employing a stand-alone interspinous spacer that functions as an extension blocker to prevent compression of neural elements without direct surgical removal of tissue adjacent to the nerves. The Superion® spacer is the only FDA approved stand-alone device available in the US. It is also the only spacer approved by the CMS to be implanted in an ambulatory surgery center. We computed the within-group effect sizes from the Superion IDE trial and compared them to results extrapolated from two randomized trials of decompressive laminectomy...
2016: BioMed Research International
https://www.readbyqxmd.com/read/27811597/predictors-of-at-home-arterial-oxygen-desaturation-events-in-ambulatory-surgical-patients
#11
Chuck Biddle, Charles Elam, Laura Lahaye, Gordon Kerr, Laura Chubb, Brad Verhulst
OBJECTIVES: Little is known about the early recovery phase occurring at-home after anesthesia and surgery in ambulatory surgical patients. We studied quantitative oximetry and quality-of-life metrics in the first 48 hours after same-day orthopedic surgery examining the association between the recovery metrics and specific patient and procedural factors. METHODS: We used the STOP-Bang score to quantify patient risk for obstructive sleep apnea in 50 adult patients at 2 centers using continuous portable oximetry and patient journaling...
November 2, 2016: Journal of Patient Safety
https://www.readbyqxmd.com/read/27792057/cost-savings-from-utilization-of-an-ambulatory-surgery-center-for-orthopaedic-day-surgery
#12
Peter D Fabricant, Mark A Seeley, Joshua C Rozell, Evan Fieldston, John M Flynn, Lawrence M Wells, Theodore J Ganley
INTRODUCTION: Healthcare providers are increasingly searching for ways to provide cost-efficient, high-quality care. Previous studies on evaluating cost used estimated cost-to-charge ratios, which are inherently inaccurate. The purpose of this study was to quantify actual direct cost savings from performing pediatric orthopaedic sports day surgery at an ambulatory surgery center (ASC) compared with a university-based children's hospital (UH). METHODS: Custom-scripted accounting software was queried for line-item costs for a period of 3 fiscal years (fiscal year 2012 to fiscal year 2014) for eight day surgery procedures at both a UH and a hospital-owned ASC...
December 2016: Journal of the American Academy of Orthopaedic Surgeons
https://www.readbyqxmd.com/read/27736658/the-direct-costs-of-epilepsy-in-russia-a-prospective-cost-of-illness-study-from-a-single-center-in-moscow
#13
Alla Guekht, Maria Mizinova, Igor Kaimovsky, Oksana Danilenko, Elisa Bianchi, Ettore Beghi
OBJECTIVE: The objective of this study was to investigate prospectively the direct costs of epilepsy in Russia, taking a patient perspective and a bottom-up approach. METHODS: The study was conducted in adolescents and adults with epilepsy seen in the ambulatory services of a city hospital in Moscow. Patients were assigned to different prognostic categories: newly diagnosed epilepsy; epilepsy in remission for 2+years; epilepsy in remission for <2years or with occasional seizures; active, nondrug-resistant epilepsy; drug-resistant epilepsy; and drug-resistant epilepsy in surgical candidates...
October 10, 2016: Epilepsy & Behavior: E&B
https://www.readbyqxmd.com/read/27694451/incidence-and-risk-factors-for-major-surgical-site-infections-in-aesthetic-surgery-analysis-of-129-007-patients
#14
Christodoulos Kaoutzanis, Varun Gupta, Julian Winocour, Bruce Shack, James C Grotting, Kent Higdon
BACKGROUND: Surgical site infections (SSIs) represent one of the most common postoperative complications in patients undergoing aesthetic surgery. OBJECTIVES: This study reports the incidence and risk factors of major SSIs following aesthetic surgery. METHODS: A prospective cohort of patients who underwent aesthetic surgery between 2008 and 2013 was identified from the CosmetAssure database. Primary outcome was occurrence of a major SSI requiring emergency room visit, hospital admission, or reoperation within 30 days of the index operation...
September 30, 2016: Aesthetic Surgery Journal
https://www.readbyqxmd.com/read/27687425/using-an-at-risk-salary-model-to-improve-throughput-in-academic-medical-center-operating-rooms
#15
Rachel M Kacmar, Brian M Davidson, Matthew Victor, Ken Bullard, Jose Melendez
STUDY OBJECTIVE: The objective was to analyze if an at-risk salary model for faculty anesthesiologists could improve on-time first case starts (FCSs) and case turnovers (TOs) in an academic hospital inpatient operating room (IOR) and ambulatory surgery center (ASC). Organizational goals were 65% and 70% on-time FCS and case TO times for IOR and ASC, respectively. DESIGN: This was a retrospective study. SETTING: Surgical cases performed at both the IORs and the ASCs at a large academic medical center were included...
November 2016: Journal of Clinical Anesthesia
https://www.readbyqxmd.com/read/27687352/outpatient-laparoscopic-sleeve-gastrectomy-first-100-cases
#16
Rachid Badaoui, Youssef Alami Chentoufi, Abdelhakim Hchikat, Lionel Rebibo, Ivan Popov, Abdennaceur Dhahri, Ghada Antoun, Jean-Marc Regimbeau, Emmanuel Lorne, Hervé Dupont
STUDY OBJECTIVE: The development of outpatient surgery was one of the major goals of public health policy in 2010. The purpose of this observational prospective study was to evaluate the feasibility of laparoscopic sleeve gastrectomy (SG) in an ambulatory setting. DESIGN: Study design was a prospective prospective observational, nonrandomized study, registered (ClinicalTrials.gov identifier: NCT01513005), with institutional review board approval and written informed consent...
November 2016: Journal of Clinical Anesthesia
https://www.readbyqxmd.com/read/27679944/clinical-epidemiological-profile-of-acute-appendicitis-retrospective-analysis-of-638-cases
#17
Amanda Pereira Lima, Felipe José Vieira, Gabriela Procópio DE Moraes Oliveira, Plínio Dos Santos Ramos, Marielle Elisa Avelino, Felipe Garcia Prado, Gilson Salomão, Francisco Campos Silva, João Vicente Linhares Rodrigues
OBJECTIVE: to describe the clinical and epidemiological profile of acute appendicitis (AA) of the patients treated at a referral center in the Juiz de Fora macro-region, Minas Gerais State, Brazil. METHODS: we conducted a retrospective, observational study in the Dr. Mozart Geraldo TeixeiraEmergency Hospital. We selected 638 patients diagnosed with AA, and analyzed the variables gender, age, evolutionary phase, length of hospital stay, pathological diagnosis, use of antibiotics, use of drains, complications and mortality...
July 2016: Revista do Colégio Brasileiro de Cirurgiões
https://www.readbyqxmd.com/read/27669653/national-surgical-trends-and-perioperative-outcomes-of-mid-urethral-sling-placement-for-stress-urinary-incontinence
#18
Emily A Slopnick, Adonis K Hijaz, Carvell T Nguyen, Robert Abouassaly, Christopher M Gonzalez, Sangeeta T Mahajan, J Welles Henderson, Matthew J Bream, Simon P Kim
OBJECTIVES: To determine contemporary trends, patient characteristics, and outcomes for mid-urethral sling placement (MUS) at inpatient and ambulatory facilities from a national database. METHODS: Using the American College of Surgeons National Surgical Quality Improvement Program data base, we identified 7,767 women who underwent isolated MUS 2006-2012. We stratified patients by hospitalization type (outpatient vs. hospitalization). Primary outcomes were 30-day complications, readmissions, and reoperations...
September 23, 2016: Urology
https://www.readbyqxmd.com/read/27664881/postoperative-acute-care-use-after-freestanding-ambulatory-surgery
#19
George Molina, Bridget A Neville, Stuart R Lipsitz, Lorri Gibbons, Ashley Kay Childers, Atul A Gawande, William R Berry, Alex B Haynes
BACKGROUND: Surgical procedures in the United States are increasingly performed in the ambulatory setting, including freestanding ambulatory surgery centers (ASCs). However, there is a lack of research and tracking of surgical outcomes in this setting. MATERIALS AND METHODS: We analyzed data from a state all-payer claims database to produce a retrospective cohort study on the rate of acute care use (emergency department [ED] visits and inpatient admissions) within 7 d after operations performed in freestanding ASCs in South Carolina...
October 2016: Journal of Surgical Research
https://www.readbyqxmd.com/read/27662397/opportunities-to-improve-the-value-of-outpatient-surgical-care
#20
Feryal Erhun, Elizabeth Malcolm, Maziyar Kalani, Kimberly Brayton, Christine Nguyen, Steven M Asch, Terry Platchek, Arnold Milstein
OBJECTIVES: Nearly 57 million outpatient surgeries-invasive procedures performed on an outpatient basis in hospital outpatient departments (HOPDs) or ambulatory surgery centers (ASCs)-produced annually in the United States account for roughly 7% of healthcare expenditures. Although moving inpatient surgeries to outpatient settings has lowered the cost of care, substantial opportunities to improve the value of outpatient surgery remain. To exploit these remaining opportunities, we composed an evidence-based care delivery composite for national discussion and pilot testing...
2016: American Journal of Managed Care
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