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Kim AG, Rizk AA, Ina JG, Magister SJ, Salata MJ. Declining Inflation-Adjusted Medicare Physician Fees: An Unsustainable Trend in Hip Arthroscopy. J Am Acad Orthop Surg 2024:00124635-990000000-00925. [PMID: 38626441 DOI: 10.5435/jaaos-d-23-00080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 02/25/2024] [Indexed: 04/18/2024] Open
Abstract
INTRODUCTION Although hip arthroscopy continues to be one of the most used arthroscopic procedures, no focused, comprehensive evaluation of reimbursement trends has been conducted. The purpose of this study was to analyze the temporal Medicare reimbursement trends for hip arthroscopy procedures. METHODS From 2011 to 2021, the Medicare Physician Fee Schedule Look-Up Tool was queried for Current Procedural Terminology (CPT) codes related to hip arthroscopy (29860 to 29863, 29914 to 29916). All monetary data were adjusted to 2021 US dollars. The compound annual growth rate and total percentage change were calculated. Mann-Kendall trend tests were used to evaluate the reimbursement trends. RESULTS Based on the unadjusted values, a significant increase in physician fee was observed from 2011 to 2021 for CPT codes 29861 (removal of loose or foreign bodies; % change: 3.49, P = 0.03) and 29862 (chondroplasty, abrasion arthroplasty, labral resection; % change: 3.19, P = 0.03). The remaining CPT codes experienced no notable changes in reimbursement based on the unadjusted values. After adjusting for inflation, all seven of the hip arthroscopy CPT codes were observed to experience a notable decline in Medicare reimbursement. Hip arthroscopy with acetabuloplasty (CPT: 29915) and labral repair (CPT: 29916) exhibited the greatest reduction in reimbursement with a decrease in physician fee of 24.69% (P < 0.001) and 24.64% (P < 0.001), respectively, over the study period. DISCUSSION Medicare reimbursement for all seven of the commonly used hip arthroscopy services did not keep up with inflation, demonstrating marked reductions from 2011 to 2021. Specifically, the inflation-adjusted reimbursements decreased between 19.23% and 24.69% between 2011 and 2021.
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Affiliation(s)
- Andrew G Kim
- From the Department of Orthopaedic Surgery and Sports Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH
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Rajeswaren V, Lu V, Chen H, Patnaik JL, Manoharan N. Healthcare Resource Utilization and Costs in an At-Risk Population With Diabetic Retinopathy. Transl Vis Sci Technol 2024; 13:12. [PMID: 38359018 PMCID: PMC10876016 DOI: 10.1167/tvst.13.2.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 01/10/2024] [Indexed: 02/17/2024] Open
Abstract
Purpose Several investigators have suggested the cost-effectiveness of earlier screening, management of risk factors, and early treatment for diabetic retinopathy (DR). We aimed to evaluate the extent of health care utilization and cost of delayed care by insurance type in a vulnerable patient population. Methods A retrospective analysis of patients with DR was conducted using electronic medical record (EMR) data from January 2014 to December 2020 at Denver Health Medical Center, a safety net institution. Patients were classified by disease severity and insurance status. DR-specific costs were assessed via Current Procedural Terminology (CPT) codes over a 24-month follow-up period. Results Among the 313 patients, a higher proportion of non-English speaking patients were uninsured. Rates of proliferative DR at presentation differed across insurance groups (62% of uninsured, 42% of discount plan, and 33% of Medicare/Medicaid, P = 0.016). There was a significant difference in the total median cost between discount plan patients ($1258, interquartile range [IQR] = $0 - $5901) and both Medicare patients ($751, IQR = $0, $7148, P = 0.037) and Medicaid patients ($593, IQR = $0 - $6299, P = 0.025). Conclusions There were higher rates of proliferative DR at presentation among the uninsured and discount plan patients and greater total median cost in discount plan patients compared to Medicare or Medicaid. These findings prioritize mitigating gaps in insurance coverage and barriers to preventative care among vulnerable populations. Translational Relevance Advanced diabetic disease and increased downstream health care utilization and cost vary across insurance type, suggesting improved access to preventative care is needed in these specific at-risk populations.
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Affiliation(s)
- Vivian Rajeswaren
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Vivian Lu
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Hongan Chen
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Jennifer L. Patnaik
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Niranjan Manoharan
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, CO, USA
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García-García JA, Carrero M, Escalona MJ, Lizcano D. Evaluation of clinical practice guideline-derived clinical decision support systems using a novel quality model. J Biomed Inform 2024; 149:104573. [PMID: 38081565 DOI: 10.1016/j.jbi.2023.104573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 11/26/2023] [Accepted: 12/08/2023] [Indexed: 01/22/2024]
Abstract
Over the last decade, clinical practice guidelines (CPGs) have become an important asset for daily life in healthcare organizations. Efficient management and digitization of CPGs help achieve organizational objectives and improve patient care and healthcare quality by reducing variability. However, digitizing CPGs is a difficult, complex task because they are usually expressed as text, and this often leads to the development of partial software solutions. At present, different research proposals and CPG-derived CDSS (clinical decision support system) do exist for managing CPG digitalization lifecycles (from modeling to deployment and execution), but they do not all provide full lifecycle support, making it more difficult to choose solutions or proposals that fully meet the needs of a healthcare organization. This paper proposes a method based on quality models to uniformly compare and evaluate technological tools, providing a rigorous method that uses qualitative and quantitative analysis of technological aspects. In addition, this paper also presents how this method has been instantiated to evaluate and compare CPG-derived CDSS by highlighting each phase of the CPG digitization lifecycle. Finally, discussion and analysis of currently available tools are presented, identifying gaps and limitations.
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Affiliation(s)
- Julián Alberto García-García
- ES3 Group (Engineering and Science for Software Systems group). Computer Languages and Systems Department. Escuela Técnica Superior de Ingeniería Informática., Avda. Reina Mercedes s/n. 41012 Seville, Spain.
| | - Manuel Carrero
- ES3 Group (Engineering and Science for Software Systems group). Computer Languages and Systems Department. Escuela Técnica Superior de Ingeniería Informática., Avda. Reina Mercedes s/n. 41012 Seville, Spain.
| | - María José Escalona
- ES3 Group (Engineering and Science for Software Systems group). Computer Languages and Systems Department. Escuela Técnica Superior de Ingeniería Informática., Avda. Reina Mercedes s/n. 41012 Seville, Spain.
| | - David Lizcano
- School of Computer Science, Madrid Open University, UDIMA., Campus Collado Villalba, Madrid, Spain.
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Hirsch JA, Milburn JM, Woo H, Chen M, Chen MM, Mocco J. 61624/26 and You! J Neurointerv Surg 2023; 15:1059-1060. [PMID: 37734931 DOI: 10.1136/jnis-2023-021005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/05/2023] [Indexed: 09/23/2023]
Affiliation(s)
- Joshua A Hirsch
- NeuroEndovascular Program, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - James M Milburn
- Radiology, Ochsner Medical System, New Orleans, Louisiana, USA
| | - Henry Woo
- Neurosurgery, Stony Brook University, Stony Brook, New York, USA
| | - Michael Chen
- Neurological Sciences, Rush University Medical Center, Chicago, Illinois, USA
| | - Melissa M Chen
- Neuroradiology, The University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA
| | - J Mocco
- The Mount Sinai Health System, New York, New York, USA
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Wang F, Palmer N, Fox K, Liao KP, Yu KH, Kou SC. Large-scale real-world data analyses of cancer risks among patients with rheumatoid arthritis. Int J Cancer 2023; 153:1139-1150. [PMID: 37246892 PMCID: PMC10524922 DOI: 10.1002/ijc.34606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 04/16/2023] [Accepted: 04/27/2023] [Indexed: 05/30/2023]
Abstract
Rheumatoid arthritis (RA) affects 24.5 million people worldwide and has been associated with increased cancer risks. However, the extent to which the observed risks are related to the pathophysiology of rheumatoid arthritis or its treatments is unknown. Leveraging nationwide health insurance claims data with 85.97 million enrollees across 8 years, we identified 92 864 patients without cancers at the time of rheumatoid arthritis diagnoses. We matched 68 415 of these patients with participants without rheumatoid arthritis by sex, race, age and inferred health and economic status and compared their risks of developing all cancer types. By 12 months after the diagnosis of rheumatoid arthritis, rheumatoid arthritis patients were 1.21 (95% confidence interval [CI] [1.14, 1.29]) times more likely to develop any cancer compared with matched enrollees without rheumatoid arthritis. In particular, the risk of developing lymphoma is 2.08 (95% CI [1.67, 2.58]) times higher in the rheumatoid arthritis group, and the risk of developing lung cancer is 1.69 (95% CI [1.32, 2.13]) times higher. We further identified the five most commonly used drugs in treating rheumatoid arthritis, and the log-rank test showed none of them is implicated with a significantly increased cancer risk compared with rheumatoid arthritis patients without that specific drug. Our study suggested that the pathophysiology of rheumatoid arthritis, rather than its treatments, is implicated in the development of subsequent cancers. Our method is extensible to investigating the connections among drugs, diseases and comorbidities at scale.
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Affiliation(s)
- Feicheng Wang
- Department of Statistics, Harvard University, Cambridge, MA
| | - Nathan Palmer
- Department of Biomedical Informatics, Harvard Medical School, Boston, MA
| | - Kathe Fox
- Department of Biomedical Informatics, Harvard Medical School, Boston, MA
| | | | - Kun-Hsing Yu
- Department of Biomedical Informatics, Harvard Medical School, Boston, MA
- Department of Pathology, Brigham and Women’s Hospital, Boston, MA
| | - S. C. Kou
- Department of Statistics, Harvard University, Cambridge, MA
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA
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Kirloskar KM, Haffner ZK, Abadeer A, Yosaitis J, Baker SB. The Innovation Press: A Primer on the Anatomy of Digital Design in Plastic Surgery. Ann Plast Surg 2023; 91:307-312. [PMID: 37489974 DOI: 10.1097/sap.0000000000003617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/26/2023]
Abstract
ABSTRACT Three-dimensional (3D) printing continues to revolutionize the field of plastic surgery, allowing surgeons to adapt to the needs of individual patients and innovate, plan, or refine operative techniques. The utility of this manufacturing modality spans from surgical planning, medical education, and effective patient communication to tissue engineering and device prototyping and has valuable implications in every facet of plastic surgery. Three-dimensional printing is more accessible than ever to the surgical community, regardless of previous background in engineering or biotechnology. As such, the onus falls on the surgeon-innovator to have a functional understanding of the fundamental pipeline and processes in actualizing such innovation. We review the broad range of reported uses for 3D printing in plastic surgery, the process from conceptualization to production, and the considerations a physician must make when using 3D printing for clinical applications. We additionally discuss the role of computer-assisted design and manufacturing and virtual and augmented reality, as well as the ability to digitally modify devices using this software. Finally, a discussion of 3D printing logistics, printer types, and materials is included. With innovation and problem solving comprising key tenets of plastic surgery, 3D printing can be a vital tool in the surgeon's intellectual and digital arsenal to span the gap between concept and reality.
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Affiliation(s)
| | | | - Andrew Abadeer
- Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital
| | | | - Stephen B Baker
- Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital
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7
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Abstract
Functional magnetic resonance imaging (fMRI) now promises to improve diagnostic and prognostic accuracy for patients with disorders of consciousness, and accordingly has been endorsed by professional society guidelines, including those of the American Academy of Neurology, American College of Rehabilitation Medicine, National Institute on Disability, Independent Living, and Rehabilitation Research, and the European Academy of Neurology. Despite multiple professional society endorsements of fMRI in evaluating patients with disorders of consciousness following severe brain injury, insurers have yet to issue clear guidance regarding coverage of fMRI for this indication. Lack of insurer coverage may be a rate-limiting barrier to accessing this technique, which could uncover essential diagnostic and prognostic information for patients and their families. The emerging clinical and ethical case for harmonized insurer recognition and reimbursement of fMRI for vulnerable persons following severe brain injury with disorders of consciousness is explained and critically evaluated.
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Affiliation(s)
- Michael J Young
- Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston
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Mustansir F, Jajja MR, Lovasik BP, Sharma J, Lin E, Sweeney JF, Sarmiento JM. Does CPT Modifier 22 Appropriately Reflect a Difficult Pancreaticoduodenectomy? Retrospective Analysis of Operative Outcomes and Cost. J Am Coll Surg 2023; 236:993-1000. [PMID: 36735633 DOI: 10.1097/xcs.0000000000000609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND CPT coding allows addition of a 2-digit modifier code to denote particularly difficult procedures necessitating additional reimbursement, called the modifier 22. The use of modifier 22 in relation to pancreatic surgery and outcomes, specifically pancreaticoduodenectomy (PD), has not been explored. STUDY DESIGN All PDs performed from 2010 to 2019 at a quaternary healthcare system were analyzed for differences in preoperative characteristics, outcomes, and cost based on the use of modifier 22. Adjusted logistic regression analysis was used to identify factors predictive of modifier 22 use. RESULTS A total of 1,284 patients underwent PD between 2010 and 2019; 1,173 with complete data were included, of which 320 (27.3%) were coded with modifier 22. Patients coded with modifier 22 demonstrated a significantly longer duration of surgery (365.9 ± 168.4 vs 227 ± 97.1; p < 0.001). They also incurred significantly higher cost of index admission ($37,446 ± 34,187 vs $28,279 ± 27,980; p = 0.002). An adjusted multivariable analysis (specifically adjusted for surgeon variation) revealed duration of surgery (p < 0.001), neoadjuvant chemotherapy (p = 0.039), class II obesity (p = 0.019), and chronic pancreatitis (p = 0.005) to be predictive of modifier 22 use. CONCLUSIONS Despite the subjective nature of this CPT modifier, modifier 22 is an appropriate marker of intraoperative difficulty. Preoperative and intraoperative characteristics that lead to its addition may be used to further delineate difficult PDs.
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Affiliation(s)
- Fatima Mustansir
- From the Department of Surgery (Mustansir, Jajja, Lovasik, Sharma, Lin, Sweeney, Sarmiento), Emory University, Atlanta, GA
| | - Mohammad Raheel Jajja
- From the Department of Surgery (Mustansir, Jajja, Lovasik, Sharma, Lin, Sweeney, Sarmiento), Emory University, Atlanta, GA
| | - Brendan P Lovasik
- From the Department of Surgery (Mustansir, Jajja, Lovasik, Sharma, Lin, Sweeney, Sarmiento), Emory University, Atlanta, GA
| | - Jyotirmay Sharma
- From the Department of Surgery (Mustansir, Jajja, Lovasik, Sharma, Lin, Sweeney, Sarmiento), Emory University, Atlanta, GA
| | - Edward Lin
- From the Department of Surgery (Mustansir, Jajja, Lovasik, Sharma, Lin, Sweeney, Sarmiento), Emory University, Atlanta, GA
| | - John F Sweeney
- From the Department of Surgery (Mustansir, Jajja, Lovasik, Sharma, Lin, Sweeney, Sarmiento), Emory University, Atlanta, GA
| | - Juan M Sarmiento
- From the Department of Surgery (Mustansir, Jajja, Lovasik, Sharma, Lin, Sweeney, Sarmiento), Emory University, Atlanta, GA
- Winship Cancer Institute (Sarmiento), Emory University, Atlanta, GA
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Cannas S, Vollmer CM. Invited Commentary: Pancreas Surgery Is Hard: Bring the Antiperspirant. J Am Coll Surg 2023; 236:1000-1002. [PMID: 36757111 DOI: 10.1097/xcs.0000000000000564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
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10
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Keloth VK, Zhou S, Lindemann L, Zheng L, Elhanan G, Einstein AJ, Geller J, Perl Y. Mining of EHR for interface terminology concepts for annotating EHRs of COVID patients. BMC Med Inform Decis Mak 2023; 23:40. [PMID: 36829139 PMCID: PMC9951157 DOI: 10.1186/s12911-023-02136-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 02/09/2023] [Indexed: 02/26/2023] Open
Abstract
BACKGROUND Two years into the COVID-19 pandemic and with more than five million deaths worldwide, the healthcare establishment continues to struggle with every new wave of the pandemic resulting from a new coronavirus variant. Research has demonstrated that there are variations in the symptoms, and even in the order of symptom presentations, in COVID-19 patients infected by different SARS-CoV-2 variants (e.g., Alpha and Omicron). Textual data in the form of admission notes and physician notes in the Electronic Health Records (EHRs) is rich in information regarding the symptoms and their orders of presentation. Unstructured EHR data is often underutilized in research due to the lack of annotations that enable automatic extraction of useful information from the available extensive volumes of textual data. METHODS We present the design of a COVID Interface Terminology (CIT), not just a generic COVID-19 terminology, but one serving a specific purpose of enabling automatic annotation of EHRs of COVID-19 patients. CIT was constructed by integrating existing COVID-related ontologies and mining additional fine granularity concepts from clinical notes. The iterative mining approach utilized the techniques of 'anchoring' and 'concatenation' to identify potential fine granularity concepts to be added to the CIT. We also tested the generalizability of our approach on a hold-out dataset and compared the annotation coverage to the coverage obtained for the dataset used to build the CIT. RESULTS Our experiments demonstrate that this approach results in higher annotation coverage compared to existing ontologies such as SNOMED CT and Coronavirus Infectious Disease Ontology (CIDO). The final version of CIT achieved about 20% more coverage than SNOMED CT and 50% more coverage than CIDO. In the future, the concepts mined and added into CIT could be used as training data for machine learning models for mining even more concepts into CIT and further increasing the annotation coverage. CONCLUSION In this paper, we demonstrated the construction of a COVID interface terminology that can be utilized for automatically annotating EHRs of COVID-19 patients. The techniques presented can identify frequently documented fine granularity concepts that are missing in other ontologies thereby increasing the annotation coverage.
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Affiliation(s)
- Vipina K Keloth
- School of Biomedical Informatics, University of Texas Health Science Center at Houston, Houston, TX, USA.
| | - Shuxin Zhou
- Department of Computer Science, New Jersey Institute of Technology, Newark, NJ, USA
| | - Luke Lindemann
- School of Medicine and Health Sciences, The George Washington University, Washington (D.C.), USA
| | - Ling Zheng
- Computer Science and Software Engineering Department, Monmouth University, West Long Branch, NJ, USA
| | - Gai Elhanan
- Renown Institute for Health Innovation, Desert Research Institute, Reno, NV, USA
| | - Andrew J Einstein
- Cardiology Division, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
- Department of Radiology, Columbia University Irving Medical Center, New York, NY, USA
| | - James Geller
- Department of Computer Science, New Jersey Institute of Technology, Newark, NJ, USA
| | - Yehoshua Perl
- Department of Computer Science, New Jersey Institute of Technology, Newark, NJ, USA
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Krefting J, Sen P, David-Rus D, Güldener U, Hawe JS, Cassese S, von Scheidt M, Schunkert H. Use of big data from health insurance for assessment of cardiovascular outcomes. Front Artif Intell 2023; 6:1155404. [PMID: 37207237 PMCID: PMC10188985 DOI: 10.3389/frai.2023.1155404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 04/13/2023] [Indexed: 05/21/2023] Open
Abstract
Outcome research that supports guideline recommendations for primary and secondary preventions largely depends on the data obtained from clinical trials or selected hospital populations. The exponentially growing amount of real-world medical data could enable fundamental improvements in cardiovascular disease (CVD) prediction, prevention, and care. In this review we summarize how data from health insurance claims (HIC) may improve our understanding of current health provision and identify challenges of patient care by implementing the perspective of patients (providing data and contributing to society), physicians (identifying at-risk patients, optimizing diagnosis and therapy), health insurers (preventive education and economic aspects), and policy makers (data-driven legislation). HIC data has the potential to inform relevant aspects of the healthcare systems. Although HIC data inherit limitations, large sample sizes and long-term follow-up provides enormous predictive power. Herein, we highlight the benefits and limitations of HIC data and provide examples from the cardiovascular field, i.e. how HIC data is supporting healthcare, focusing on the demographical and epidemiological differences, pharmacotherapy, healthcare utilization, cost-effectiveness and outcomes of different treatments. As an outlook we discuss the potential of using HIC-based big data and modern artificial intelligence (AI) algorithms to guide patient education and care, which could lead to the development of a learning healthcare system and support a medically relevant legislation in the future.
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Affiliation(s)
- Johannes Krefting
- Department of Cardiology, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
- German Center for Cardiovascular Research e.V. (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
- *Correspondence: Johannes Krefting
| | - Partho Sen
- Department of Cardiology, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Diana David-Rus
- Department of Cardiology, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Ulrich Güldener
- Department of Cardiology, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Johann S. Hawe
- Department of Cardiology, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Salvatore Cassese
- Department of Cardiology, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
- German Center for Cardiovascular Research e.V. (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | - Moritz von Scheidt
- Department of Cardiology, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
- German Center for Cardiovascular Research e.V. (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | - Heribert Schunkert
- Department of Cardiology, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
- German Center for Cardiovascular Research e.V. (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
- Heribert Schunkert
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Plusch KJ, Graham JG, Zangrilli JA, Vaccaro AR, Beredjiklian PK, Purtill JJ, Rivlin M. New Evaluation and Management Code Level Selection Trends in Hip and Knee Osteoarthritis Patients. J Arthroplasty 2022; 37:2134-2139. [PMID: 35688406 DOI: 10.1016/j.arth.2022.05.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 05/27/2022] [Accepted: 05/31/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND On January 1, 2021, the American Medical Association implemented changes regarding the outpatient Evaluation and Management (E/M) criteria dictating Current Procedural Terminology code level selection to help diminish administrative burden and emphasize medical decision-making as the primary determinant in E/M level of service (EML). The goal of this study was to describe EML coding trends in outpatient visits for hip and knee osteoarthritis after the 2021 Centers for Medicare and Medicaid Services changes to the E/M system. METHODS All outpatient visits for primary hip and knee osteoarthritis within the divisions of Joint Replacement, Operative Sports Medicine, and Nonoperative Sports Medicine at a single orthopaedic practice were retrospectively analyzed during 2 separate 10-month timeframes in 2019 and 2021. The primary endpoint was the visit EML (1 through 5) based on Current Procedural Terminology E/M codes. RESULTS In 2019, 7.8% of all visits were billed as level 2, 85.8% of all visits were billed as level 3, and 6.3% of all visits were billed as level 4. In 2021, 2.8% of visits were billed as level 2, 54% of visits were billed as level 3, and 41.3% of visits were billed as level 4. Level 1 and Level 5 visits did not exceed 2% in either year. Across all 3 divisions, level 2 and 3 visits decreased significantly (P < .05), while level 4 visits increased significantly (P < .05). CONCLUSION Since the E/M coding criteria overhaul in 2021, there has been a significant trend towards higher level of service code selection across multiple divisions in our orthopaedic practice.
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Affiliation(s)
- Kyle J Plusch
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Jack G Graham
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Julian A Zangrilli
- Department of Orthopaedic Surgery, Rowan University School of Osteopathic Medicine, Stratford, New Jersey
| | - Alexander R Vaccaro
- Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Pedro K Beredjiklian
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - James J Purtill
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Michael Rivlin
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
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Abeysinghe R, Black A, Kaduk D, Li Y, Reich C, Davydov A, Yao L, Cui L. Towards quality improvement of vaccine concept mappings in the OMOP vocabulary with a semi-automated method. J Biomed Inform 2022; 134:104162. [PMID: 36029954 PMCID: PMC9940475 DOI: 10.1016/j.jbi.2022.104162] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 07/13/2022] [Accepted: 08/09/2022] [Indexed: 11/26/2022]
Abstract
The Observational Medical Outcomes Partnership (OMOP) Common Data Model (CDM) provides a unified model to integrate disparate real-world data (RWD) sources. An integral part of the OMOP CDM is the Standardized Vocabularies (henceforth referred to as the OMOP vocabulary), which enables organization and standardization of medical concepts across various clinical domains of the OMOP CDM. For concepts with the same meaning from different source vocabularies, one is designated as the standard concept, while the others are specified as non-standard or source concepts and mapped to the standard one. However, due to the heterogeneity of source vocabularies, there may exist mapping issues such as erroneous mappings and missing mappings in the OMOP vocabulary, which could affect the results of downstream analyses with RWD. In this paper, we focus on quality assurance of vaccine concept mappings in the OMOP vocabulary, which is necessary to accurately harness the power of RWD on vaccines. We introduce a semi-automated lexical approach to audit vaccine mappings in the OMOP vocabulary. We generated two types of vaccine-pairs: mapped and unmapped, where mapped vaccine-pairs are pairs of vaccine concepts with a "Maps to" relationship, while unmapped vaccine-pairs are those without a "Maps to" relationship. We represented each vaccine concept name as a set of words, and derived term-difference pairs (i.e., name differences) for mapped and unmapped vaccine-pairs. If the same term-difference pair can be obtained by both mapped and unmapped vaccine-pairs, then this is considered as a potential mapping inconsistency. Applying this approach to the vaccine mappings in OMOP, a total of 2087 potentially mapping inconsistencies were obtained. A randomly selected 200 samples were evaluated by domain experts to identify, validate, and categorize the inconsistencies. Experts identified 95 cases revealing valid mapping issues. The remaining 105 cases were found to be invalid due to the external and/or contextual information used in the mappings that were not reflected in the concept names of vaccines. This indicates that our semi-automated approach shows promise in identifying mapping inconsistencies among vaccine concepts in the OMOP vocabulary.
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Affiliation(s)
- Rashmie Abeysinghe
- Department of Neurology, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Adam Black
- Odysseus Data Services, Cambridge, MA, USA
| | | | | | - Christian Reich
- IQVIA, Cambridge, MA, USA,Observational Health Data Sciences and Informatics (OHDSI), New York, NY, USA
| | | | | | - Licong Cui
- School of Biomedical Informatics, The University of Texas Health Science Center at Houston, Houston, TX, USA.
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Ding L, Cabana MD. 50 Years Ago in TheJournalofPediatrics: A Half-Century of the Evolution in Newborn Data Analyses. J Pediatr 2022; 248:50. [PMID: 36116856 DOI: 10.1016/j.jpeds.2022.06.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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15
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Zhou D, Gan Z, Shi X, Patwari A, Rush E, Bonzel CL, Panickan VA, Hong C, Ho YL, Cai T, Costa L, Li X, Castro VM, Murphy SN, Brat G, Weber G, Avillach P, Gaziano JM, Cho K, Liao KP, Lu J, Cai T. Multiview Incomplete Knowledge Graph Integration with application to cross-institutional EHR data harmonization. J Biomed Inform 2022; 133:104147. [PMID: 35872266 DOI: 10.1016/j.jbi.2022.104147] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 07/05/2022] [Accepted: 07/15/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The growing availability of electronic health records (EHR) data opens opportunities for integrative analysis of multi-institutional EHR to produce generalizable knowledge. A key barrier to such integrative analyses is the lack of semantic interoperability across different institutions due to coding differences. We propose a Multiview Incomplete Knowledge Graph Integration (MIKGI) algorithm to integrate information from multiple sources with partially overlapping EHR concept codes to enable translations between healthcare systems. METHODS The MIKGI algorithm combines knowledge graph information from (i) embeddings trained from the co-occurrence patterns of medical codes within each EHR system and (ii) semantic embeddings of the textual strings of all medical codes obtained from the Self-Aligning Pretrained BERT (SAPBERT) algorithm. Due to the heterogeneity in the coding across healthcare systems, each EHR source provides partial coverage of the available codes. MIKGI synthesizes the incomplete knowledge graphs derived from these multi-source embeddings by minimizing a spherical loss function that combines the pairwise directional similarities of embeddings computed from all available sources. MIKGI outputs harmonized semantic embedding vectors for all EHR codes, which improves the quality of the embeddings and enables direct assessment of both similarity and relatedness between any pair of codes from multiple healthcare systems. RESULTS With EHR co-occurrence data from Veteran Affairs (VA) healthcare and Mass General Brigham (MGB), MIKGI algorithm produces high quality embeddings for a variety of downstream tasks including detecting known similar or related entity pairs and mapping VA local codes to the relevant EHR codes used at MGB. Based on the cosine similarity of the MIKGI trained embeddings, the AUC was 0.918 for detecting similar entity pairs and 0.809 for detecting related pairs. For cross-institutional medical code mapping, the top 1 and top 5 accuracy were 91.0% and 97.5% when mapping medication codes at VA to RxNorm medication codes at MGB; 59.1% and 75.8% when mapping VA local laboratory codes to LOINC hierarchy. When trained with 500 labels, the lab code mapping attained top 1 and 5 accuracy at 77.7% and 87.9%. MIKGI also attained best performance in selecting VA local lab codes for desired laboratory tests and COVID-19 related features for COVID EHR studies. Compared to existing methods, MIKGI attained the most robust performance with accuracy the highest or near the highest across all tasks. CONCLUSIONS The proposed MIKGI algorithm can effectively integrate incomplete summary data from biomedical text and EHR data to generate harmonized embeddings for EHR codes for knowledge graph modeling and cross-institutional translation of EHR codes.
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Affiliation(s)
| | | | - Xu Shi
- University of Michigan, MI, USA
| | | | - Everett Rush
- Department of Energy, Oak Ridge National Lab, Oak Ridge, TN, USA
| | - Clara-Lea Bonzel
- Harvard Medical School, Boston, MA, USA; VA Boston Healthcare System, Boston, MA, USA
| | - Vidul A Panickan
- Harvard Medical School, Boston, MA, USA; VA Boston Healthcare System, Boston, MA, USA
| | - Chuan Hong
- VA Boston Healthcare System, Boston, MA, USA; Duke University, Durham, NC, USA
| | - Yuk-Lam Ho
- VA Boston Healthcare System, Boston, MA, USA
| | - Tianrun Cai
- VA Boston Healthcare System, Boston, MA, USA; Brigham and Women's Hospital, Boston, MA, USA
| | | | | | | | | | - Gabriel Brat
- Harvard Medical School, Boston, MA, USA; Beth Israel Deaconess Medical Center, Boston, MA, USA
| | | | | | - J Michael Gaziano
- Harvard Medical School, Boston, MA, USA; VA Boston Healthcare System, Boston, MA, USA; Brigham and Women's Hospital, Boston, MA, USA
| | - Kelly Cho
- Harvard Medical School, Boston, MA, USA; VA Boston Healthcare System, Boston, MA, USA; Brigham and Women's Hospital, Boston, MA, USA
| | - Katherine P Liao
- VA Boston Healthcare System, Boston, MA, USA; Brigham and Women's Hospital, Boston, MA, USA
| | - Junwei Lu
- VA Boston Healthcare System, Boston, MA, USA; Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Tianxi Cai
- Harvard Medical School, Boston, MA, USA; VA Boston Healthcare System, Boston, MA, USA; Harvard T.H. Chan School of Public Health, Boston, MA, USA.
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16
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Graham JG, Plusch K, Rivlin M, Sodha S, Gallant GG, Beredjiklian P. Outpatient Visit Current Procedural Terminology Code Level Selection Trends in Hand Surgery Following Criteria Changes by the American Medical Association. Cureus 2022; 14:e27125. [PMID: 36004013 PMCID: PMC9392854 DOI: 10.7759/cureus.27125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/21/2022] [Indexed: 11/05/2022] Open
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DeBoer E, Alsbrooks K. Procedure Code Utilization for Vascular Access Device Placement in the Inpatient Setting: A Retrospective Analysis. Perspect Health Inf Manag 2022; 19:1d. [PMID: 36035331 PMCID: PMC9335166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Vascular access (VA) is essential to inpatient care, and the documentation/coding practices for vascular access device (VAD) placement procedures remain unexplored. Accurate documentation may present benefits for patients, providers, and researchers. A retrospective analysis was performed in adult inpatients (2015 to 2020) using Cerner Real World Data™ to evaluate the utilization of CPT codes for VAD placement/replacement procedures. A total of 14,253,584 patient encounters were analyzed, 0.111 percent (n=15,833) of which received at least one VAD procedure code. Non-tunneled CVC procedures had the highest code rate (0.067 percent), while PIV/midline procedures were the least likely to be coded (0.004 percent). The annual proportion of code utilization increased from 10.9 percent in 2015 to 19.7 percent in 2020 (p<0.0001). Despite widespread use of VADs in the inpatient setting, the procedure coding rate was found to be remarkably low. Appropriate coding/documentation practices may ensure proper care by capturing VA-related patient history, and improve research quality and resource/staff allocation.
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18
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Wise KL, Parikh HR, Okelana B, Only AJ, Reams M, Harrison A, Braman J, Craig E, Cunningham BP. Measurement of value in rotator cuff repair: patient-level value analysis for the 1-year episode of care. J Shoulder Elbow Surg 2022; 31:72-80. [PMID: 34390841 DOI: 10.1016/j.jse.2021.07.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 06/25/2021] [Accepted: 07/11/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Rotator cuff repair (RCR) is one of the most common elective orthopedic procedures, with predictable indications, techniques, and outcomes. As a result, this surgical procedure is an ideal choice for studying value. The purpose of this study was to perform patient-level value analysis (PLVA) within the setting of RCR over the 1-year episode of care. METHODS Included patients (N = 396) underwent RCR between 2009 and 2016 at a single outpatient orthopedic surgery center. The episode of care was defined as 1-year following surgery. The Western Ontario Rotator Cuff index was collected at both the initial preoperative baseline assessment and the 1-year postoperative mark. The total cost of care was determined using time-driven activity-based costing (TDABC). Both PLVA and provider-level value analysis were performed. RESULTS The average TDABC cost of care was derived at $5413.78 ± $727.41 (95% confidence interval, $5341.92-$5485.64). At the patient level, arthroscopic isolated supraspinatus tears yielded the highest value coefficient (0.82; analysis-of-variance F test, P = .01). There was a poor correlation between the change in the 1-year Western Ontario Rotator Cuff score and the TDABC cost of care (r2 = 0.03). Provider-level value analysis demonstrated significant variation between the 8 providers evaluated (P < .01). CONCLUSION RCR is one of the most common orthopedic procedures, yet the correlations between cost of care and patient outcomes are unknown. PLVA quantifies the ratio of functional improvement to the TDABC-estimated cost of care at the patient level. This is the first study to apply PLVA over the first-year episode of care. With health care transitioning toward value-based delivery, PLVA offers a quantitative tool to measure the value of individual patient care delivery over the entire episode of care.
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19
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Ng MK, Vakharia RM, Bozic KJ, Callaghan JJ, Mont MA. Clinical and Administrative Databases Used in Lower Extremity Arthroplasty Research. J Arthroplasty 2021; 36:3608-15. [PMID: 34130871 DOI: 10.1016/j.arth.2021.05.034] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 05/18/2021] [Accepted: 05/24/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The use of national databases in lower extremity arthroplasty research has grown rapidly in recent years. We aimed to better characterize available databases by: (1) quantifying the number of these studies in the highest impact arthroplasty journals; (2) comparing respective sample sizes; and (3) contrasting their measured variables/outcomes. METHODS An extensive literature search was conducted to identify all database studies in the top 12 highest impact factor journals that published arthroplasty research between January 1, 2018 and December 31, 2019. A total of 5070 publications were identified. These studies were sorted by both database utilized and journal published. Tables were constructed to compare/contrast databases by metrics and measured outcome parameters including coding, patient sample size, preoperative comorbidities, postoperative complications, and limitations/barriers to their use. RESULTS Four hundred twenty-six database studies (8.4%, range 0.4%-29.7% per journal) were identified, of which 139 were from non-English-speaking arthroplasty databases. Among English-speaking arthroplasty databases, the 5 most common sources were National Surgical Quality Improvement Project (n = 72), Medicare (n = 62, 39 from Medicare Claims and 23 from PearlDiver), Nationwide Inpatient Sample (n = 35), PearlDiver non-Medicare private insurance (n = 18), and Statewide Planning and Research Cooperative System (n = 18). Metrics, outcome parameters, and features of commonly used registries were reviewed. CONCLUSION Database studies constitute an important part of arthroplasty-specific orthopedic research. Their use will continue to grow in the future, and it would be beneficial for clinicians/researchers to be aware of and familiarize themselves with their features to understand which are most appropriate for their work.
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20
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Abstract
AIMS This study aimed to evaluate whether an enhanced recovery protocol (ERP) for arthroplasty established during the COVID-19 pandemic at a safety net hospital can be associated with a decrease in hospital length of stay (LOS) and an increase in same-day discharges (SDDs) without increasing acute adverse events. METHODS A retrospective review of 124 consecutive primary arthroplasty procedures performed after resuming elective procedures on 11 May 2020 were compared to the previous 124 consecutive patients treated prior to 17 March 2020, at a single urban safety net hospital. Revision arthroplasty and patients with < 90-day follow-up were excluded. The primary outcome measures were hospital LOS and the number of SDDs. Secondary outcome measures included 90-day complications, 90-day readmissions, and 30day emergency department (ED) visits. RESULTS The mean LOS was significantly reduced from 2.02 days (SD 0.80) in the pre-COVID cohort to 1.03 days (SD 0.65) in the post-COVID cohort (p < 0.001). No patients in the pre-COVID group were discharged on the day of surgery compared to 60 patients (48.4%) in the post-COVID group (p < 0.001). There were no significant differences in 90-day complications (13.7% (n = 17) vs 9.7% (n = 12); p = 0.429), 30-day ED visits (1.6% (n = 2) vs 3.2% (n = 4); p = 0.683), or 90-day readmissions (2.4% (n = 3) vs 1.6% (n = 2); p = 1.000) between the pre-COVID and post-COVID groups, respectively. CONCLUSION Through use of an ERP, arthroplasty procedures were successfully resumed at a safety net hospital with a shorter LOS and increased SDDs without a difference in acute adverse events. The resulting increase in healthcare value therefore may be considered a 'silver lining' to the moratorium on elective arthroplasty during the COVID-19 pandemic. These improved efficiencies are expected to continue in post-pandemic era. Cite this article: Bone Jt Open 2021;2(10):871-878.
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Affiliation(s)
- Adam J. Taylor
- Harbor-UCLA Medical Center, Torrance, California, USA
- Rancho Los Amigos National Rehabilitation Center, Downey, California, USA
| | - Robert D. Kay
- Harbor-UCLA Medical Center, Torrance, California, USA
- Rancho Los Amigos National Rehabilitation Center, Downey, California, USA
| | - Erik Y. Tye
- Harbor-UCLA Medical Center, Torrance, California, USA
- Rancho Los Amigos National Rehabilitation Center, Downey, California, USA
| | - Jason A. Bryman
- Harbor-UCLA Medical Center, Torrance, California, USA
- Rancho Los Amigos National Rehabilitation Center, Downey, California, USA
| | - Donald Longjohn
- Harbor-UCLA Medical Center, Torrance, California, USA
- Department of Orthopaedic Surgery, Keck Hospital of USC, Los Angeles, California, USA
| | - Soheil Najibi
- Harbor-UCLA Medical Center, Torrance, California, USA
| | - Robert P. Runner
- Rancho Los Amigos National Rehabilitation Center, Downey, California, USA
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21
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Highsmith MJ, Fantini CM, Smith DG. Contemplating Health Economics, Coding and Reimbursement in Orthotics, Prosthetics and Pedorthics. Can Prosthet Orthot J 2021; 4:36125. [PMID: 37614990 PMCID: PMC10443486 DOI: 10.33137/cpoj.v4i2.36125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Reimbursement to U.S. healthcare service providers is largely transitioning from fee for service to fee for value for those clinicians who code using current procedural terminology and through their coding, describe their professional services. The Orthotic, Prosthetic and Pedorthic profession (O&P), currently codes using a system that describes the devices they evaluate for, fabricate, fit and maintain and their professional services are incorporated into their codes. These O&P codes, in contrast to those for other healthcare disciplines, are predominantly product based rather than service based, focusing on product features and function more than clinical service. This editorial manuscript provides a brief overview of the system the US O&P profession uses currently, particularly in the context of other healthcare professions transitioning to value based coding and reimbursement and culminates in a call to action for the profession to academically consider the strengths and weaknesses of the current system relative to alternative systems.
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Affiliation(s)
- MJ Highsmith
- School of Physical Therapy & Rehabilitation Sciences, Morsani College of Medicine, University of South Florida, Tampa, Florida, USA
- U.S. Department of Veterans Affairs, Rehabilitation & Prosthetics Services, Washington, USA
| | - CM Fantini
- U.S. Department of Veterans Affairs, Rehabilitation & Prosthetics Services, Washington, USA
| | - DG Smith
- Department of Physical Medicine and Rehabilitation, Uniformed University of the Health Sciences, Bethesda, Maryland, USA
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, Washington, USA
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22
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Williams BR, Smith LC, Only AJ, Parikh HR, Swiontkowski MF, Cunningham BP. Unplanned Emergency and Urgent Care Visits After Outpatient Orthopaedic Surgery. J Am Acad Orthop Surg Glob Res Rev 2021; 5. [PMID: 34543235 DOI: 10.5435/JAAOSGlobal-D-21-00209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 08/29/2021] [Indexed: 11/30/2022]
Abstract
Introduction This study sought to determine (1) incident risk, (2) chief report, (3) risk factors, and (4) total cost of unplanned healthcare visits to an emergency and/or urgent care (ED/UC) facility within 30 days of an outpatient orthopaedic procedure. Methods This was a retrospective database review of 5,550 outpatient surgical encounters from a large metropolitan healthcare system between 2012 and 2016. Statistical analysis consisted of measuring the ED/UC incident risk, respective to the procedures and anatomical region. Patient-specific risk factors were evaluated through multigroup comparative statistics. Results Of the 5,550 study patients, 297 (5.4%) presented to an ED/UC within 30 days of their index procedure, with 23 (0.4%) needing to be readmitted. Native English speakers, patients older than 45 years, and nonsmokers had significant reduced relative risk of unplanned ED or UC visit within 30 days of index procedure (P < 0.01). In addition, hand tendon repair/graft had the greatest risk incidence for ED/UC visit (11.0%). Unplanned ED/UC reimbursements totaled $146,357.34, averaging $575.65 per visit. Discussion This study provides an evaluation of outpatient orthopaedic procedures and their relationship to ED/UC visits. Specifically, this study identifies patient-related and procedural-related attributes that associate with an increased risk for unplanned healthcare utilization.
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Acuña AJ, Jella TK, Samuel LT, Schwarzkopf R, Fehring TK, Kamath AF. Inflation-Adjusted Medicare Reimbursement for Revision Hip Arthroplasty: Study Showing Significant Decrease from 2002 to 2019. J Bone Joint Surg Am 2021; 103:1212-1219. [PMID: 33764932 DOI: 10.2106/jbjs.20.01643] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Investigations into reimbursement trends for primary and revision arthroplasty procedures have demonstrated a steady decline over the past several years. Revision total hip arthroplasty (rTHA) due to infection (rTHA-I) has been associated with higher resource utilization and complexity, but long-term inflation-adjusted data have yet to be compared between rTHA-I and rTHA due to aseptic complications (rTHA-A). The present study was performed to analyze temporal reimbursement trends regarding rTHA-I procedures compared with those for rTHA-A procedures. METHODS The Centers for Medicare & Medicaid Services (CMS) Physician Fee Schedule Look-Up Tool was used to extract Medicare reimbursements associated with 1-stage and 2-stage rTHA-I as well as 1-stage rTHA-A procedures from 2002 to 2019. Current Procedural Terminology (CPT) codes for rTHA were grouped according to the American Academy of Orthopaedic Surgeons coding reference guide. Monetary values were adjusted for inflation using the consumer price index (U.S. Bureau of Labor Statistics; reported as 2019 U.S. dollars) and used to calculate the cumulative and average annual percent changes in reimbursement. RESULTS Following inflation adjustment, the physician fee reimbursement for rTHA-A decreased by a mean [and standard deviation] of 27.26% ± 3.57% (from $2,209.11 in 2002 to $1,603.20 in 2019) for femoral component revision, 27.41% ± 3.57% (from $2,130.55 to $1,542.91) for acetabular component revision, and 27.50% ± 2.56% (from $2,775.53 to $2,007.61) for both-component revision. Similarly, for a 2-stage rTHA-I, the mean reimbursement declined by 18.74% ± 3.87% (from $2,063.36 in 2002 to $1,673.36 in 2019) and 24.45% ± 3.69% (from $2,328.79 to $1,755.45) for the explantation and reimplantation stages, respectively. The total decline in physician fee reimbursement for rTHA-I ($1,020.64 ± $233.72) was significantly greater than that for rTHA-A ($580.72 ± $107.22; p < 0.00001). CONCLUSIONS Our study demonstrated a consistent devaluation of both rTHA-I and rTHA-A procedures from 2002 to 2019, with a larger deficit seen for rTHA-I. A continuation of this trend could create substantial disincentives for physicians to perform such procedures and limit access to care at the population level. LEVEL OF EVIDENCE Economic and Decision Analysis Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Alexander J Acuña
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Tarun K Jella
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Linsen T Samuel
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Ran Schwarzkopf
- Hospital for Joint Diseases, New York University Langone Orthopedic Hospital, New York, NY
| | | | - Atul F Kamath
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
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Jella TK, Acuña AJ, Samuel LT, Schwarzkopf R, Fehring TK, Kamath AF. Medicare Physician Fee Reimbursement for Revision Total Knee Arthroplasty Has Not Kept Up with Inflation from 2002 to 2019. J Bone Joint Surg Am 2021; 103:778-785. [PMID: 33269896 DOI: 10.2106/jbjs.20.01034] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND As orthopaedic physician fees continue to come under scrutiny by the U.S. Centers for Medicare & Medicaid Services (CMS), there is a continued need to evaluate trends in reimbursement rates across contemporary time intervals. Although substantially lower work relative value units (RVUs) have been previously demonstrated for septic revision total knee arthroplasty (TKA) compared with aseptic revisions, to our knowledge, there has been no corresponding analysis comparing total physician fees. Therefore, the purpose of our study was to analyze temporal trends in Medicare physician fees for septic and aseptic revision TKAs. METHODS Current Procedural Terminology (CPT) codes related to septic 1-stage and 2-stage revision TKAs and aseptic revision TKAs were categorized. From 2002 to 2019, the facility rates of physician fees associated with each CPT code were obtained from the CMS Physician Fee Schedule Look-Up Tool. Monetary data from Medicare Administrative Contractors at 85 locations were used to calculate nationally representative means. All total physician fee values were adjusted for inflation and were translated to 2019 U.S. dollars using Consumer Price Index data from the U.S. Bureau of Labor Statistics. Cumulative annual percentage changes and compound annual growth rates (CAGRs) were computed utilizing adjusted physician fee data. RESULTS After adjusting for inflation, the total mean Medicare reimbursement (and standard deviation) for aseptic revision TKA decreased 24.83% ± 3.65% for 2-component revision and 24.21% ± 3.68% for 1-component revision. The mean septic revision TKA total Medicare reimbursement declined 23.29% ± 3.73% for explantation and 33.47% ± 3.24% for reimplantation. Both the dollar amount (p < 0.0001) and the percentage (p < 0.0001) of the total Medicare reimbursement decline for septic revision TKA were significantly greater than the decline for aseptic revision TKA. CONCLUSIONS Septic revision TKAs have been devalued at a rate greater than their aseptic counterparts over the past 2 decades. Coupled with our findings, the increased resource utilization of septic revision TKAs may result in financial barriers for physicians and subsequently may reduce access to care for patients with periprosthetic joint infections. CLINICAL RELEVANCE The devaluation of revision TKAs may result in reduced patient access to infection management at facilities unable to bear the financial burden of these procedures.
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Affiliation(s)
- Tarun K Jella
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Alexander J Acuña
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Linsen T Samuel
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Ran Schwarzkopf
- Department of Orthopedic Surgery, New York University Langone Health Medical Center, New York, NY
| | | | - Atul F Kamath
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
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Mohammad LM, Vidalis BM, Fatemi L, Coffman RR, Qeadan F, Kimmell KT. Use of Standardized History and Physical Examination for Neurosurgical Patients Improves Clinical Documentation and Reimbursement. World Neurosurg 2021; 148:e667-e673. [PMID: 33497824 DOI: 10.1016/j.wneu.2021.01.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Revised: 01/13/2021] [Accepted: 01/15/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Documentation is the cornerstone of good patient care and vital to proper coding and billing. Consistent and standardized documentation improves communication among physicians and can lead to better reimbursement. By understanding which elements in the neurosurgery history and physical examination are omitted the most often and the effects on the coding level, institutional-specific solutions can be implemented. METHODS We performed a retrospective study of neurosurgical patients at a single academic institution who undergone a neurosurgery history and physical examination for an initial inpatient admission from July 2015 to July 2016. The data collected included documentation type (typed, dictated, dynamic documentation without a template, neurosurgery history and physical examination template [NHPT]) and ultimate coding level (1, 2, or 3) determined by a review by a professional coder. RESULTS A total of 609 notes were reviewed. Of the 609 notes, 88 (14.4%) were missing an element of documentation. The most common missing element was the physical examination (40 of 88; 45.5%), followed by a combination (27 of 88; 30.7%), review of systems (14 of 88; 15.9%), and medical, family, and/or social history (7 of 88; 8.0%). The dynamic documentation without template notes had the highest percentage of missing elements (49 of 96; 51.0%), followed by the typed notes (7 of 49; 14.3%) and dictated notes (30 of 268; 11.2%) compared with the NHPT notes (2 of 196; 1.0%). CONCLUSION The most common missing elements for inpatient neurosurgery documentation were the review of systems and physical examination. The documents with the highest percentage of missing elements were those that used dynamic documentation without a template. We recommend implementing a dedicated NHPT to improve capturing these elements for improved clinical documentation. Such changes could also improve the coding level and subsequent reimbursement.
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Affiliation(s)
- Laila M Mohammad
- Department of Neurosurgery, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA.
| | - Benjamin M Vidalis
- Department of Neurosurgery, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA
| | - Lida Fatemi
- Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA
| | - Rebecca R Coffman
- Department of Neurosurgery, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA
| | - Fares Qeadan
- Department of Family and Preventive Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Kristopher T Kimmell
- Department of Neurosurgery, University of Rochester Medical Center, Rochester, New York, USA
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Nguyen TH, Hirsch JA, Chen MM, Golding L, Leslie-Mazwi TM, Nicola GN, Schirmer CM, Milburn JM. The impending conversion factor crisis and neurointerventional practice. J Neurointerv Surg 2020; 13:301-303. [PMID: 33257412 DOI: 10.1136/neurintsurg-2020-017005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/30/2020] [Indexed: 11/04/2022]
Affiliation(s)
- Theresa H Nguyen
- Department of Radiology, Ochsner Medical System, New Orleans, Louisiana, USA
| | - Joshua A Hirsch
- Department of NeuroInterventional Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Melissa M Chen
- Department of Neuroradiology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Lauren Golding
- Triad Radiology Associates PLLC, Winston-Salem, North Carolina, USA
| | - Thabele M Leslie-Mazwi
- Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts, USA.,Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Greg N Nicola
- Hackensack Radiology Group, Hackensack, New Jersey, USA
| | - Clemens M Schirmer
- Department of Neurosurgery and Neuroscience Institute, Geisinger, Wilkes-Barre, Pennsylvania, USA.,Research Institute of Neurointervention, Paracelsus Medical University, Salzburg, Austria
| | - James M Milburn
- Department of Radiology, Ochsner Medical System, New Orleans, Louisiana, USA
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Glauser G, Sharma N, Beatson N, Dimentberg R, Savarese F, Gagliardi M, Grady MS, Malhotra NR. Surgical CPT Coding Discrepancies: Analysis of Surgeons and Employed Coders. Am J Med Qual 2020; 36:263-269. [PMID: 32959674 DOI: 10.1177/1062860620959440] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Surgeon providers and billing professionals use Current Procedural Terminology (CPT) codes to specify patient treatment and associated charges. In the present study, coding discrepancies between surgeons' first pass coding and employed coders' final codes were investigated. A total of 500 patients over 3 months were retrospectively analyzed for coding discrepancies. To quantify the impact of change, codes with the most accumulated discrepancies were studied and change to annual relative value unit (RVU) was determined. Final submission of codes to billing demonstrated a 161% increase in total codes by the professional coders, versus original surgeon-derived codes (1594 vs 987 CPT codes). The most common source of change between the surgeon and coder was the addition of distinct codes by the billing professional (270 patients, 54.51%). These results demonstrate the existence of coding discrepancies. Future investigation will evaluate the communication between surgeons and billing professionals.
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Wake N, Nussbaum JE, Elias MI, Nikas CV, Bjurlin MA. 3D Printing, Augmented Reality, and Virtual Reality for the Assessment and Management of Kidney and Prostate Cancer: A Systematic Review. Urology 2020; 143:20-32. [DOI: 10.1016/j.urology.2020.03.066] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 03/19/2020] [Accepted: 03/26/2020] [Indexed: 02/06/2023]
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Ballard DH, Mills P, Duszak R, Weisman JA, Rybicki FJ, Woodard PK. Medical 3D Printing Cost-Savings in Orthopedic and Maxillofacial Surgery: Cost Analysis of Operating Room Time Saved with 3D Printed Anatomic Models and Surgical Guides. Acad Radiol 2020; 27:1103-1113. [PMID: 31542197 DOI: 10.1016/j.acra.2019.08.011] [Citation(s) in RCA: 106] [Impact Index Per Article: 26.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Revised: 08/20/2019] [Accepted: 08/26/2019] [Indexed: 12/16/2022]
Abstract
RATIONALE AND OBJECTIVE Three-dimensional (3D) printed anatomic models and surgical guides have been shown to reduce operative time. The purpose of this study was to generate an economic analysis of the cost-saving potential of 3D printed anatomic models and surgical guides in orthopedic and maxillofacial surgical applications. MATERIALS AND METHODS A targeted literature search identified operating room cost-per-minute and studies that quantified time saved using 3D printed constructs. Studies that reported operative time differences due to 3D printed anatomic models or surgical guides were reviewed and cataloged. A mean of $62 per operating room minute (range of $22-$133 per minute) was used as the reference standard for operating room time cost. Different financial scenarios were modeled with the provided cost-per-minute of operating room time (using high, mean, and low values) and mean time saved using 3D printed constructs. RESULTS Seven studies using 3D printed anatomic models in surgical care demonstrated a mean 62 minutes ($3720/case saved from reduced time) of time saved, and 25 studies of 3D printed surgical guides demonstrated a mean 23 minutes time saved ($1488/case saved from reduced time). An estimated 63 models or guides per year (or 1.2/week) were predicted to be the minimum number to breakeven and account for annual fixed costs. CONCLUSION Based on the literature-based financial analyses, medical 3D printing appears to reduce operating room costs secondary to shortening procedure times. While resource-intensive, 3D printed constructs used in patients' operative care provides considerable downstream value to health systems.
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Affiliation(s)
- David H Ballard
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S. Kingshighway Blvd, Campus Box 8131, St. Louis, MO 63110.
| | | | - Richard Duszak
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Jeffery A Weisman
- University of Illinois at Chicago Occupational Medicine, Chicago, Illinois
| | - Frank J Rybicki
- Department of Radiology, University of Cincinnati, Cincinnati, Ohio
| | - Pamela K Woodard
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S. Kingshighway Blvd, Campus Box 8131, St. Louis, MO 63110
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Sireci AN, Patel JL, Joseph L, Hiemenz MC, Rosca OC, Caughron SK, Thibault-Sennett SA, Burke TL, Aisner DL. Molecular Pathology Economics 101: An Overview of Molecular Diagnostics Coding, Coverage, and Reimbursement: A Report of the Association for Molecular Pathology. J Mol Diagn 2020; 22:975-993. [PMID: 32504675 PMCID: PMC7267794 DOI: 10.1016/j.jmoldx.2020.05.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Revised: 04/27/2020] [Accepted: 05/18/2020] [Indexed: 11/26/2022] Open
Abstract
Widespread indications for use of molecular diagnostics in various aspects of clinical medicine have driven proliferation of testing. The rapid adoption and continuous technological evolution of molecular diagnostics have often strained the development and maintenance of a functional underlying framework of coding, coverage, and reimbursement policies, thereby presenting challenges to various stakeholders, including molecular professionals, payers, and patients. A multidisciplinary working group convened by the Association for Molecular Pathology Economic Affairs Committee was tasked to describe the complex landscape of molecular pathology economics and highlight opportunities for member engagement. In this article, on the basis of review and synthesis of government regulations and procedures, published payer policy documents, peer-reviewed literature, and expert consensus, the Working Group navigates the ecosystem of molecular pathology economics in terms of stakeholders, coding systems and processes, coverage policy determination, and pricing mechanisms. The composition and interrelatedness of various working groups and committees are emphasized to highlight the functional underpinnings of the system. Molecular professionals must be conversant in the language and complex inner workings of molecular pathology economics to lead successful, viable laboratories and advocate effectively for policy development on their behalf. This overview is provided to be a resource to molecular professionals as they navigate the reimbursement landscape.
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Affiliation(s)
- Anthony N Sireci
- EAC101 Working Group, a Working Group of the Association for Molecular Pathology Economic Affairs Committee, Rockville, Maryland; Loxo Oncology, a wholly owned subsidiary of Eli Lilly, Stamford, Connecticut
| | - Jay L Patel
- EAC101 Working Group, a Working Group of the Association for Molecular Pathology Economic Affairs Committee, Rockville, Maryland; Department of Pathology, University of Utah and ARUP Laboratories, Salt Lake City, Utah
| | - Loren Joseph
- EAC101 Working Group, a Working Group of the Association for Molecular Pathology Economic Affairs Committee, Rockville, Maryland; Division of Clinical Pathology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Matthew C Hiemenz
- EAC101 Working Group, a Working Group of the Association for Molecular Pathology Economic Affairs Committee, Rockville, Maryland; Department of Pathology and Laboratory Medicine, Children's Hospital Los Angeles, Los Angeles, California; Department of Pathology, Keck School of Medicine of USC, Los Angeles, California
| | - Oana C Rosca
- EAC101 Working Group, a Working Group of the Association for Molecular Pathology Economic Affairs Committee, Rockville, Maryland; Department of Pathology and Laboratory Medicine, Northwell Health System, Staten Island University Hospital, Staten Island, New York
| | - Samuel K Caughron
- EAC101 Working Group, a Working Group of the Association for Molecular Pathology Economic Affairs Committee, Rockville, Maryland; The MAWD Pathology Group, Lenexa, Kansas
| | | | - Tara L Burke
- Association for Molecular Pathology, Rockville, Maryland
| | - Dara L Aisner
- EAC101 Working Group, a Working Group of the Association for Molecular Pathology Economic Affairs Committee, Rockville, Maryland; Department of Pathology, University of Colorado School of Medicine, Aurora, Colorado.
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Wise KL, McCreary DL, Parikh HR, Horst PK, Koenig KM, Cunningham BP, Ring DC. Factors Associated with a Second Opioid Prescription Fill in Total Knee Arthroplasty. J Arthroplasty 2020; 35:S163-7. [PMID: 32229150 DOI: 10.1016/j.arth.2020.03.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 02/29/2020] [Accepted: 03/01/2020] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Total knee arthroplasty (TKA) creates a relatively large degree of nociception, making it a good setting to study variation in pain intensity and pain alleviation. The purpose of this study is to investigate factors associated with a second prescription of opioid medications within 30 days of primary TKA. METHODS Using an insurance database, we studied 1372 people over a 6-year period with no mental health comorbidities including substance misuse and no comorbid pain illness at the time of TKA. Factors associated with a second prescription of opioid medication within 30 days of TKA were sought among patient demographics and the overall prescription morphine milligram equivalents. Patient and prescription-related risk factors were evaluated utilizing logistic relative risk regression. We reserved a year of data, 222 people, to evaluate the performance of the derived model. RESULTS More than half the patients filled a second prescription for opioids within 30 days of TKA. Factors associated with a second prescription of opioid medication within 30 days of TKA included age (P < .01), current smoker (P = .01), and the total morphine milligram equivalents of the initial prescription (P < .01). Applied to the 222 people we reserved for validation, the model was 81% sensitive and 14% specific for a second prescription within 30 days, with a positive predictive value of 74%, and a negative predictive value of 20%. CONCLUSION People that are given more opioids tend to request more opioids, but our model had limited diagnostic performance characteristics indicating that we are not accounting for the key factors associated with a second opioid prescription. Future studies might address undiagnosed patient social and mental health opportunities, factors known to associate with pain intensity and satisfaction with pain alleviation. LEVEL OF EVIDENCE Diagnostic Level III.
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Burton BN, Gabriel RA. Current Procedural Terminology Used to Identify Transcarotid Artery Revascularization Cases. J Cardiothorac Vasc Anesth 2020; 34:2277-2278. [PMID: 32387017 DOI: 10.1053/j.jvca.2020.03.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 03/12/2020] [Indexed: 11/11/2022]
Affiliation(s)
- Brittany N Burton
- Department of Anesthesiology and Perioperative Medicine, University of California Los Angeles, Los Angeles, CA
| | - Rodney A Gabriel
- Department of Anesthesiology, University of California San Diego, San Diego, CA; Department of Medicine, Division of Biomedical Informatics, University of California San Diego, San Diego, CA
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Kwak MS, Cha JM, Ahn JH, Chae MK, Jeong S, Lee HH. Practical strategy for optimizing the timing of anti-tumor necrosis factor-α therapy in Crohn disease: A nationwide population-based study. Medicine (Baltimore) 2020; 99:e18925. [PMID: 32150045 PMCID: PMC7478703 DOI: 10.1097/md.0000000000018925] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
There is little consensus on the optimal timing of anti-tumor necrosis factor (anti-TNF) therapy to decrease the rates of hospitalization and surgery in Crohn disease (CD). We aimed to assess the real-world outcomes of anti-TNF therapy and estimate the optimal timing of anti-TNF therapy in Korean patients with CD.Claims data were extracted from the Korean Health Insurance Review and Assessment Service database. Incident patients diagnosed with CD between 2009 and 2016, with at least 1 anti-TNF drug prescription, and with follow-up duration > 6 months were stratified according to the number of relapses prior to initiation of anti-TNF therapy: groups A (≤1 relapse), B (2 relapses), C (3 relapses), and D (≥4 relapses). The cumulative survival curves free from emergency hospitalization (EH) and surgery were compared across groups.Among the 2173 patients analyzed, the best and worst prognoses were noted in groups A and D, respectively. The incidences of EH and surgery decreased significantly as the use of anti-TNF agents increased. The 5-year rate of hospitalization was significantly lower in group A than in groups C and D (P = .004 and .020, respectively), but similar between groups A and B. The 5-year rate of surgery was lower in group A than in group C (P = .024), but similar among groups A, B, and D.In Asian patients with CD, anti-TNF therapy reduces the risk of EH and surgery and should be considered before three relapses, regardless of disease duration.
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Affiliation(s)
- Min Seob Kwak
- Department of Internal Medicine, Kyung Hee University Hospital at Gangdong
- Department of Medicine, Graduate School, Kyung Hee University
| | - Jae Myung Cha
- Department of Internal Medicine, Kyung Hee University Hospital at Gangdong
- Department of Medicine, Graduate School, Kyung Hee University
| | - Ji Hyun Ahn
- Department of Medicine, Graduate School, Kyung Hee University
| | - Min Kyu Chae
- Department of Medicine, Graduate School, Kyung Hee University
| | - Sara Jeong
- Department of Medicine, Graduate School, Kyung Hee University
| | - Hun Hee Lee
- Kyung Hee University Industry-Academic Cooperation Foundation, Seoul, Republic of Korea
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Mehan WA, Schaefer PW, Hirsch JA. Academic Performance–Based Compensation Models. J Am Coll Radiol 2019; 16:1621-7. [DOI: 10.1016/j.jacr.2019.05.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 05/16/2019] [Accepted: 05/17/2019] [Indexed: 11/21/2022]
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Chen MM, Hirsch JA, Lee RK, Hughes DR, Nicola GN, Rosenkrantz AB. Determining the Patient Complexity of Head CT Examinations: Implications for Proper Valuation of a Critical Imaging Service. Curr Probl Diagn Radiol 2019; 49:177-181. [PMID: 31160096 DOI: 10.1067/j.cpradiol.2019.05.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Revised: 04/05/2019] [Accepted: 05/07/2019] [Indexed: 11/22/2022]
Abstract
PURPOSE The head-computed tomography (CT) exam code was recently identified by policy makers as having a potentially overvalued resource value units (RVU). A critical aspect in determining RVUs is the complexity of patients undergoing the service. This study evaluated the complexity of patients undergoing head-CT. METHODS The 2017 Medicare PSPS Master File was used to identify the most common site for performing head-CT examinations. Given the most common location, the 5% Research Identifiable File, was then used to evaluate complexity of patients undergoing head CT on the same day as an emergency department (ED) visit based on the Evaluation & Management (E&M) "level" of these visits (1-least complex to 5-most complex patient) and the ICD-10 diagnosis coding associated with the billed head CT claims. RESULTS 56.1% of head CT examinations were performed in the ED. Seventy percent of noncontrast exams performed in the ED were ordered in the most complex patient encounters (level 5 E&M visits). The most common ICD-10 code for head-CT without intravenous contrast billed with a level 5 E&M visit was "dizziness and giddiness," and for head-CT without and with intravenous contrast was "headache." CONCLUSION Head-CT is not only most frequently ordered in the ED, but also during the most complex ED visits, suggesting that the ICD-10 codes associated with such exams do not appropriately reflects patient complexity. The valuation process should also consider the complexity of associated billed patient encounters, as indicated by E&M visit levels.
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Affiliation(s)
| | | | - Ryan K Lee
- Thomas Jefferson University, Philadelphia, PA
| | - Danny R Hughes
- Georgia Institute of Technology, Atlanta, GA.; Harvey L. Neiman Health Policy Institute, Reston, VA
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Hirsch JA. The pincer movement of cost and quality in neurointerventional care: resource management as an imperative. J Neurointerv Surg 2019; 11:323-5. [DOI: 10.1136/neurintsurg-2019-014871] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2019] [Indexed: 11/03/2022]
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Thompson RC, Keating FK. PET myocardial blood flow is now officially declared ready for prime time (and a little bit about how the US coding/valuation/coverage system works). J Nucl Cardiol 2019; 26:316-317. [PMID: 29980965 DOI: 10.1007/s12350-018-1363-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Accepted: 06/26/2018] [Indexed: 10/28/2022]
Affiliation(s)
- Randall C Thompson
- St. Luke's Mid America Heart Institute and the University of Missouri - Kansas City, 4300 Wornall Rd, Kansas City, MO, 64111, USA.
| | - Friederike K Keating
- Division of Cardiology, University of Vermont Medical Center, McClure 1, 111 Colchester Ave, Burlington, VT, 05401, USA
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Kethman WC, Shelton EA, Kin C, Morris AM, Shelton AA. Effects of Colorectal Surgery Classification on Reported Postoperative Surgical Site Infections. J Surg Res 2019; 236:340-344. [PMID: 30694775 DOI: 10.1016/j.jss.2018.12.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2018] [Revised: 10/20/2018] [Accepted: 12/03/2018] [Indexed: 02/05/2023]
Abstract
BACKGROUND Current procedural terminology (CPT) for colon and rectal surgery lacks procedural granularity and misclassification rates are unknown. However, they are used in performance measurement, for example, in surgical site infection (SSI). The objective of this study was to determine whether American College of Surgeons National Surgical Quality Improvement Program (NSQIP) abstraction methods accurately classify types of colorectal operations and, by extension, reported SSI rates. MATERIALS AND METHODS This was a retrospective study conducted at a single tertiary care center. The colectomy- and proctectomy-targeted NSQIP database from January 2011 to July 2016 was used to perform a semiautomated reclassification (SAR) of all colectomy and proctectomy cases performed by colorectal surgeons. The primary outcome was the difference in perioperative SSI rates by case classification method. RESULTS Thousand sixty-three patients underwent a colectomy or proctectomy during the study period with a mean age of 55.7 (SD = 16.7) years. Use of the NSQIP classification scheme resulted in 849 colectomy and 214 proctectomy cases. Use of the SAR method resulted in 650 colectomy cases and 413 proctectomy cases (P < 0.001), a 23.4% reclassification of colectomy cases. The group of cases classified as colectomy by SAR had a lower rate of deep/organ space infections than those classified as colectomy by NSQIP (4.5% versus 7.1%, P = 0.034). CONCLUSIONS These findings highlight the challenges of CPT code-based patient classification and subsequent outcomes analysis. Expanding the CPT system to more accurately represent colorectal operations would allow for more representative reported outcomes, thus enabling benchmarking and quality improvement.
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Affiliation(s)
- William C Kethman
- Department of Surgery, Section of Colorectal Surgery, Stanford University School of Medicine, Stanford, California.
| | | | - Cindy Kin
- Department of Surgery, Section of Colorectal Surgery, Stanford University School of Medicine, Stanford, California
| | - Arden M Morris
- Department of Surgery, Section of Colorectal Surgery, Stanford University School of Medicine, Stanford, California
| | - Andrew A Shelton
- Department of Surgery, Section of Colorectal Surgery, Stanford University School of Medicine, Stanford, California
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Hirsch JA, Leslie-Mazwi T, Nicola GN, Milburn J, Kirsch C, Rosman DA, Gilligan C, Manchikanti L. Storm rising! The Obamacare exchanges will catalyze change: why physicians need to pay attention to the weather. J Neurointerv Surg 2018; 11:101-106. [DOI: 10.1136/neurintsurg-2018-014412] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/27/2018] [Indexed: 11/03/2022]
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Valand HA, Chu S, Bhala R, Foley R, Hirsch JA, Tu RK. Comparison of Advanced Imaging Resources, Radiology Workforce, and Payment Methodologies between the United States and Canada. AJNR Am J Neuroradiol 2018; 39:1785-1790. [PMID: 30166430 DOI: 10.3174/ajnr.a5755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 06/14/2018] [Indexed: 11/07/2022]
Abstract
The purpose of this Practice Perspectives was to review the United States and Canadian approaches to health care access and payment for advanced imaging. The historical background, governmental role, workforce, coding, payment, radiologic challenges, cost, resource intensity, and overall outcomes in longevity are reviewed.
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Affiliation(s)
- H A Valand
- From the American University of Integrative Sciences (H.A.V.), Brampton, Ontario, Canada
| | - S Chu
- Vancouver Coastal Health Authority (S.C.), Washington State Radiological Society, Vancouver, British Columbia, Canada
| | - R Bhala
- American Society of Neuroradiology (R.B.), Oak Brook, Illinois
| | - R Foley
- Ontario Association of Radiologists (R.F.), Oakville, Ontario, Canada
| | - J A Hirsch
- Massachusetts General Hospital (J.A.H.), Harvard Medical School, Boston, Massachusetts
| | - R K Tu
- Progressive Radiology (R.K.T.), George Washington University, United Medical Center, Falls Church, Virginia.
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Ren Y, Kok HK, Zhou K, Maingard J, Chandra RV, Lee MJ, Barras CD, Brooks M, Albuquerque FC, Tarr RW, Hirsch JA, Asadi H. The 100 most cited articles in the Journal of NeuroInterventional Surgery. J Neurointerv Surg 2018; 10:1020-1028. [DOI: 10.1136/neurintsurg-2018-014079] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 06/20/2018] [Indexed: 01/21/2023]
Abstract
BackgroundThe Journal of NeuroInterventional Surgery (JNIS) published its first volume in 2009. Over the ensuing years, JNIS flourished and has published a considerable number of high-profile articles. Citation analysis is a method of quantifying various metrics related to scholarly publications.ObjectiveTo apply citation analysis to the 100 most cited papers in the history of JNIS.MethodsThe most cited articles in JNIS were identified by using the Web of Science database. The top 100 articles were ranked according to their number of citations. Further information was obtained for each article, including citations per year, year of publication, authorship, article topics, and article type and level of evidence.ResultsThe total number of citations for the 100 most cited articles in JNIS ranged from 18 to 132 (median 26.0). Most articles (75%) were published between 2012 and 2015 and originated in the USA (79%). Eighteen authors have contributed five or more articles to the top 100 list. The most common topics are related to acute ischemic stroke and cerebral aneurysm.ConclusionsThis study highlights the influence of JNIS over its first decade by providing a comprehensive list of the 100 most cited articles and their authors as well as topics covered. This study also highlights the important factors driving the growth of JNIS.
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Spilberg G, Nicola GN, Rosenkrantz AB, Silva Iii E, Schirmer CM, Ghoshhajra BB, Choradia N, Do R, Hirsch JA. Understanding the impact of 'cost' under MACRA: a neurointerventional imperative! J Neurointerv Surg 2018; 10:1005-1011. [PMID: 30038063 DOI: 10.1136/neurintsurg-2018-013972] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 04/23/2018] [Accepted: 04/26/2018] [Indexed: 11/04/2022]
Abstract
The cost of providing healthcare in the United States continues to rise. The Affordable Care Act created systems to test value-based alternative payments models. Traditionally, procedure-based specialists such as neurointerventionalists have largely functioned in, and are thus familiar with, the traditional Fee for Service system. Administrative charge data would suggest that neurointerventional surgery is an expensive specialty. The Medicare Access and CHIP Reauthorization Act consolidated pre-existing federal performance programs in the Merit-based Incentive Payments System (MIPS), including a performance category called 'cost'. Understanding cost as a dimension that contributes to the value of care delivered is critical for succeeding in MIPS and offers a meaningful route for favorably bending the cost curve.
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Affiliation(s)
- Gabriela Spilberg
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | | | | | - Clemens M Schirmer
- Department of Neurosurgery, Neuroscience Institute, Geisinger, Wilkes-Barre, Pennsylvania, USA
| | - Brian B Ghoshhajra
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | - Rose Do
- Department of Cardiology and Cardiac Surgery, Veterans Affairs Medical Center, Long Beach, Kaiser Permanente of Southern California, Acumen, LLC, Long Beach, California, USA
| | - Joshua A Hirsch
- Interventional Neuroradiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Golding LP, Nicola GN, Ansari SA, Rosenkrantz AB, Silva III E, Manchikanti L, Hirsch JA. MACRA 2.5: the legislation moves forward. J Neurointerv Surg 2018; 10:1224-1228. [DOI: 10.1136/neurintsurg-2018-013910] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 06/08/2018] [Accepted: 06/09/2018] [Indexed: 11/04/2022]
Abstract
The Medicare and CHIP Reauthorization Act of 2015 remains the payment policy law of the land. 2017 was the first year in which performance reporting will tangibly impact future physician payments. The Centers for Medicare & Medicaid Services (CMS) considers 2017 and 2018 transitional years before full implementation in 2019. As such, 2018 increases the reporting requirements over 2017 in the form of a gradual phase-in while introducing several key changes and new elements. Indeed, it is the nature of the transition itself that led to the somewhat unique title of this manuscript, i.e., MACRA 2.5. Stakeholder feedback to the CMS regarding the program has ranged widely from the elimination of core components to expanding reporting to non-government payers. This article explores the potential impact on neurointerventional physicians.
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44
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Zhang Y, Zhang G. A Domain-Specific Terminology for Retinopathy of Prematurity and Its Applications in Clinical Settings. J Healthc Eng 2018; 2018:9237319. [PMID: 29850007 DOI: 10.1155/2018/9237319] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Accepted: 02/19/2018] [Indexed: 11/17/2022]
Abstract
A terminology (or coding system) is a formal set of controlled vocabulary in a specific domain. With a well-defined terminology, each concept in the target domain is assigned with a unique code, which can be identified and processed across different medical systems in an unambiguous way. Though there are lots of well-known biomedical terminologies, there is currently no domain-specific terminology for ROP (retinopathy of prematurity). Based on a collection of historical ROP patients' data in the electronic medical record system, we extracted the most frequent terms in the domain and organized them into a hierarchical coding system—ROP Minimal Standard Terminology, which contains 62 core concepts in 4 categories. This terminology has been successfully used to provide highly structured and semantic-rich clinical data in several ROP-related applications.
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Becnel LB, Hastak S, Ver Hoef W, Milius RP, Slack M, Wold D, Glickman ML, Brodsky B, Jaffe C, Kush R, Helton E. BRIDG: a domain information model for translational and clinical protocol-driven research. J Am Med Inform Assoc 2018; 24:882-890. [PMID: 28339791 DOI: 10.1093/jamia/ocx004] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Accepted: 01/05/2017] [Indexed: 12/14/2022] Open
Abstract
Background It is critical to integrate and analyze data from biological, translational, and clinical studies with data from health systems; however, electronic artifacts are stored in thousands of disparate systems that are often unable to readily exchange data. Objective To facilitate meaningful data exchange, a model that presents a common understanding of biomedical research concepts and their relationships with health care semantics is required. The Biomedical Research Integrated Domain Group (BRIDG) domain information model fulfills this need. Software systems created from BRIDG have shared meaning "baked in," enabling interoperability among disparate systems. For nearly 10 years, the Clinical Data Standards Interchange Consortium, the National Cancer Institute, the US Food and Drug Administration, and Health Level 7 International have been key stakeholders in developing BRIDG. Methods BRIDG is an open-source Unified Modeling Language-class model developed through use cases and harmonization with other models. Results With its 4+ releases, BRIDG includes clinical and now translational research concepts in its Common, Protocol Representation, Study Conduct, Adverse Events, Regulatory, Statistical Analysis, Experiment, Biospecimen, and Molecular Biology subdomains. Interpretation The model is a Clinical Data Standards Interchange Consortium, Health Level 7 International, and International Standards Organization standard that has been utilized in national and international standards-based software development projects. It will continue to mature and evolve in the areas of clinical imaging, pathology, ontology, and vocabulary support. BRIDG 4.1.1 and prior releases are freely available at https://bridgmodel.nci.nih.gov .
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Affiliation(s)
- Lauren B Becnel
- Clinical Data Interchange Standards Consortium, Austin, TX, USA.,Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, TX, USA
| | | | | | | | - MaryAnn Slack
- Food and Drug Administration Office of Strategic Programs, Silver Spring, MD, USA
| | - Diane Wold
- Clinical Data Interchange Standards Consortium, Austin, TX, USA
| | - Michael L Glickman
- Computer Network Architects Inc. and ISO/TC 215 Health Informatics, Rockville, MD, USA
| | - Boris Brodsky
- Food and Drug Administration Office of Strategic Programs, Silver Spring, MD, USA
| | - Charles Jaffe
- HL7 (Health Level 7 International), Ann Arbor, MI, USA
| | - Rebecca Kush
- Clinical Data Interchange Standards Consortium, Austin, TX, USA
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Lee CI, Gupta S, Sherry SJ, Chiunda A, Olson E, Chokshi FH, Mankowski-Gettle L, Mendiratta-Lala M, Lee YZ, Moser FG, Duszak R Jr. Translating New Imaging Technologies to Clinical Practice. Acad Radiol 2018; 25:3-8. [PMID: 28843464 DOI: 10.1016/j.acra.2017.03.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2017] [Accepted: 03/30/2017] [Indexed: 11/24/2022]
Abstract
Radiology continues to benefit from constant innovation and technological advances. However, for promising new imaging technologies to reach widespread clinical practice, several milestones must be met. These include regulatory approval, early clinical evaluation, payer reimbursement, and broader marketplace adoption. Successful implementation of new imaging tests into clinical practice requires active stakeholder engagement and a focus on demonstrating clinical value during each phase of translation.
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Hsiao SJ, Mansukhani MM, Carter MC, Sireci AN. The History and Impact of Molecular Coding Changes on Coverage and Reimbursement of Molecular Diagnostic Tests: Transition from Stacking Codes to the Current Molecular Code Set Including Genomic Sequencing Procedures. J Mol Diagn 2017; 20:177-183. [PMID: 29269278 DOI: 10.1016/j.jmoldx.2017.10.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 10/17/2017] [Accepted: 10/23/2017] [Indexed: 11/24/2022] Open
Abstract
Changes in coding and coverage generate an uncertain reimbursement environment for molecular pathology laboratories. We analyzed our experience with two representative molecular oncology tests: a T-cell receptor (TCR) β rearrangement test and a large (467-gene) cancer next-generation sequencing panel, the Columbia Combined Cancer Panel (CCCP). Before 2013, the TCR β test was coded using stacked current procedural terminology codes and subsequently transitioned to a tier 1 code. CCCP was coded using a combination of tier 1 and 2 codes until 2015, when a new Genomic Sequencing Procedure code was adopted. A decrease in reimbursement of 61% was observed for the TCR β test on moving from stacking to tier 1 codes. No initial increase in total rejection rate was observed, but a subsequent increase in rejection rates in 2015 and 2016 was noted. The CCCP test showed a similar decrease (48%) in reimbursement after adoption of the new Genomic Sequencing Procedure code and was accompanied by a sharp increase in rejection rates both on implementation of the new code and over time. Changes in coding can result in substantial decreases in reimbursement. This may be a barrier to patient access because of the high cost of molecular diagnostics. Revisions to the molecular code set will continue. These findings help laboratories and manufacturers prepare for the financial impact and advocate appropriately.
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Affiliation(s)
- Susan J Hsiao
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, New York
| | - Mahesh M Mansukhani
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, New York
| | - Melissa C Carter
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, New York
| | - Anthony N Sireci
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, New York.
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Abstract
In this second article, we continue the review of current health care economics as it relates to radiologists, specifically framed by topics defined by the Accreditation Council for Graduate Medical Education in the evaluation of neuroradiology fellows. The discussion in this article is focused on topics pertaining to levels 4 and 5, which are the more advanced levels of competency defined by the Accreditation Council for Graduate Medical Education Neuroradiology Milestones on Health Care Economics and System Based Practice.
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Affiliation(s)
- S L Weiner
- From the Neuroradiology Section, Department of Radiology, George Washington University Hospital, Washington, DC
| | - R Tu
- From the Neuroradiology Section, Department of Radiology, George Washington University Hospital, Washington, DC
| | - R Javan
- From the Neuroradiology Section, Department of Radiology, George Washington University Hospital, Washington, DC
| | - M R Taheri
- From the Neuroradiology Section, Department of Radiology, George Washington University Hospital, Washington, DC.
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49
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Hirsch JA, Rosenkrantz AB, Nicola GN, Harvey HB, Duszak R, Silva E, Barr RM, Klucznik RP, Brook AL, Manchikanti L. Contextualizing the first-round failure of the AHCA: down but not out. J Neurointerv Surg 2017; 9:595-600. [DOI: 10.1136/neurintsurg-2017-013136] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Accepted: 04/18/2017] [Indexed: 11/03/2022]
Abstract
On 8 November 2016 the American electorate voted Donald Trump into the Presidency and a majority of Republicans into both houses of Congress. Since many Republicans ran for elected office on the promise to ‘repeal and replace’ Obamacare, this election result came with an expectation that campaign rhetoric would result in legislative action on healthcare. The American Health Care Act (AHCA) represented the Republican effort to repeal and replace the Affordable Care Act (ACA). Key elements of the AHCA included modifications of Medicaid expansion, repeal of the individual mandate, replacement of ACA subsidies with tax credits, and a broadening of the opportunity to use healthcare savings accounts. Details of the bill and the political issues which ultimately impeded its passage are discussed here.
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50
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Jacobs JP, Lahey SJ, Nichols FC, Levett JM, Johnston GG, Freeman RK, St Louis JD, Painter J, Yohe C, Wright CD, Kanter KR, Mayer JE, Naunheim KS, Rich JB, Bavaria JE. How Is Physician Work Valued? Ann Thorac Surg 2017; 103:373-380. [PMID: 28109347 DOI: 10.1016/j.athoracsur.2016.11.059] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 11/19/2016] [Indexed: 10/20/2022]
Abstract
Strategies to value physician work continue to evolve. The Society of Thoracic Surgeons and The Society of Thoracic Surgeons National Database have an increasingly important role in this evolution. An understanding of the Current Procedural Terminology (CPT) system (American Medical Association [AMA], Chicago, IL) and the Relative Value Scale Update Committee (RUC) is necessary to comprehend how physician work is valued. In 1965, with the dawn of increasingly complex medical care, immense innovation, and the rollout of Medicare, the need for a common language describing medical services and procedures was recognized as being of critical importance. In 1966, the AMA, in cooperation with multiple major medical specialty societies, developed the CPT system, which is a coding system for the description of medical procedures and medical services. The RUC was created by the AMA in response to the passage of the Omnibus Budget Reconciliation Act of 1989, legislation of the United States of America Federal government that mandated that the Centers for Medicare & Medicaid Services adopt a relative value methodology for Medicare physician payment. The role of the RUC is to develop relative value recommendations for the Centers for Medicare & Medicaid Services. These recommendations include relative value recommendations for new procedures or services and also updates to relative value recommendations for previously valued procedures or services. These recommendations pertain to all physician work delivered to Medicare beneficiaries and propose relative values for all physician services, including updates to those based on the original resource-based relative value scale developed by Hsaio and colleagues. In so doing, widely differing work and services provided can be reviewed and comparisons of their relative value (to each other) can be established. The resource-based relative value scale assigns value to physician services using relative value units (RVUs), which consist of three components: work RVU, practice expense RVU, and malpractice RVU, also known as professional liability insurance RVU. The Centers for Medicare & Medicaid Services retains the final decision-making authority on the RVUs associated with each procedure or service. The purpose of this article is to discuss the role that the CPT codes and the RUC play in the valuation of physician work and to provide an example of how the methodology for valuation of physician work continues to evolve.
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Affiliation(s)
- Jeffrey P Jacobs
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; Division of Cardiovascular Surgery, Department of Surgery, Johns Hopkins All Children's Heart Institute, Johns Hopkins All Children's Hospital and Florida Hospital for Children, Saint Petersburg, Tampa, and Orlando, Florida.
| | - Stephen J Lahey
- Division of Cardiothoracic Surgery, Department of Surgery, University of Connecticut School of Medicine, Farmington, Connecticut
| | - Francis C Nichols
- Division of General Thoracic Surgery, Mayo Clinic, Rochester, Minnesota
| | | | | | | | - James D St Louis
- University of Missouri-Kansas City School of Medicine, Kansas City, Missouri
| | - Julie Painter
- Medical Reimbursement Analysis & Solutions, Thornton, Colorado
| | - Courtney Yohe
- The Society of Thoracic Surgeons, Government Relations, Washington, DC
| | - Cameron D Wright
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | | | - John E Mayer
- Department of Cardiac Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | | | - Jeffrey B Rich
- vue Based Healthcare Solutions, Virginia Beach, Virginia
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- The Society of Thoracic Surgeons, Chicago, Illinois
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