Epidemiology, patterns of care and prognosis of acute kidney injury in critically ill patients: A multicenter study in Argentina (The EPIRA study).

BACKGROUND: Acute kidney injury (AKI) is associated with high morbidity and mortality rates in the intensive care unit (ICU). In low- and middle-income countries (LMICs), epidemiological information about this condition is still scarce. Our main objective was to characterize its epidemiology, prognosis, and its treatment. METHODS: This multicenter prospective cohort study included 1466 patients from 35 ICUs during 6 months in Argentina in 2018. Risk factors and outcomes in patients with and without AKI, and between AKI on admission (AKIadm) and that developed during hospitalization (AKIhosp) were analyzed. RESULTS: AKI occurred in 61.3% of patients (900/1466); 72.6% were AKIadm and 27.3% AKIhosp. Risk factors were age, BMI, arterial hypertension, cardiovascular diseases, diabetes, SOFA, APACHE II, dehydration, sepsis, vasopressor use, radiocontrast, diuresis/h and mechanical ventilation. Independent predictors for AKI were sepsis, diabetes, dehydration, vasopressors on admission, APACHE II and radiocontrast use. Renal replacement therapies (RRT) requirement in AKI patients was 14.8%. Hospital mortality in AKI vs. non-AKI was 38.7% and 23.3% (p < 0.001); and in AKIadm vs. AKIhosp, 41.2% and 37.8% (p = 0.53). CONCLUSIONS: ICU-acquired AKI has high incidence, complications and mortality. Risk factors for AKI and RRT utilization were similar to those described in other epidemiological studies. AKIadm was more frequent than AKIhosp, but had equal prognosis.

Knowledge is payment: understanding state prompt-payment laws.

Faced with lagging receivables, hospitals across the country increasingly are suing delinquent payers to obtain payment. States have responded to the provider payment crisis by enacting and enforcing a rash of new laws requiring payers to pay claims within strict time frames or face steep penalties. To take advantage of the protection afforded by these laws, providers need to be aware of prompt-payment statutes in states in which they provide care, in which their patients live, and in which their payers are located. By becoming aware of their rights and obligations under these laws, providers can use the prompt-payment regulations proactively to avoid payment backlogs without resorting to litigation.

Managed care under siege: how an effective compliance program can protect your company.

This article discusses the current enforcement emphasis on managed care fraud and examines how managed care organizations can utilize compliance programs, including legal audits, to protect against unwarranted investigations and liability. The article reviews the elements of an effective compliance program, how to conduct an internal audit, and the risks and benefits of a voluntary disclosure in the event fraudulent activity is discovered.

Fraud & abuse in managed care--what does it mean for home care providers?

Managed care and home care are both increasingly popular as market and regulatory forces push payors and providers to reduce costs. The reform initiatives that have given rise to the increase in both these services, however, have also increased scrutiny of fraud and abuse. What do home care providers need to be aware of to protect themselves?