Accuracy of medical billing data against the electronic health record in the measurement of colorectal cancer screening rates.

OBJECTIVE: Medical billing data are an attractive source of secondary analysis because of their ease of use and potential to answer population-health questions with statistical power. Although these datasets have known susceptibilities to biases, the degree to which they can distort the assessment of quality measures such as colorectal cancer screening rates are not widely appreciated, nor are their causes and possible solutions. METHODS: Using a billing code database derived from our institution's electronic health records, we estimated the colorectal cancer screening rate of average-risk patients aged 50-74 years seen in primary care or gastroenterology clinic in 2016-2017. 200 records (150 unscreened, 50 screened) were sampled to quantify the accuracy against manual review. RESULTS: Out of 4611 patients, an analysis of billing data suggested a 61% screening rate, an estimate that matches the estimate by the Centers for Disease Control. Manual review revealed a positive predictive value of 96% (86%-100%), negative predictive value of 21% (15%-29%) and a corrected screening rate of 85% (81%-90%). Most false negatives occurred due to examinations performed outside the scope of the database-both within and outside of our institution-but 21% of false negatives fell within the database's scope. False positives occurred due to incomplete examinations and inadequate bowel preparation. Reasons for screening failure include ordered but incomplete examinations (48%), lack of or incorrect documentation by primary care (29%) including incorrect screening intervals (13%) and patients declining screening (13%). CONCLUSIONS: Billing databases are prone to substantial bias that may go undetected even in the presence of confirmatory external estimates. Caution is recommended when performing population-level inference from these data. We propose several solutions to improve the use of these data for the assessment of healthcare quality.

Mammography coding and reimbursement.

This article describes mammography coding and reimbursement, coding responsibilities for personnel and the importance of coding accuracy. After completing this article, the reader will: Recognize basic terms associated with mammography coding and reimbursement. Explain reimbursement differences between screening and diagnostic mammography. Understand the responsibilities of mammography facility personnel in accurate coding. Recognize the impact of coding, reimbursement and regulation on the economics of mammography practice. Explain basic coding concepts for screening, diagnostic and follow-up mammographic studies. Describe some new breast imaging technologies reimbursed by Medicare.

Indirect costs, cost-utility variations and the funding of paediatric cochlear implantation.

OBJECTIVE: To demonstrate the existence of variations in cost-utility associated with indirect costs in paediatric cochlear implantation; to illustrate the implications of this for purchasing decisions and; to posit a potential solution to anomalies in purchasing that may otherwise result when services are publicly funded. METHODS: Data was taken from published sources on the cost of implantation, outcomes measured in terms of quality adjusted life years (QALY) and in savings in education costs associated with paediatric cochlear implantation. Cost-utility ratios across education authorities were calculated using a single centre's implantation costs. RESULTS: Variations in savings across education authorities show that the cost per QALY gain associated with paediatric cochlear implantation can vary between approximately $12,000 and $18,000 assuming an exchange rate of $1.45 = 1 pound sterling for the same implant centre. These variations have the potential to produce situations in which less efficient implant centres are preferred by purchasers over more efficient ones or in which candidates with poorer outcomes are selected for funding over candidates with superior outcomes. It is important that savings associated with education be taken into consideration in evaluations intended to inform purchasing decisions regarding implantation. Equally it is important that potentially anomalous decisions be avoided if evaluations are to remain credible. It is argued that this may be achievable if public funding for implantation is determined at a national level and ring-fenced i.e. devoted exclusively to use in cochlear implantation.

El costo estándar: teoría y aplicación / Standard cost: theory and application

El estudio muestra las ventajas de aplicar el Costo Estándar en instituciones de salud, tomando como ejemplo un Laboratorio Central perteneciente a un Hospital Docente-Asistencial. La investigación es de carácter descriptivo y analítico utilizando las pruebas estadística de promedio y desviación estándar para comparar los costos estándar con los costos observados. En la institución estudiada, la variación total de los costos debido a cambios de precio, cantidad y volumen, según factores trabajo e insumo, resulta desfavorable en los dos primeros meses del año. En Enero por cantidad y en Febrero por precio. Este tipo de estudio permite estándares y, en consecuencia, conocer las variaciones en relación a él (eficiencia), el análisis de sus causas y la toma de decisiones. Este sistema de costo permite la determinación de precios "reales" y avala, por tanto, la negociación con las instituciones financiadoras