Billing and Coding: Disparities in Healthcare Provider Training.

BACKGROUND: In the United States, healthcare providers document and code healthcare encounters and submit claims to insurers for reimbursement. Most providers eligible for individual-level insurer reimbursement do not receive coding/billing training. The purpose of this commentary is to provide an overview of training disparities. METHODS: The top 100 universities within five healthcare disciplines (dietetics, nursing, pharmacy, social work, medicine) were asked about available didactic curriculum and coding resources provided during training. Results were compared across disciplines, by geographic region, funding mechanism, and size. RESULTS: Twenty-seven percent of schools/universities contacted participated; the response was greater among public institutions (73%) and varied by discipline. Coverage of coding/billing in the didactic curriculum varied: it was covered in 40 dietetics programs (93%), 23 nursing programs (57%), and 14 pharmacy programs (28%). None of the 36 social work programs covered coding/billing, and only 5% of the 20 medical schools did. No statistically significant differences by region or funding were noted; however, coverage of coding/billing in the curriculum did differ by discipline (p<0.0001). DISCUSSION: Upon graduation, healthcare providers may be ill-prepared to code/bill for services. This knowledge is crucial for sustainable health service provision and does not appear to be consistently provided within curriculum to healthcare students. Further study is needed to understand and address this training gap.

ABT-450/ ritonavir and ABT-267 in combination with ABT-333 for the treatment of hepatitis C virus.

INTRODUCTION: The global prevalence of chronic hepatitis C virus (HCV) is estimated to be 80 - 115 million and currently viremic infections account for 350,000 deaths annually. As the knowledge about HCV evolves, new anti-viral treatments have been developed. The primary goal of antiviral therapies has been to eradicate HCV virus from serum and achieve sustained virologic response (SVR). Historically, interferon has been a staple of nearly all HCV treatment regimens, despite significant toxic effects. AREAS COVERED: In recent years, HCV treatment has changed rapidly and significantly. All-oral treatment regimens show promise for treatment with shorter duration and more manageable side effects. New antivirals aimed at improving SVR may provide a cure to nearly all HCV-infected patients. The unique combination of ABT-450 (paritaprevir) and ABT-267 (ombitasvir) provides highly effective treatment for patients with genotype 1 HCV. This review will examine the antiviral properties, pharmacokinetics, pharmacodynamics, and side effects of these agents. EXPERT OPINION: The combination of ABT-450/r and ABT-267 has improved potency, favorable side effect profile, and low risk of resistance compared to the first-generation protease inhibitors. This combination is likely to be a major part of novel upcoming HCV treatment regimens and is likely to be widely used by clinicians. Additional data is awaited in additional patient populations, and with possible shorter treatment durations.

Inflammatory breast cancer clusters: A hypothesis.

Cancer clusters have long been a focus of interest because of the possibility of identifying etiologic agents. Only on rare occasions, however, have such cluster investigations been successful. One major difficulty in cluster investigations, particularly in the area of breast cancer, is the long latent period. There have been a number of publications providing a discouraging picture regarding cancer cluster investigations. The possibility of learning from a cluster investigation, however, is greatly increased if the cancer involved is relatively rare and if it has a short latent period. Inflammatory breast cancer (IBC) fits these criteria and is worth pursuing because of the strong evidence that environmental factors play a major role. In this report we describe our experience with several clusters and the lessons learned which are now being utilized to improve investigation of future IBC clusters. The first IBC cluster that we evaluated was in 2000, when we were asked to investigate an apparent cluster of IBC in Castro Valley, California where three women in an office setting of 24 people were diagnosed with IBC in a ten month period from May 1999 to March 2000. Our investigation of this striking cluster did not yield a specific trigger for this cluster but it did indicate that the women involved all had at least two IBC risk factors that may well have made them susceptible to getting IBC. We are now investigating another apparent cluster in Texas and are aware of several others requiring careful consideration. We see a need for a consistent protocol for the evaluation of IBC clusters focusing on the laboratory investigation of environmental triggers, primarily infectious agents and chemical carcinogens.

Anaphylaxis and insect allergy.

PURPOSE OF REVIEW: Anaphylaxis is an acute-onset and potentially life-threatening allergic reaction that can be caused by numerous allergic triggers including stinging insects. This review focuses on recent advances, natural history, risk factors and therapeutic considerations. RECENT FINDINGS: Recent work suggests that concerns over insect allergy diagnosis continue to exist. This is especially true with individuals who have a convincing history of a serious life-threatening anaphylactic event, but lack the necessary diagnostic criteria of venom-specific IgE by skin test or in-vitro diagnostic methods to confirm the diagnosis. The role of occult mastocytosis or increased basophile reactivity may play a role in this subset population. Additionally, epinephrine continues to be underutilized as the primary acute intervention for an anaphylactic reaction in the emergent setting. SUMMARY: The incidence of anaphylaxis continues to rise across all demographic groups, especially those less than 20 years of age. Fortunately, the fatalities related to anaphylaxis appear to have decreased over the past decades. Our understanding of various triggers, associated risk factors, as well as an improved understanding and utilization of biological markers such as serum tryptase have improved. Our ability to treat insect anaphylaxis by venom immunotherapy is highly effective. Unfortunately, anaphylaxis continues to be underappreciated and undertreated especially in regard to insect sting anaphylaxis. This includes the appropriate use of injectable epinephrine as the primary acute management tool. These findings suggest that continued education of the general population, primary care healthcare providers and emergency departments is required.