BACKGROUND: Fenestrated endovascular aneurysm repair (FEVAR) allows endovascular treatment of thoracoabdominal and juxtarenal aneurysms previously outside the indications of use for standard devices. However, because of considerable device costs and increased procedure time, FEVAR is thought to result in financial losses for medical centers and physicians. We hypothesized that surgeon leadership in the coding, billing, and contractual negotiations for FEVAR procedures will increase medical center contribution margin (CM) and physician reimbursement. METHODS: At the UMass Memorial Center for Complex Aortic Disease, a vascular surgeon with experience in medical finances is supported to manage the billing and coding of FEVAR procedures for medical center and physician reimbursement. A comprehensive financial analysis was performed for all FEVAR procedures (2011-2015), independent of insurance status, patient presentation, or type of device used. Medical center CM (actual reimbursement minus direct costs) was determined for each index FEVAR procedure and for all related subsequent procedures, inpatient or outpatient, 3 months before and 1 year subsequent to the index FEVAR procedure. Medical center CM for outpatient clinic visits, radiology examinations, vascular laboratory studies, and cardiology and pulmonary evaluations related to FEVAR were also determined. Surgeon reimbursement for index FEVAR procedure, related adjunct procedures, and assistant surgeon reimbursement were also calculated. All financial analyses were performed and adjudicated by the UMass Department of Finance. RESULTS: The index hospitalization for 63 FEVAR procedures incurred $2,776,726 of direct costs and generated $3,027,887 in reimbursement, resulting in a positive CM of $251,160. Subsequent related hospital procedures (n = 26) generated a CM of $144,473. Outpatient clinic visits, radiologic examinations, and vascular laboratory studies generated an additional CM of $96,888. Direct cost analysis revealed that grafts accounted for the largest proportion of costs (55%), followed by supplies (12%), bed (12%), and operating room (10%). Total medical center CM for all FEVAR services was $492,521. Average surgeon reimbursements per FEVAR from 2011 to 2015 increased from $1601 to $2480 while the surgeon payment denial rate declined from 50% to 0%. Surgeon-led negotiations with the Centers for Medicare & Medicaid Services during 2015 resulted in a 27% increase in physician reimbursement for the remainder of 2015 ($2480 vs $3068/case) and a 91% increase in reimbursement from 2011 ($1601 vs $3068). Assistant surgeon reimbursement also increased ($266 vs $764). Concomitant FEVAR-related procedures generated an additional $27,347 in surgeon reimbursement. CONCLUSIONS: Physician leadership in the coding, billing, and contractual negotiations for FEVAR results in a positive medical center CM and increased physician reimbursement.
Aortic Aneurysm/economics , Aortic Aneurysm/surgery , Blood Vessel Prosthesis Implantation/economics , Clinical Coding , Contracts/economics , Endovascular Procedures/economics , Fee-for-Service Plans/economics , Hospital Costs , Leadership , Negotiating , Physician's Role , Surgeons/economics , Attitude of Health Personnel , Benchmarking/economics , Blood Vessel Prosthesis Implantation/classification , Competitive Bidding/economics , Cost-Benefit Analysis , Databases, Factual , Endovascular Procedures/classification , Fee-for-Service Plans/classification , Health Expenditures , Hospital Charges , Humans , Massachusetts , Process Assessment, Health Care/classification , Process Assessment, Health Care/economics , Retrospective Studies , Treatment Outcome
An outcome assessment, the patient assessment used in an endpoint, is the measuring instrument that provides a rating or score (categorical or continuous) that is intended to represent some aspect of the patient's health status. Outcome assessments are used to define efficacy endpoints when developing a therapy for a disease or condition. Most efficacy endpoints are based on specified clinical assessments of patients. When clinical assessments are used as clinical trial outcomes, they are called clinical outcome assessments (COAs). COAs include any assessment that may be influenced by human choices, judgment, or motivation. COAs must be well-defined and possess adequate measurement properties to demonstrate (directly or indirectly) the benefits of a treatment. In contrast, a biomarker assessment is one that is subject to little, if any, patient motivational or rater judgmental influence. This is the first of two reports by the ISPOR Clinical Outcomes Assessment - Emerging Good Practices for Outcomes Research Task Force. This report provides foundational definitions important for an understanding of COA measurement principles. The foundation provided in this report includes what it means to demonstrate a beneficial effect, how assessments of patients relate to the objective of showing a treatment's benefit, and how these assessments are used in clinical trial endpoints. In addition, this report describes intrinsic attributes of patient assessments and clinical trial factors that can affect the properties of the measurements. These factors should be considered when developing or refining assessments. These considerations will aid investigators designing trials in their choice of using an existing assessment or developing a new outcome assessment. Although the focus of this report is on the development of a new COA to define endpoints in a clinical trial, these principles may be applied more generally. A critical element in appraising or developing a COA is to describe the treatment's intended benefit as an effect on a clearly identified aspect of how a patient feels or functions. This aspect must have importance to the patient and be part of the patient's typical life. This meaningful health aspect can be measured directly or measured indirectly when it is impractical to evaluate it directly or when it is difficult to measure. For indirect measurement, a concept of interest (COI) can be identified. The COI must be related to how a patient feels or functions. Procedures are then developed to measure the COI. The relationship of these measurements with how a patient feels or functions in the intended setting and manner of use of the COA (the context of use) could then be defined. A COA has identifiable attributes or characteristics that affect the measurement properties of the COA when used in endpoints. One of these features is whether judgment can influence the measurement, and if so, whose judgment. This attribute defines four categories of COAs: patient reported outcomes, clinician reported outcomes, observer reported outcomes, and performance outcomes. A full description as well as explanation of other important COA features is included in this report. The information in this report should aid in the development, refinement, and standardization of COAs, and, ultimately, improve their measurement properties.
Clinical Trials as Topic/standards , Endpoint Determination/standards , Health Services Research/standards , Process Assessment, Health Care/standards , Activities of Daily Living , Clinical Trials as Topic/classification , Consensus , Emotions , Endpoint Determination/classification , Health Services Research/classification , Health Status , Humans , Process Assessment, Health Care/classification , Recovery of Function , Terminology as Topic , Treatment Outcome
Introducción: Exponemos una descripción de los trastornos mentales no graves atendidos en una época de fuerte impacto de crisis económica y se comparan con épocas anteriores más benignas. Así mismo, se describe la actitud que hemos desarrollado hacia la patología no grave haciendo sobre todo hincapié en la intervención psicosocial. Material y Métodos: Pacientes nuevos atendidos en los cinco primeros meses del año 2012 y se discrimina a aquellos catalogados como trastorno mental no grave. En estos, valoramos la existencia de problemas psicosociales, laborales, económicos y del grupo primario de apoyo, asÍ como las actuaciones en el marco psicosocial que hemos llevado a cabo o a las que hemos derivado. Resultados: hasta en el 70% de los casos existen problemas psicosociales y entendemos que dichos factores pueden ser condicionantes importantes en los trastornos. Entendemos que el tener medidas claras de intervención psicosocial es fundamental más allá de un abordaje principalmente clínico. Conclusiones: Muchas veces se ha propugnado que el trastorno mental no grave debe ser atendido, casi exclusivamente por Atención Primaria. Desde nuestra experiencia entendemos que desde los Centros de Salud mental y con una buena coordinación tanto con servicios sociales, atención primaria y diversas asociaciones de intervención psicosocial, se puede desarrollar una labor fundamental (AU)
Introduction: We expose a description of the non-serious ment6al disorders treated in a time of strong impact of economic crisis and it´s compared with more benign earlier times. Likewise there is described the attitude that we have developed towards the non-severe pathology emphasizing specially in the psychosocial intervention. Material and methods: New patients attended in the first five months of 2012 were separated nonserious mental disorder. We valued psychosocial, employ, economic and the primary group support problems and the interventions in psychosocial area that we have done or those who we have sent Results: Up to 70% of cases psychosocial problems exists and we understand these factors can be very important in the disorders. Having clear measures of intervention psychosocial is basic beyond a principally clinical approaching. Conclusions: Often it has been said that nonsevere mental disorders must be attended almost exclusively al Primary health care. From our experience we understand Mental health centers and with a good coordination so much with Social services, Primary health care and different groups of psychosocial intervention a major support can be developed (AU)
Female , Humans , Male , Mental Disorders/pathology , Mental Disorders/psychology , Therapeutics/classification , Therapeutics/psychology , Primary Health Care , Process Assessment, Health Care/ethics , Mental Disorders/classification , Mental Disorders/complications , Therapeutics/trends , Therapeutics , Primary Health Care/methods , Process Assessment, Health Care/classification
BACKGROUND: Prioritisation instruments were developed for patients on waiting list for hip and knee arthroplasties (AI) and cataract surgery (CI). The aim of the study was to assess their convergent and discriminant validity and inter-observer reliability. METHODS: Multicentre validation study which included orthopaedic surgeons and ophthalmologists from 10 hospitals. Participating doctors were asked to include all eligible patients placed in the waiting list for the procedures under study during the medical visit. Doctors assessed patients' priority through a visual analogue scale (VAS) and administered the prioritisation instrument. Information on socio-demographic data and health-related quality of life (HRQOL) (HUI3, EQ-5D, WOMAC and VF-14) was obtained through a telephone interview with patients. The correlation coefficients between the prioritisation instrument score and VAS and HRQOL were calculated. For the reliability study a self-administered questionnaire, which included hypothetic patients' scenarios, was sent via postal mail to the doctors. The priority of these scenarios was assessed through the prioritisation instrument. The intraclass correlation coefficient (ICC) between doctors was calculated. RESULTS: Correlations with VAS were strong for the AI (0.64, CI95%: 0.59-0.68) and for the CI (0.65, CI95%: 0.62-0.69), and moderate between the WOMAC and the AI (0.39, CI95%: 0.33-0.45) and the VF-14 and the CI (0.38, IC95%: 0.33-0.43). The results of the discriminant analysis were in general as expected. Inter-observer reliability was 0.79 (CI95%: 0.64-0.94) for the AI, and 0.79 (CI95%: 0.63-0.95) for the CI. CONCLUSION: The results show acceptable validity and reliability of the prioritisation instruments in establishing priority for surgery.
Arthroplasty, Replacement, Hip , Arthroplasty, Replacement, Knee , Cataract Extraction , Health Care Rationing , Process Assessment, Health Care/classification , Waiting Lists , Aged , Aged, 80 and over , Female , Health Care Rationing/methods , Health Care Surveys , Humans , Male , Middle Aged , Ophthalmology , Orthopedics , Patient Selection , Process Assessment, Health Care/standards , Quality of Life , Reproducibility of Results , Socioeconomic Factors , Spain
Contenido: Capitulo I. 1. 2 Determinación de la calidad de servicio. 1. 3 Caracteristicas para que un servicio de salud tenga calidad, Capitulo II. 2. 1 Definición del servicio, 2. 2 Definición de servico al cliente, 2. 3 Principales caracteristicas de los servicios, 2. 4 Expectativas del cliente respecto al servicio, 2. 5 Definición de servios de salud, Capitulo III. 3. 1 Definición de procesos, 3. 2 Características de los procesos, 3. 3 Los clientes, 3. 4 Jerarquia del proceso, 3. 5 Selección de los responsables del proceso, 3. 6 Definición de los límites de un proceso, 3. 7 Representación de un proceso, 3. 8 Simbologia de un diagrama de flujo, . Capítulo IV. 4. 1 Naturaleza y domicilio de la caja nacional de salud, 4. 2 Misión, políticas, objetivos y campo de aplicación, 4. 3 Servcios, 4. 4 Organización, 4. 5 Personal, 4. 6 sDefinición de centros médicos, Capítulo V. Metodologia, 5. 1 Método de investigación, 5. 2 Tipo de estudio, 5. 3 Formulación de la hipótesis, 5. 4 Unidad de an álisis, 5. 5 Determinación del universo y la muestra, 5. 6 Técnicas de investigación, 5. 7 Operacionalización de variables, Capítulo VI. La calidad de servicio de consulta externa de la C. N. C. , 6. 1 Acceso a los servicios, 6. 2 Eficiencia, 6. 3 Continuidad y oportunidad, 6. 4 Competencia profesional, 6. 5 Conclusiones del capítulo, Capítulo VII, Expectativas del cliente respecto al servicio médico, 7. 1 Fiabilidad, 7. 2 Seguridad, comodidad y empatia, 7. 3 Capacidad de respuesta, 7. 4 Elementos tangibles, 7. 5 Conclusiones del capítulo
Referral and Consultation/classification , Process Assessment, Health Care/classification , Total Quality Management
One of the most important instruments for gathering information and processing data relating to professional and organisational quality in health systems is "healthcare processes classification". The authors found that a typical problem of many European countries is a lack of reliable information in the field of healthcare, mainly because the development of quality instruments, including healthcare processes classification, is not a priority for medical and other health professions. Additionally, it is difficult to update this instrument coherently with organisational changes and developmental achievements. This article describes the approach used by the University Medical Centre in Ljubjana, Slovenia, to redesign its healthcare processes classification in order to improve the quality of healthcare.
Academic Medical Centers/standards , Process Assessment, Health Care/classification , Total Quality Management/methods , Academic Medical Centers/organization & administration , Data Collection/methods , Hospital Bed Capacity, 500 and over , Hospitals, Public/organization & administration , Hospitals, Public/standards , Humans , Organizational Case Studies , Organizational Culture , Organizational Innovation , Process Assessment, Health Care/methods , Slovenia , Staff Development
Dentists, like most managers, believe that unanticipated team results are evidence of poor performance on the part of employees. While this can be the case, it is much more likely that most variation is inherent in the system and is probably not under the control of staff. The dentist, as the manager, has full control and full responsibility for guaranteeing that the office runs effectively and for improving its operation.
Process Assessment, Health Care , Dental Auxiliaries , Dentists , Humans , Interprofessional Relations , Leadership , Process Assessment, Health Care/classification , Process Assessment, Health Care/methods , Process Assessment, Health Care/organization & administration , Process Assessment, Health Care/standards , Total Quality Management
Fundamento: el Servicio de Radiodiagnóstico genera productos intermedios y trabaja a demanda en red con el resto del hospital. El tiempo es factor clave condicionante de la efectividad y del resultado global asistencial. Métodos: se estudiaron tiempos de respuesta en ecografías, radiología general y Tomografía Computerizada (TC) antes y después de implantar diferentes cambios organizativos en los circuitos asistenciales. Resultados: el tiempo medio global desde la petición a la salida del informe fue de 95 horas 24 m. y 43 horas 42 m. en circuito previo y modificado en las ecografías, respectivamente. La radiología general tuvo una media de 58 horas 48 m. en el primer circuito y de 18 horas y 6 m. en el modificado y en la TC la media pasa de 88 horas 42 m. a 54 horas 42 m., respectivamente. Conclusiones: los cambios organizativos han influido muy favorablemente en todas las etapas del proceso de radiodiagnóstico y, en consecuencia, en los tiempos totales de la hospitalización, considerando este punto como paso intermedio en el camino hacia unos servicios de mayor calidad (AU)
Process Assessment, Health Care/standards , Process Assessment, Health Care/organization & administration , Quality Control , Radiography/standards , Diagnostic Imaging/methods , Diagnostic Imaging/standards , Health Services/organization & administration , Process Assessment, Health Care/classification , Process Assessment, Health Care/trends , Process Assessment, Health Care , Radiology/standards , Technology, Radiologic/organization & administration , Protective Devices/supply & distribution , Protective Devices/standards , Technology
