Assuntos
Atitude do Pessoal de Saúde , Overdose de Drogas/terapia , Hospitalização/estatística & dados numéricos , Hospitais Psiquiátricos/ética , Piridinas/toxicidade , Tentativa de Suicídio/psicologia , Humanos , Incidência , Narração , Readmissão do Paciente/estatística & dados numéricos , Relações Profissional-Paciente , Tentativa de Suicídio/prevenção & controle , ZolpidemRESUMO
The Patient Protection and Affordable Care Act passed in 2010 will result in dramatic expansion of publically funded health insurance coverage for low-income individuals. It is estimated that of the 32 million newly insured, 16 million will obtain coverage through expansion of the Medicaid Program, and the remaining 16 million will purchase coverage through their employer or newly legislated insurance exchanges. While the Act contains numerous provisions to improve access to private insurance as discussed in Part I of this analysis, public sector coverage will significantly be affected. The cost of health care reform will be borne disproportionately by Medicare, which faces nearly $500 billion in cuts to be identified by a new independent board. Transplant centers should be concerned about the impact of the reform on the financial aspects of transplantation. In addition, this legislation also utilizes the Medicare Program to drive reform of the health care delivery system, by encouraging the development of integrated Accountable Care Organizations, experimentation with new 'models' of healthcare delivery, and expanded support for Comparative Effectiveness Research. Transplant providers, including transplant centers and physicians/surgeons need to lead this movement, drawing on our experience providing comprehensive multidisciplinary care under global budgets with publically reported outcomes.
Assuntos
Atenção à Saúde/economia , Patient Protection and Affordable Care Act , Setor Público/economia , Reforma dos Serviços de Saúde/legislação & jurisprudência , Humanos , Seguro Saúde/economia , Medicare/economia , Transplante de Órgãos/economia , Patient Protection and Affordable Care Act/economia , Patient Protection and Affordable Care Act/organização & administração , Estados UnidosRESUMO
The Health Care Reform (HCR) legislation passed by Congress in 2010 will have significant impact on transplant centers, patients and health care professionals. The Act seeks to expand coverage, limit the growth in health care costs and reform the delivery and insurance systems. In Part I of this two part series, we provide an overview and perspective of changes in private health insurance resulting from HCR. Under the plan, all Americans will be required to purchase coverage through their employer or via an improved individual/small group market. This legislation limits abusive practices such as limitations on preexisting conditions, lifetime and annual coverage limitations and dropping of beneficiaries if they become sick. The legislation will also limit high-cost plans and regulate premium increases. Private sector reforms are likely to benefit our patients by increasing the number of patients with access to transplant services, since the use of 'preexisting' conditions will be eliminated. However without a concomitant increase in the organ supply, longer waiting times and greater use of marginal organs are likely to increase the cost of transplant. Furthermore, transplant providers will receive reduced reimbursement as a result of market consolidation and the growing power of large transplant networks.
Assuntos
Reforma dos Serviços de Saúde/legislação & jurisprudência , Reembolso de Seguro de Saúde/economia , Transplante de Órgãos/economia , Patient Protection and Affordable Care Act , Planos de Assistência de Saúde para Empregados/economia , Planos de Assistência de Saúde para Empregados/legislação & jurisprudência , Custos de Cuidados de Saúde , Humanos , Reembolso de Seguro de Saúde/tendências , Falência Renal Crônica/terapia , National Health Insurance, United States/economia , National Health Insurance, United States/legislação & jurisprudência , Patient Protection and Affordable Care Act/economia , Setor Privado/economia , Estados UnidosRESUMO
The transplant center regulations recently published by the Centers for Medicare and Medicaid (CMS) mandate that observed program-specific survival outcomes to fall within expected risk-adjusted outcomes. Meeting these outcomes is essential to continued participation in the Medicare program. Both donor and recipient variables not considered in current risk adjustment models can result in inferior outcomes and therefore may cause an overestimation of transplant center expected performance, precluding participation in the federally funded Medicare program. We reviewed the most recent four reporting periods published by the Scientific Registry for Transplant Recipients on their public website. We identified kidney, liver and heart transplant programs that were flagged for having outcomes statistically lower than expected as well as those that failed to meet CMS criteria. We also analyzed whether center volumes correlated with outcomes in these centers. We highlight the need for mitigating factors that could justify inferior outcomes under specific circumstances. Failure to reach consensus on such a mechanism for appeal may result in risk-averse behavior by transplant centers with respect to innovation and therefore hamper the ability to advance the field of transplantation. We propose a methodology that may address this emerging dilemma.
Assuntos
Medicare/economia , Transplante de Órgãos/normas , Avaliação de Resultados em Cuidados de Saúde , Risco Ajustado , Centers for Medicare and Medicaid Services, U.S. , Difusão de Inovações , Sobrevivência de Enxerto , Transplante de Coração/efeitos adversos , Transplante de Coração/mortalidade , Humanos , Transplante de Rim/efeitos adversos , Transplante de Rim/mortalidade , Transplante de Fígado/efeitos adversos , Transplante de Fígado/mortalidade , Responsabilidade Social , Sociedades Médicas , Resultado do Tratamento , Estados UnidosRESUMO
The Centers for Medicare and Medicaid Services (CMS) has developed a set of regulations that spell out the Conditions of Participation (CoPs) for provider hospitals that wish to be certified (and thus eligible for reimbursement) by Medicare for transplant services. The American Society of Transplant Surgeons (ASTS) Council has played a major role in providing CMS with advice and guidance in the development and ongoing implementation of these conditions through a process of fruitful dialogue. In this report, we highlight the events that led to the development of the regulations and describe the process to date in implementing the CoPs. We have raised some important questions regarding the effectiveness of the regulations for improving safety, and we have highlighted the cost associated with their implementation. This report has been vetted by and represents the opinions of the Council of the ASTS.
Assuntos
Centers for Medicare and Medicaid Services, U.S./legislação & jurisprudência , Transplante de Órgãos/legislação & jurisprudência , Obtenção de Tecidos e Órgãos/legislação & jurisprudência , Centers for Medicare and Medicaid Services, U.S./economia , Centers for Medicare and Medicaid Services, U.S./normas , Humanos , Falência Renal Crônica/cirurgia , Transplante de Rim/economia , Transplante de Rim/legislação & jurisprudência , Transplante de Rim/normas , Medicaid/economia , Medicaid/legislação & jurisprudência , Medicaid/normas , Medicare/economia , Medicare/legislação & jurisprudência , Medicare/normas , Transplante de Órgãos/economia , Transplante de Órgãos/normas , Mecanismo de Reembolso , Sociedades Médicas , Obtenção de Tecidos e Órgãos/economia , Obtenção de Tecidos e Órgãos/normas , Estados UnidosAssuntos
Cardiologia/legislação & jurisprudência , Consulta Remota/legislação & jurisprudência , Confidencialidade/legislação & jurisprudência , Fraude/legislação & jurisprudência , Humanos , Licenciamento em Medicina/legislação & jurisprudência , Medicaid/legislação & jurisprudência , Medicare/legislação & jurisprudência , Estados UnidosAssuntos
Revisão da Utilização de Seguros/normas , Prontuários Médicos/classificação , Medicare Part B , Radiologia/economia , Indexação e Redação de Resumos/normas , Centers for Medicare and Medicaid Services, U.S. , Humanos , Revisão da Utilização de Seguros/classificação , Manuais como Assunto , Estados UnidosAssuntos
Instituições de Assistência Ambulatorial/economia , Diagnóstico por Imagem/economia , Oncologia/economia , Escalas de Valor Relativo , Sociedades , Instituições de Assistência Ambulatorial/organização & administração , Centers for Medicare and Medicaid Services, U.S. , Oncologia/legislação & jurisprudência , Medicare/economia , Medicare/legislação & jurisprudência , Tecnologia Radiológica/economia , Tecnologia Radiológica/legislação & jurisprudência , Estados UnidosRESUMO
The Health Care Financing Administration has released final regulations concerning physician payment reform. The new method will significantly affect global, technical, and professional reimbursement. The American Society of Echocardiography is preparing response to these regulations.
Assuntos
Ecocardiografia/economia , Medicare Part B/legislação & jurisprudência , Escalas de Valor Relativo , Centers for Medicare and Medicaid Services, U.S. , Tabela de Remuneração de Serviços/legislação & jurisprudência , Humanos , Estados UnidosRESUMO
In Experiment 1, frequency-discrimination thresholds were estimated in a 2-interval, forced-choice, backward masking procedure with a masker acoustically dissimilar to the targets. Young subjects were more efficient in escaping the effects of masking than were their elderly counterparts. In Experiment 2, young and elderly subjects performed the same task, with a masker acoustically similar to the targets and with a target-dissimilar masker. Under target-similar masking and at short target-masker intervals, the elderly demonstrated significant improvement, reaching the level of performance of the young, whereas under the target-dissimilar masker, the age-related differences were restored. Both age-related slowing of information processing and increase in stimulus persistence can account for the results of Experiment 1, but only increased stimulus persistence explains the results of Experiment 2.
Assuntos
Envelhecimento/psicologia , Percepção Auditiva , Memória , Mascaramento Perceptivo , Adolescente , Adulto , Idoso , Limiar Auditivo , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Modelos Neurológicos , PsicoacústicaRESUMO
Some Medicare carriers have independently decided to treat all billings for echocardiographic services as radiologic, whereas others have decided to treat billings from multispecialty practices that include a radiologist as radiologic services. The result is that the radiology fee schedules are being applied, even though the services were not supplied by radiologists.
Assuntos
Ecocardiografia/economia , Medicare/economia , Mecanismo de Reembolso , Orçamentos , Centers for Medicare and Medicaid Services, U.S. , Ética Médica , Honorários Médicos , Controle de Formulários e Registros , Humanos , Joint Commission on Accreditation of Healthcare Organizations , Legislação Médica , Encaminhamento e Consulta , Estados UnidosRESUMO
Medicare reimbursement for echocardiographic procedures is clouded by the fact that Medicare defines ultrasound services to be "radiologic." As such, a 40% limitation has been imposed in some states. In addition, as a result of the Omnibus Budget Reconciliation Act of 1987, a new radiology fee structure was negotiated with Medicare, without the input of internists and cardiologists, that may significantly affect reimbursement patterns for echocardiographic services. Those who perform and interpret cardiac ultrasound studies are again urged to use the medicine codes (90,000 series) rather than radiology codes (70,000 series).
Assuntos
Ecocardiografia/economia , Medicare/legislação & jurisprudência , Mecanismo de Reembolso/legislação & jurisprudência , Indexação e Redação de Resumos , Tabela de Remuneração de Serviços/legislação & jurisprudência , Humanos , Estados UnidosRESUMO
We investigated age-related differences in the time course of two-tone frequency discrimination. Healthy young and elderly adults with normal hearing acuity in the 500-2000 Hz range performed a two-alternative forced choice frequency discrimination task. The stimuli were short tones separated by either a 250-ms (short), 850-ms (medium), or 3000-ms (long) silent inter-interstimulus interval (ISI). Frequency discrimination thresholds were estimated using an adaptive staircase procedure. Although young listeners performed better than the elderly at all ISIs, the latter showed a dramatic elevation of discrimination thresholds at 250 ms, while the thresholds of the young subjects increased significantly at 3000 ms. These results suggest that the elderly may be especially vulnerable to the effects of masking produced by the second tone at the short interval, whereas the young listeners tend to be differentially affected by the trace decay at long ISI. The results are discussed in the framework of stimulus persistence hypothesis.
Assuntos
Envelhecimento/fisiologia , Atenção , Limiar Auditivo/fisiologia , Transtornos Cognitivos , Memória de Curto Prazo/fisiologia , Discriminação da Altura Tonal/fisiologia , Estimulação Acústica , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Limiar Diferencial , Humanos , Pessoa de Meia-Idade , Mascaramento Perceptivo/fisiologiaAssuntos
Departamentos Hospitalares/economia , Medicare/legislação & jurisprudência , Ambulatório Hospitalar/economia , Sistema de Pagamento Prospectivo/legislação & jurisprudência , Serviço Hospitalar de Radiologia/economia , Centros Cirúrgicos/economia , Indexação e Redação de Resumos , Humanos , Estados UnidosRESUMO
The Omnibus Budget Reconciliation Act of 1987 has significantly changed the rules governing the way in which charges must be made to Medicare concerning certain tests, including ultrasound, by a physician who provides these tests by means of an outside supplier. If the physician does not identify the supplier or indicate the amount charged by the supplier for the test, no payment is allowed, and the physician may not bill the beneficiary any amount for the test.
Assuntos
Orçamentos/legislação & jurisprudência , Ecocardiografia/economia , Honorários Médicos , Medicare/economia , Humanos , Medicare/legislação & jurisprudência , Mecanismo de Reembolso/legislação & jurisprudência , Estados UnidosRESUMO
When a sonographer renders diagnostic interpretations from echocardiographic data, the possibility exists that state statutes concerning the unauthorized practice of medicine may be violated. Problems likely exist in this regard when the sonographer renders such interpretations without proper physician interaction or when the physician delegates such responsibilities to the sonographer. In such situations the physician may be guilty of aiding and abetting the unauthorized practice of medicine. Such practices may also violate various reimbursement rules and policies. Given such a situation, even the rendering of preliminary results by sonographers without appropriate supervision by the physician may be in violation of various state statutes and rules governing reimbursement procedures.