Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 751
Filtrar
2.
Tex Med ; 115(3): 20-25, 2019 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-30855697

RESUMO

Molina Healthcare of Texas isn't the only insurer to give physicians prompt-pay problems, and it won't be the last. Some of the practices trying to recover payments blame not just the health plan, but also the extended response time from the state regulator overseeing insurance products and conduct: the Texas Department of Insurance, which says it's hiring staff and making other changes to improve that response.


Assuntos
Sistemas Pré-Pagos de Saúde/legislação & jurisprudência , Revisão da Utilização de Seguros/legislação & jurisprudência , Reembolso de Seguro de Saúde/estatística & dados numéricos , Médicos/economia , Humanos , Reembolso de Seguro de Saúde/legislação & jurisprudência , Governo Estadual , Texas , Fatores de Tempo
3.
Seton Hall Law Rev ; 49(1): 1-51, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30557921

RESUMO

For the better part of a decade, Americans have had a front-row seat to a fervent and turbulent debate over the future of their health care system. The passage of the Patient Protection and Affordable Care Act of 2010 (ACA), the most comprehensive health reform effort since the mid-1960s, ushered in a new era in health law and policy, granting millions of Americans access to health care. After multiple legal challenges and congressional efforts that ultimately failed to slay the law, the ACA had become entrenched by the end of the Obama administration, even though pieces of the law had failed to work exactly as planned. Now, with the surprising election of President Donald Trump, reenergized Republicans are targeting the law once more, and it suddenly appears more vulnerable than ever. Dynamic uncertainty again permeates the national debate. Although most powerful protections of the ACA may evaporate--no small event, to be sure--the value-based era which it unleashed seems here to stay. Indeed, this era--focused on efficiency, standardization, and quality within American medicine--has just begun to bear fruit. Illustrated prominently by recent changes to Medicare that alter how the program pays its doctors for services they provide to its beneficiaries, America is moving away from the old strictures of fee-for-service medicine. At the same time, traditional legal tools, and particularly the federal government's most prominent anti-fraud tool, the civil federal False Claims Act (FCA), seem to be facing new limits. This has been recently evident in medical necessity-based fraud cases, and particularly highly publicized fights that have targeted the burgeoning industry of hospice care. This Article tracks this development, ultimately arguing that the move to "reimbursement-based regulation" may be a positive step in finally reining in the worst excesses of American health care. But it also cautions against the deceptive simplicity of allowing medical heterogeneity and clinical complexity to prevent application of America's most powerful anti-fraud tools to its medical industry. Just because reimbursement policy has shifted to shoulder some of the regulatory burden of overtreatment does not mean that health care fraud--like fee-for-service medicine--should be confined to the past. In the end--and regardless of whatever legislation the national debate surrounding American health care produces--American medicine must adequately address its susceptibility to overtreatment, its incentives toward financial excess and waste, and its inability to push providers and entities into adopting more efficient practices. Medicare is finally moving quickly to bring about effective changes, and the program is seeking clarity in the midst of a period of tremendous uncertainty for American health care.


Assuntos
Fraude/legislação & jurisprudência , Cuidados Paliativos na Terminalidade da Vida/legislação & jurisprudência , Medicare/legislação & jurisprudência , Cuidados Paliativos na Terminalidade da Vida/economia , Humanos , Revisão da Utilização de Seguros/legislação & jurisprudência , Reembolso de Seguro de Saúde/legislação & jurisprudência , Medicare/economia , Estados Unidos
4.
Fed Regist ; 83(160): 41144-784, 2018 Aug 17.
Artigo em Inglês | MEDLINE | ID: mdl-30192475

RESUMO

We are revising the Medicare hospital inpatient prospective payment systems (IPPS) for operating and capital-related costs of acute care hospitals to implement changes arising from our continuing experience with these systems for FY 2019. Some of these changes implement certain statutory provisions contained in the 21st Century Cures Act and the Bipartisan Budget Act of 2018, and other legislation. We also are making changes relating to Medicare graduate medical education (GME) affiliation agreements for new urban teaching hospitals. In addition, we are providing the market basket update that will apply to the rate-of-increase limits for certain hospitals excluded from the IPPS that are paid on a reasonable cost basis, subject to these limits for FY 2019. We are updating the payment policies and the annual payment rates for the Medicare prospective payment system (PPS) for inpatient hospital services provided by long-term care hospitals (LTCHs) for FY 2019. In addition, we are establishing new requirements or revising existing requirements for quality reporting by specific Medicare providers (acute care hospitals, PPS-exempt cancer hospitals, and LTCHs). We also are establishing new requirements or revising existing requirements for eligible professionals (EPs), eligible hospitals, and critical access hospitals (CAHs) participating in the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs (now referred to as the Promoting Interoperability Programs). In addition, we are finalizing modifications to the requirements that apply to States operating Medicaid Promoting Interoperability Programs. We are updating policies for the Hospital Value-Based Purchasing (VBP) Program, the Hospital Readmissions Reduction Program, and the Hospital-Acquired Condition (HAC) Reduction Program. We also are making changes relating to the required supporting documentation for an acceptable Medicare cost report submission and the supporting information for physician certification and recertification of claims.


Assuntos
Economia Hospitalar/legislação & jurisprudência , Medicaid/economia , Medicare/economia , Sistema de Pagamento Prospectivo/economia , Registros Eletrônicos de Saúde , Interoperabilidade da Informação em Saúde/economia , Interoperabilidade da Informação em Saúde/legislação & jurisprudência , Humanos , Revisão da Utilização de Seguros/economia , Revisão da Utilização de Seguros/legislação & jurisprudência , Reembolso de Seguro de Saúde , Medicaid/legislação & jurisprudência , Medicare/legislação & jurisprudência , Sistema de Pagamento Prospectivo/legislação & jurisprudência , Qualidade da Assistência à Saúde/economia , Qualidade da Assistência à Saúde/legislação & jurisprudência , Reembolso de Incentivo/economia , Reembolso de Incentivo/legislação & jurisprudência , Estados Unidos
5.
J Public Health (Oxf) ; 40(4): 871-877, 2018 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-29506041

RESUMO

Taking advantage of its single-payer, universal insurance system, Taiwan has leveraged its exhaustive database of health claims data for research purposes. Researchers can apply to receive access to pseudonymized (coded) medical data about insured patients, notably their diagnoses, health status and treatments. In view of the strict safeguards implemented, the Taiwanese government considers that this research use does not require patients' consent (either in the form of an opt-in or in the form of an opt-out). A group of non-governmental organizations has challenged this view in the Taiwanese Courts, but to no avail. The present article reviews the arguments both against and in favor of patients' consent for re-use of their data in research. It concludes that offering patients an opt-out would be appropriate as it would best balance the important interests at issue.


Assuntos
Pesquisa Biomédica/métodos , Consentimento Livre e Esclarecido/estatística & dados numéricos , Revisão da Utilização de Seguros/ética , Pesquisa Biomédica/ética , Pesquisa Biomédica/legislação & jurisprudência , Pesquisa Biomédica/estatística & dados numéricos , Bases de Dados como Assunto , Humanos , Consentimento Livre e Esclarecido/ética , Consentimento Livre e Esclarecido/legislação & jurisprudência , Revisão da Utilização de Seguros/legislação & jurisprudência , Taiwan , Cobertura Universal do Seguro de Saúde
6.
Fed Regist ; 82(240): 59514-5, 2017 12 15.
Artigo em Inglês | MEDLINE | ID: mdl-29251465

RESUMO

We are extending the expiration dates of the following body systems in the Listing of Impairments (listings) in our regulations: Musculoskeletal System, Cardiovascular System, Digestive System, and Skin Disorders. We are making no other revisions to these body systems in this final rule. This extension ensures that we will continue to have the criteria we need to evaluate impairments in the affected body systems at step three of the sequential evaluation processes for initial claims and continuing disability reviews.


Assuntos
Avaliação da Deficiência , Definição da Elegibilidade/legislação & jurisprudência , Seguro por Invalidez/legislação & jurisprudência , Previdência Social/legislação & jurisprudência , Humanos , Revisão da Utilização de Seguros/legislação & jurisprudência , Estados Unidos
7.
Fed Regist ; 82(228): 56560-6, 2017 Nov 29.
Artigo em Inglês | MEDLINE | ID: mdl-29232071

RESUMO

This document delays for ninety (90) days--through April 1, 2018--the applicability of a final rule amending the claims procedure requirements applicable to ERISA-covered employee benefit plans that provide disability benefits (Final Rule). The Final Rule was published in the Federal Register on December 19, 2016, became effective on January 18, 2017, and was scheduled to become applicable on January 1, 2018. The delay announced in this document is necessary to enable the Department of Labor to carefully consider comments and data as part of its effort, pursuant to Executive Order 13777, to examine regulatory alternatives that meet its objectives of ensuring the full and fair review of disability benefit claims while not imposing unnecessary costs and adverse consequences.


Assuntos
Benefícios do Seguro/legislação & jurisprudência , Revisão da Utilização de Seguros/legislação & jurisprudência , Seguro por Invalidez/legislação & jurisprudência , Humanos , Fatores de Tempo
8.
J Dtsch Dermatol Ges ; 15(11): 1103-1109, 2017 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-29064628

RESUMO

BACKGROUND AND OBJECTIVES: "Off-label use" is defined as the prescription of pharmaceutical products outside their approved indications. Rare diseases frequently lack "on-label" treatment options. In order to avoid reimbursement claims following the prescription of off-label drugs, physicians in Germany can - on a case-by-case basis - file an application for cost coverage with the competent health insurance prior to treatment initiation. PATIENTS AND METHODS: We conducted a chart review for cost coverage requests submitted by two outpatient clinics at a university-affiliated dermatology department between 2010 and 2012 (clinic for autoimmune diseases and urticaria clinic). Insurance providers, acceptance rates, reasons for rejection, and processing times were analyzed. RESULTS: The analysis showed that 56.8 % of applications for off-label use (n = 44) were approved during the first round. The rate increased to 75.0 % when including approvals granted after up to two rejections. The time between initial application and the response of health insurers was 49 days (median). In case of cost coverage approval, treatments were initiated 92 days (median) after the initial request. CONCLUSIONS: The present case series shows that, in the majority of cases, health insurers in Germany have agreed to reimburse the costs of proposed off-label therapies. A prospective study is required in order to evaluate whether current changes to legal regulations (GKV-Versorgungsstrukturgesetz, Patientenrechtegesetz) adequately address the problems identified.


Assuntos
Dermatologia/legislação & jurisprudência , Programas Nacionais de Saúde/legislação & jurisprudência , Uso Off-Label/legislação & jurisprudência , Mecanismo de Reembolso/legislação & jurisprudência , Dermatologia/economia , Alemanha , Humanos , Revisão da Utilização de Seguros/economia , Revisão da Utilização de Seguros/legislação & jurisprudência , Cobertura do Seguro/economia , Cobertura do Seguro/legislação & jurisprudência , Programas Nacionais de Saúde/economia , Uso Off-Label/economia , Mecanismo de Reembolso/economia , Estudos Retrospectivos
9.
Fed Regist ; 82(148): 36080-6, 2017 Aug 03.
Artigo em Inglês | MEDLINE | ID: mdl-28805357

RESUMO

This document amends the Department of Veterans Affairs (VA) Schedule for Rating Disabilities by revising the portion of the schedule that addresses dental and oral conditions. The effect of this action is to ensure that the rating schedule uses current medical terminology and to provide detailed and updated criteria for evaluation of dental and oral conditions for disability rating purposes.


Assuntos
Avaliação da Deficiência , Pessoas com Deficiência/legislação & jurisprudência , Seguro por Invalidez/legislação & jurisprudência , Doenças da Boca/classificação , Doenças Estomatognáticas/classificação , Odontopatias/classificação , Ajuda a Veteranos Incapacitados/legislação & jurisprudência , Veteranos/legislação & jurisprudência , Humanos , Revisão da Utilização de Seguros/legislação & jurisprudência , Estados Unidos
10.
Injury ; 48(8): 1853-1857, 2017 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-28648408

RESUMO

Hip fractures are a major cause of trauma related death, usually occurring in vulnerable elderly patients. There are an estimated 70,000 hip fractures in the UK per year with numbers set to rise. The estimated annual cost to the healthcare economy is in the region of £2 billion. A 17-year review examining litigation related to hip fractures was undertaken. Under a freedom of information request, data was obtained relating to all orthopaedic claims made to the NHS Litigation Authority (NHSLA) between 1995 and 2012. Data was filtered to identify cases involving hip fractures examining litigation trends related to this specific area. 10263 NHSLA orthopaedic cases were identified, of which 13.3% (n=1364) cases related to the hip and femur. Hip fractures made up 16.7% (n=229). The total cost of hip fracture litigation was over £7 million with an average cost per case of £32,700. The commonest reasons for litigation were diagnostic errors (30.6%), issues with care (24.9%) alleged incompetent surgery (15.7%) and development of pressure sores (5.7%). This study highlights the main causes of litigation in patients sustaining hip fractures, with diagnosis in the emergency department and ward presenting a significant problem. In addition, the data identifies a range of care related issues, as well as several surgical factors and highlights the importance of pressure area care. We discuss these and make suggestions on how to improve practice in this area with the aim of improving patient care and reducing litigation.


Assuntos
Compensação e Reparação/legislação & jurisprudência , Erros de Diagnóstico/legislação & jurisprudência , Fixação de Fratura/efeitos adversos , Fraturas do Quadril , Revisão da Utilização de Seguros/estatística & dados numéricos , Ortopedia , Medicina Estatal/legislação & jurisprudência , Bases de Dados Factuais , Erros de Diagnóstico/economia , Fixação de Fratura/economia , Fixação de Fratura/legislação & jurisprudência , Fidelidade a Diretrizes/legislação & jurisprudência , Humanos , Revisão da Utilização de Seguros/legislação & jurisprudência , Imperícia/legislação & jurisprudência , Imperícia/estatística & dados numéricos , Ortopedia/legislação & jurisprudência , Ortopedia/normas , Lesão por Pressão , Reino Unido
12.
J Hosp Med ; 12(4): 251-255, 2017 04.
Artigo em Inglês | MEDLINE | ID: mdl-28411297

RESUMO

Hospitalists and other providers must classify hospitalized patients as inpatient or outpatient, the latter of which includes all observation stays. These orders direct hospital billing and payment, as well as patient out-of-pocket expenses. The Centers for Medicare & Medicaid Services (CMS) audits hospital billing for Medicare beneficiaries, historically through the Recovery Audit program. A recent U.S. Government Accountability Office (GAO) report identified problems in the hospital appeals process of Recovery Audit program audits to which CMS proposed reforms. In the context of the GAO report and CMS's proposed improvements, we conducted a study to describe the time course and process of complex Medicare Part A audits and appeals reaching Level 3 of the 5-level appeals process as of May 1, 2016 at 3 academic medical centers. Of 219 appeals reaching Level 3, 135 had a decision--96 (71.1%) successful for the hospitals. Mean total time since date of service was 1663.3 days, which includes mean days between date of service and audit (560.4) and total days in appeals (891.3). Government contractors were responsible for 70.7% of total appeals time. Overall, government contractors and judges met legislative timeliness deadlines less than half the time (47.7%), with declining compliance at successive levels (discussion, 92.5%; Level 1, 85.4%; Level 2, 38.8%; Level 3, 0%). Most Level 1 and Level 2 decision letters (95.2%) cited time-based (24-hour) criteria for determining inpatient status, despite 70.3% of denied appeals meeting the 24-hour benchmark. These findings suggest that the Medicare appeals system merits process improvement beyond current proposed reforms. Journal of Hospital Medicine 2017;12:251-255.


Assuntos
Centros Médicos Acadêmicos , Hospitalização/economia , Hospitalização/legislação & jurisprudência , Revisão da Utilização de Seguros/legislação & jurisprudência , Medicare Part A/legislação & jurisprudência , Fraude/prevenção & controle , Gastos em Saúde , Auditoria Médica/métodos , Medicare Part A/normas , Estados Unidos
13.
Anesth Analg ; 124(4): 1304-1310, 2017 04.
Artigo em Inglês | MEDLINE | ID: mdl-28319551

RESUMO

BACKGROUND: Analysis of closed malpractice claims allows the study of rare but serious complications and likely results in improved patient safety by raising awareness of such complications. Clinical studies and closed claims analyses have previously reported on the common complications associated with intrathecal drug delivery systems (IDDS) and spinal cord stimulators (SCS). This study provides a contemporary analysis of claims from within the past 10 years. METHODS: We performed a closed claims analysis for a period January 1, 2009 to December 31, 2013 for cases with pain medicine as the primary service. These cases were identified using the Controlled Risk Insurance Company (CRICO) Comparative Benchmarking System (CBS), a database containing more than 300,000 malpractice claims from more than 400 academic and community institutions, representing approximately 30% of malpractice cases in the United States. The clinical narratives, which included medical files, claims files, depositions, and expert witness testimony, were reviewed by the authors, as were the CRICO coded variables, which included algorithmically determined contributing factors to the patient injury. RESULTS: Intrathecal drug delivery systems represented 17 of the closed claims; spinal cord stimulators represented 11 of the closed claims. The most common chronic pain diagnoses for which a device was implanted included failed back surgery syndrome and spasticity. The average total incurred for pain medicine claims was $166,028. Damaging events included IDDS refill errors (eg, subcutaneous administration of medication, reprogramming errors), intraoperative nerve damage, and postoperative infection (eg, epidural abscess, meningitis). High-severity outcomes included nerve damage (eg, paraplegia) and death. Medium-severity outcomes included drug reactions (eg, respiratory arrest from opioid overdose) and the need for reoperation. For both IDDS and SCS, deficits in technical skill were the most common contributing factor to injury, followed by deficits in clinical judgment, communication, and documentation. CONCLUSIONS: Implanted devices used for pain management involve a significant risk of morbidity and mortality. Proper education of providers and patients is essential. Providers must acquire the technical skills required for the implantation and refilling of these devices and the clinical skills required for the identification and management of complications such as intrathecal granuloma. Proper patient selection and clear communication between the provider and the patient about these possible complications are of paramount importance.


Assuntos
Dor Crônica/terapia , Bombas de Infusão Implantáveis , Revisão da Utilização de Seguros/legislação & jurisprudência , Responsabilidade Legal , Manejo da Dor/métodos , Adulto , Idoso , Dor Crônica/diagnóstico , Feminino , Humanos , Bombas de Infusão Implantáveis/efeitos adversos , Masculino , Pessoa de Meia-Idade , Manejo da Dor/efeitos adversos
14.
Hernia ; 21(2): 215-221, 2017 04.
Artigo em Inglês | MEDLINE | ID: mdl-28181088

RESUMO

PURPOSE: Surgical repair of groin hernia should be carried out with minimal complication rates, and it is important to have regular quality control and accurate means of assessment. The Swedish healthcare system has a mutual insurance company (LÖF) that receives claims from patients who have suffered healthcare-related damage or malpractice. The Swedish Hernia Register (SHR) currently covers around 98% of all Swedish groin hernia operations. The aim of this study was to analyse damage claims following groin hernia repair surgery and link these with entries in the SHR, in order to identify risk factors and causes of injuries and malpractice associated with hernia repair. METHODS: Data on all 48,574 groin hernia operations registered in the SHR between 2008 and 2010 were compared and linked with data on claims made to the Swedish National Patient Injury Insurance (LÖF). RESULTS: Of the 130 damage claims received by LÖF, 26 dealt with bleeding, 20 with testicular injury and 7 with intestinal lesions. Eighty (62%) of the complications were considered malpractice according to the Swedish Patient Injury Act. Acute and recurrent surgery, sutured repair and general anaesthesia were associated with a significantly increased risk for a damage claim independently the patients were compensated or not. Females filed claims in greater proportion than males. There was no significant difference in background factors between claims accepted by LÖF and compensated and those who were rejected compensation. CONCLUSION: Risk factors for filing a damage claim included acute surgery, operation for recurrence, sutured repair and general anaesthesia, whereas local anaesthesia reduced the risk.


Assuntos
Hérnia Femoral/cirurgia , Hérnia Inguinal/cirurgia , Herniorrafia/efeitos adversos , Herniorrafia/legislação & jurisprudência , Revisão da Utilização de Seguros/legislação & jurisprudência , Imperícia/legislação & jurisprudência , Feminino , Hérnia Femoral/epidemiologia , Hérnia Inguinal/epidemiologia , Herniorrafia/estatística & dados numéricos , Humanos , Revisão da Utilização de Seguros/estatística & dados numéricos , Responsabilidade Legal , Masculino , Imperícia/estatística & dados numéricos , Pessoa de Meia-Idade , Sistema de Registros/estatística & dados numéricos , Reoperação , Estudos Retrospectivos , Fatores de Risco , Suécia/epidemiologia
15.
Fed Regist ; 82(10): 4974-5140, 2017 Jan 17.
Artigo em Inglês | MEDLINE | ID: mdl-28102985

RESUMO

This final rule revises the procedures that the Department of Health and Human Services (HHS) follows at the Administrative Law Judge (ALJ) level for appeals of payment and coverage determinations for items and services furnished to Medicare beneficiaries, enrollees in Medicare Advantage (MA) and other Medicare competitive health plans, and enrollees in Medicare prescription drug plans, as well as appeals of Medicare beneficiary enrollment and entitlement determinations, and certain Medicare premium appeals. In addition, this final rule revises procedures that the Department of Health and Human Services follows at the Centers for Medicare & Medicaid Services (CMS) and the Medicare Appeals Council (Council) levels of appeal for certain matters affecting the ALJ level.


Assuntos
Revisão da Utilização de Seguros/legislação & jurisprudência , Cobertura do Seguro/legislação & jurisprudência , Medicare Part C/legislação & jurisprudência , Medicare Part D/legislação & jurisprudência , Humanos , Seguro de Serviços Farmacêuticos/economia , Seguro de Serviços Farmacêuticos/legislação & jurisprudência , Medicare Part C/economia , Medicare Part D/economia , Estados Unidos
16.
Fed Regist ; 82(11): 5844-84, 2017 Jan 18.
Artigo em Inglês | MEDLINE | ID: mdl-28102996

RESUMO

We are revising our medical evidence rules. The revisions include redefining several key terms related to evidence, revising our rules about acceptable medical sources (AMS), revising how we consider and articulate our consideration of medical opinions and prior administrative medical findings, revising our rules about medical consultants (MC) and psychological consultants (PC), revising our rules about treating sources, and reorganizing our evidence regulations for ease of use. These revisions conform our rules to the requirements of the Bipartisan Budget Act of 2015 (BBA), reflect changes in the national healthcare workforce and in the manner that individuals receive medical care, and emphasize the need for objective medical evidence in disability and blindness claims. We expect that these changes will simplify our rules to make them easier to understand and apply, and allow us to continue to make accurate and consistent disability determinations and decisions.


Assuntos
Avaliação da Deficiência , Definição da Elegibilidade/legislação & jurisprudência , Revisão da Utilização de Seguros/legislação & jurisprudência , Previdência Social/legislação & jurisprudência , Humanos , Estados Unidos
17.
Fed Regist ; 82(12): 6265-71, 2017 Jan 19.
Artigo em Inglês | MEDLINE | ID: mdl-28102999

RESUMO

The Department of Veterans Affairs (VA) is amending its regulations concerning recognition of certain national, State, and regional or local organizations for purposes of VA claims representation. Specifically, this rulemaking allows the Secretary to recognize tribal organizations in a similar manner as the Secretary recognizes State organizations. The final rule allows a tribal organization that is established and funded by one or more tribal governments to be recognized for the purpose of providing assistance on VA benefit claims. In addition, the final rule allows an employee of a tribal government to become accredited through a recognized State organization in a similar manner as a County Veterans' Service Officer (CVSO) may become accredited through a recognized State organization. The effect of this action is to address the needs of Native American populations who are geographically isolated from existing recognized Veterans Service Organizations (VSOs) or who may not be utilizing other recognized VSOs due to cultural barriers or lack of familiarity with those organizations.


Assuntos
Índios Norte-Americanos/legislação & jurisprudência , Revisão da Utilização de Seguros/legislação & jurisprudência , Navegação de Pacientes/legislação & jurisprudência , Veteranos/legislação & jurisprudência , Acreditação/legislação & jurisprudência , Humanos , Benefícios do Seguro/legislação & jurisprudência , Estados Unidos
18.
Clin Obstet Gynecol ; 60(2): 431-446, 2017 06.
Artigo em Inglês | MEDLINE | ID: mdl-28098575

RESUMO

Obstetric practice carries a high risk of medical liability and involves both obstetricians and anesthesiologists. Analysis of data from the Anesthesia Closed Claims Project database shows an increase in the proportion of anesthesia claims for maternal death and brain damage between the 1990s and 2000 and later, primarily due to hemorrhage. The proportion of claims for newborn brain damage remained unchanged while those for maternal nerve injury and minor injuries decreased. Use of massive transfusion protocols and clinical drills have been shown to improve outcomes from hemorrhage. Good communication and teamwork are critical for reducing obstetric liability.


Assuntos
Anestesia Obstétrica/efeitos adversos , Anestesiologia , Revisão da Utilização de Seguros/legislação & jurisprudência , Seguro de Responsabilidade Civil/legislação & jurisprudência , Responsabilidade Legal , Adulto , Anestesiologia/legislação & jurisprudência , Anestesiologia/tendências , Dano Encefálico Crônico/induzido quimicamente , Dano Encefálico Crônico/epidemiologia , Bases de Dados Factuais , Feminino , Humanos , Recém-Nascido , Revisão da Utilização de Seguros/tendências , Seguro de Responsabilidade Civil/tendências , Imperícia/legislação & jurisprudência , Imperícia/tendências , Traumatismos dos Nervos Periféricos/induzido quimicamente , Traumatismos dos Nervos Periféricos/epidemiologia , Gravidez , Resultado do Tratamento
19.
Arch Dis Child Fetal Neonatal Ed ; 102(2): F110-F115, 2017 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-27553590

RESUMO

OBJECTIVES: Neonatal hypoglycaemia is a potential cause of neonatal morbidity, and on rare but tragic occasions causes long-term neurodevelopmental harm with consequent emotional and practical costs for the family. The organisational cost to the NHS includes the cost of successful litigation claims. The purpose of the review was to identify themes that could alert clinicians to common pitfalls and thus improve patient safety. DESIGN: The NHS Litigation Authority (NHS LA) Claims Management System was reviewed to identify and review 30 claims for injury secondary to neonatal hypoglycaemia, which were notified to the NHS LA between 2002 and 2011. SETTING: NHS LA. PATIENTS: Anonymised documentation relating to 30 neonates for whom claims were made relating to neonatal hypoglycaemia. Dates of birth were between 1995 and 2010. INTERVENTIONS: Review of documentation held on the NHS LA database. MAIN OUTCOME MEASURES: Identifiable risk factors for hypoglycaemia, presenting clinical signs, possible deficits in care, financial costs of litigation. RESULTS: All claims related to babies of at least 36 weeks' gestation. The most common risk factor for hypoglycaemia was low birth weight or borderline low birth weight, and the most common reported presenting sign was abnormal feeding behaviour. A number of likely deficits in care were reported, all of which were avoidable. In this 10-year reporting period, there were 25 claims for which damages were paid, with a total financial cost of claims to the NHS of £162 166 677. CONCLUSIONS: Acknowledging that these are likely to be the most rare but most seriously affected cases, the clinical themes arising from these cases should be used for further development of training and guidance to reduce harm and redivert NHS funds from litigation to direct care.


Assuntos
Hipoglicemia/prevenção & controle , Erros Médicos/legislação & jurisprudência , Medicina Estatal/legislação & jurisprudência , Bases de Dados Factuais , Humanos , Lactente , Mortalidade Infantil , Recém-Nascido , Revisão da Utilização de Seguros/legislação & jurisprudência , Jurisprudência , Erros Médicos/estatística & dados numéricos , Estudos Retrospectivos , Fatores de Risco
20.
Fed Regist ; 81(242): 90987-97, 2016 12 16.
Artigo em Inglês | MEDLINE | ID: mdl-28030884

RESUMO

We are revising our rules so that more of our procedures at the hearing and Appeals Council levels of our administrative review process are consistent nationwide. We anticipate that these nationally consistent procedures will enable us to administer our disability programs more efficiently and better serve the public.


Assuntos
Definição da Elegibilidade/legislação & jurisprudência , Definição da Elegibilidade/organização & administração , Revisão da Utilização de Seguros/legislação & jurisprudência , Revisão da Utilização de Seguros/organização & administração , Previdência Social/legislação & jurisprudência , Previdência Social/organização & administração , Avaliação da Deficiência , Humanos , Seguro por Invalidez/legislação & jurisprudência , Seguro por Invalidez/organização & administração , Estados Unidos
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA