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Healthcare Payment Systems
Published in Jennifer Doley, Mary J. Marian, Adult Malnutrition, 2023
The principal diagnosis necessitating hospital admission decides the Major Diagnostic Category (MDC) assigned to the patient for that hospital stay.3 Within this MDC, the individual Diagnosis Related Group (DRG) is determined based on details of the patient’s diagnosis and hospital treatment. If the patient is managed medically, the principal diagnosis determines the DRG assignment; if the patient is primarily managed surgically, then the type of surgery will determine the DRG assignment. Secondary diagnoses, known as Complications or Comorbidities (CCs) and Major Complications or Comorbidities (MCCs), can increase the cost of care above what would have been required if the patient only needed treatment for the principal diagnosis. When these secondary diagnoses are documented, treated, and coded, the patient may be assigned to a different severity level within the DRG grouping; this is then known as the Medicare Severity – DRG (MS-DRG). See Figure 14.1. A higher payment is given to hospitals for MS-DRGs associated with a CC, and an even higher payment for MS-DRGs associated an MCC.3
Contemporary Challenges in Academic Health Science Center Financial Management
Published in Steven A. Wartman, Confluence of Policy and Leadership in Academic Health Science Centers, 2022
Jeffrey R. Balser, Edward R. Marx, John F. Manning
At Vanderbilt, we have implemented an Executive Summary Dashboard that is available to hospital, clinic, and medical school leaders and managers. The tool provides, in real time, patient care revenue, inpatient and outpatient clinic visit and discharge volumes, inpatient bed utilization, inpatient length of stay, and other variables. All values are reported relative to the current budget. The dashboard is updated daily so the management team can develop a routine of examining the results each morning. A benefit of using an electronic dashboard instead of a report is its interactive nature, allowing one to “drill down” into specific details and quickly analyze the root cause of a budget variance. For example, if inpatient discharges are falling behind budget in an operational area, one can examine discharges by Major Diagnostic Category and can see the estimated margin, length of stay, and case mix index for this general area of clinical activity. The analysis can be broken down further into individual Diagnosis Related Groups, to determine whether admissions related to particular medical conditions are involved. Alternatively, if the dashboard reveals a variance in outpatient visits, the utility provides a detailed view of clinic visits by individual clinic location, with volumes relative to budget and prior year. This level of detail allows all members of the management team to quickly identify issues of concern, and to work together to put plans in place to address operational challenges impacting financial performance.
Naming the Mad Mind
Published in Petteri Pietikainen, Madness, 2015
During the fin de siècle (ca. 1890–1914), it was neurasthenia, even more than hysteria, that represented the most widespread and talked-about neurosis. Compared to hysteria, neurasthenia was a more ‘heroic’ illness, because it initially afflicted the intellectual classes who worked hard and overtaxed their brain day in day out. Initially, neurasthenics were both paragons and victims of modern life; they represented the vanguard of cultural progress, but they were also victims of a modern, increasingly hectic and nerve-wracking urban lifestyle. It was no coincidence that Beard had his office in Manhattan. In the early decades of the twentieth century, neurasthenia shifted from a predominantly somatic to a predominantly psychological disease entity. In Vienna, Sigmund Freud had created the influential ‘anxiety neurosis’ in the 1890s; in Paris, Freud’s rival Pierre Janet developed a sort of psychological version of neurasthenia that he called ‘psychasthenia’ in 1903; and, in Bern, Switzerland, the nerve pathologist Paul Dubois introduced the term ‘psychoneurosis’ in 1904. Neurasthenia, psychasthenia and psychoneurosis (as well as ‘traumatic neurosis’) formed the illness category of ‘neurosis’, a generic term for milder mental afflictions. During the first half of the twentieth century, neurosis (including its sub-categories) became the most common mental malady in the western world and a major diagnostic category in psychiatry and neurology (Pietikainen 2007).
Neurological patient and informal caregiver quality of life, and caregiver burden: A cross-sectional study of postdischarge community neurological nursing recipients
Published in Contemporary Nurse, 2022
Judith Dianne Pugh, Kathleen McCoy, Anne M. Williams, Catherine A. Pienaar, Brenda Bentley, Leanne Monterosso
A convenience sample of adult patients referred to the community neurological nursing service between 1 October 2016 and 27 June 2017 was recruited within two weeks of discharge from a tertiary WA public metropolitan hospital. Convenience sampling was chosen due to the limited timescale set by the project's funder. The patients’ adult primary informal caregivers, that is, persons regularly assisting them without payment, such as family or friend, were also invited to participate. Patients were eligible if 18 years or older with principal medical diagnoses in the Australian Refined Diagnosis Related Group Version 7.0 of the Major Diagnostic Category 01 ‘Diseases and Disorders of the Nervous System’. Exclusions were: same-day medical neurological diagnoses, apheresis, acute/chronic para/quadriplegia, skull fractures, other head injuries, surgical procedures, telemetric EEG monitoring, and nervous system disorders with ventilator support. Additional exclusion criteria were: discharged/transferred to acute hospital/residential aged care services/psychiatric hospital/other health care accommodation; discharged against medical advice/from leave/to other institutions; diagnosis/complication requiring extended hospital stay.
Economic implications of adding a novel algorithm to optimize cardiac resynchronization therapy: rationale and design of economic analysis for the AdaptResponse trial
Published in Journal of Medical Economics, 2020
Gerasimos Filippatos, Xiaoxiao Lu, Stelios I. Tsintzos, Michael R. Gold, Wilfried Mullens, David Birnie, Ahmad S. Hersi, Kengo Kusano, Christophe Leclercq, Dedra H. Fagan, Bruce L. Wilkoff
Readmissions are known to be a predictor of longer-term outcomes. Reducing readmissions is aimed at both improving patient outcomes and reducing costs. Several financial incentives exist against readmissions shortly after index admissions. Substantial differences exist in readmission policies across countries. In the U.S., the Affordable Care Act was added to the Social Security Act to establish the Hospital Readmissions Reduction Program37. This program reduces all Medicare inpatient payments when readmissions within 30 days of discharge from an “index admission” exceed a moving threshold based on national averages and hospital-specific risk adjustments. HF inpatient admissions were one of the first hospitalization types identified in the rules of this program as relevant “index admissions.” In England, above a local set threshold between hospitals and payers (Clinical Commissioning Groups [CCGs]), the emergency readmissions within 30 days of discharge of the initial hospitalization are not reimbursed. However, the policy was updated in 2019 with the introduction of a blended payment system for emergency care. In practice, a transition period will be necessary for the new system to be implemented. In Germany, if a second hospitalization occurs within the upper LoS of the first DRG, then all coding from both admissions are merged to lead to a common DRG (see Supplementary Appendix Figure 1). In this case the hospital needs to cover the costs of two events within a single payment. Similarly, if two hospitalizations occur within 30 days of each other, starting with the first day of hospitalizations, and the hospitalizations belong to the same major diagnostic category (e.g. circulatory system diseases) again the cases are merged. Therefore, this is a loss-making endeavor because hospitals receive reimbursement for only the more expensive of two hospitalizations and need to cover the cost for the less expensive one themselves.