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Impact of Diagnosis-Related Groups’ Prospective Payment on Utilization of Medical Intensive Care: Estimate of Medicare Payment

Estimate of Medicare Payment The Medicare prospective payment system of DRGs was implemented for hospital fiscal years beginning on or after October 1, 1983. Medicare DRG payment rates, as outlined in the Federal Register, are determined by multiplying a base rate (which differs by hospital during the four-year prospective payment implementation) by the DRG relative…

Impact of Diagnosis-Related Groups’ Prospective Payment on Utilization of Medical Intensive Care

Impact of Diagnosis-Related Groups' Prospective Payment on Utilization of Medical Intensive Care

Medicare prospective payment by diagnosis-related. A groups (DRGs) has resulted in radical transformation of the health care system in the United States. It has also raised fears that DRG-induced financial losses will result in admission policies and practice styles not always in the best interest of good patient care. A recent study from Rush-Presbyterian-St. Lukes…

The Greenfield Vena Cava Filter: Indications and Discussion

Indications and Discussion No technique can be evaluated without establishing an “ideal” standard. In our view, such an ideal caval interruptive approach would incorporate the following features: (1) The procedure should be applicable with safety and efficacy by physicians of reasonable skill after modest periods of training. (2) The procedure should be performed without general…

The Greenfield Vena Cava Filter: Caval Perforation

The Greenfield Vena Cava Filter: Caval Perforation

Caval Perforation As stated previously, when the filter springs open during insertion, its struts engage the wall of the vena cava with some force. Penetration of the caval wall by the sharp anchoring prongs is necessary to prevent filter migration. Whether the prongs actually perforate the cava is not documented, but there have been no…

The Greenfield Vena Cava Filter: Anticoagulation

Anticoagulation Anticoagulation remains the primary therapy for deep venous thrombosis. Caval filtration serves to protect the patient from one complication of this disease (pulmonary embolism) but has no effect on venous thrombosis. Therefore, anticoagulation should be administered as usual if no contraindication exists. While he prefers to discontinue heparinization briefly prior to insertion, Greenfield contends…

The Greenfield Vena Cava Filter: Recurrent Pulmonary Embolism

The Greenfield Vena Cava Filter: Recurrent Pulmonary Embolism

Recurrent Pulmonary Embolism The purpose of caval filtration is to prevent pulmonary embolism. One of the arguments against the use of the Mobin-Uddin umbrella, and indeed, all other devices which can lead to caval occlusion, is that future embolization may take pace through extensive venous collateral circulation. In addition, the presence of a foreign surface…

The Greenfield Vena Cava Filter: Operative Complication

Operative Complication Most series documenting operative complications were compiled prior to the changes made in 1983, changes designed to improve certain reported complications of insertion: oblique placement, clot formation during insertion, and difficult accurate placement into the infrarenal IVC. Anecdotal reports substantiate these improvements. Therefore, these early reports likely represent “worse case” scenarios. We have…

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