News - Part 4

Impact of Diagnosis-Related Groups' Prospective Payment on Utilization of Medical Intensive Care: ResultsTable 2 summarizes the financial impact of Medicare payments for patients receiving medical intensive care. In 1984, the average projected DRG payment for the 267 Medicare patients treated in the MICU was $10,683 per discharge. The average DRG weight per discharge was 1.94, in contrast to the overall hospital case mix index for medicare patients of 1.78. Total payments (including outlier payments) of $3,230,099 vs costs of $5,845,328 resulted in a total loss of $2,615,229. Payment amounted to only 55 percent of costs. In 1985, the average projected DRG payment for 241 Medicare patients treated in MICU was $10,605 per discharge. The average DRG weight was 1.90, in contrast to overall hospital case mix index of 1.85. Total payments (including outlier payments) of $2,982,697 vs costs of $6,383,942 resulted in a net loss of $3,401,245. Payment amounted to only 47 percent of costs. Payment and costs are for all days of the hospital stay, in both the MICU and other units. Read the rest of this entry »

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 weight, a measure of relative costliness for each of the 468 DRGs. Three other types of payment can be made in addition to the DRG payment rate: 1) “pass-through” costs, which include capital-related and direct educational costs, paid in a lump sum rather than on a per-case basis; 2) “indirect” educational costs, which are determined by a hospitals full-time equivalent resident-to-bed ratio applied to the Federal portion of the DRG payments; and 3) “outlier” payments, which apply to patients staying beyond the DRG-specific length of stay threshold or incurring atypieally high costs for the DRG. Read the rest of this entry »

Impact of Diagnosis-Related Groups' Prospective Payment on Utilization of Medical Intensive CareMedicare 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 Medical Center, Chicago, revealed significant institutional financial losses by an academic medical intensive care unit. In this study, (modeled after the Rush-Presbyterian-St. Lukes study) we examined the financial impact of DRG payments for Medicare patients receiving medical intensive care at another large multispecialty tertiary care referral center. We also looked for any change in admission practices or utilization of MICU beds by admitting physicians after one years experience with DRGs. website Read the rest of this entry »

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 anesthesia and with minimal patient invasion. (3) The approach should not interfere, acutely, with caval blood flow to a significant degree. (4) All potential emboli above a defined size (eg, 2 mm diameter) should be prevented. (5) Acute and chronic complications of the procedure (eg, bleeding, caval thrombosis) should be minimal. (6) The approach should be applicable despite concurrent anticoagulant or thrombolytic therapy. (7) The interruption should be reversible. alta white teeth whitening Read the rest of this entry »

The Greenfield Vena Cava Filter: Caval PerforationCaval 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 reported complications attributed to this. However, strut perforation can take place in a minority of cases, particularly if there is angled insertion, or if an effort is made to alter the position of a filter after it has been extruded. Methods used to assess filter position have included computerized tomography, ultrasound, and venacavography. Strut perforation has been the potential cause of two retroperitoneal hematomata, one case mimicking intestinal obstruction, and one case of reversible hematuria. Long-term experience with patients both treated and untreated with anticoagulants has not revealed other complications. generic wellbutrin Read the rest of this entry »

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 that anticoagulation is not an absolute contraindication to filter placement. This assertion is supported by the experience of Gomez et al who routinely administered 7,500 units of heparin immediately prior to venotomy in those patients without contraindication and noted no increase in complications. In the two reported cases of retroperitoneal hematoma in association with a filter, both patients received excessive anticoagulation therapy. In one of the cases, the patient underwent laparotomy 18 months later (for another condition), at which time, one arm of the filter was noted to have perforated the I VC. The actual timing could not be proven, and the earlier bleed would suggest that the perforation took place during or shortly after insertion. There is no other evidence that patients receiving anticoagulation therapy are at increased risk of caval hemorrhage. starlix 60 mg Read the rest of this entry »

The Greenfield Vena Cava Filter: Recurrent Pulmonary EmbolismRecurrent 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 in the blood stream may activate clotting, and the “protector” may then become the seed from which future embolic episodes grow. Read the rest of this entry »

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