Median Payment Research Articles

Variations in Hospital Billing for Total Joint Arthroplasty

Although regional variations in Medicare spending are known, it is not clear whether regional variations exist in hospital charges for total joint arthroplasty. Data from Centers for Medicare and Medicaid Services (CMS) on Diagnosis Related Groups 469 and 470 (Major Joint with and without Major Complicating or Comorbid Condition) from 2011 were analyzed for variation by region. Drastic variations in charges between institutions were apparent with significant differences between regions for hospital charges and payments. The median hospital charge nationwide was $71,601 and $46,219 for Diagnosis Related Groups 469 and 470, respectively, with corresponding median payments of $21,231 and $13,743. Weak to no correlation was found between hospital charges and payments despite adjustments for wage index, cost of living, low-income care and teaching institution status.

Geographic variation in out-of-pocket expenditures of elderly Medicare beneficiaries.

To examine whether out-of-pocket expenditures (OOPEs) exhibit the same geographic variation as Medicare claims, given wide variation in the costs of U.S. health care, but no information on how that translates into OOPEs or financial burden for older Americans. Retrospective cohort study. Data from the Health and Retirement Study linked to Medicare claims. A nationally representative cohort of 4,657 noninstitutionalized, community-dwelling, fee-for-service elderly Medicare beneficiaries interviewed in 2006 and 2008. The primary predictor was per capita Medicare spending quintile according to hospital referral region. The primary outcome was a self-reported, validated measure of annual OOPEs excluding premiums. Mean and median adjusted per capita Medicare payments were $5,916 and $2,635, respectively; mean and median adjusted OOPEs were $1,525 and $779, respectively. Adjusted median Medicare payments were $3,474 in the highest cost quintile and $1,942 in the lowest cost quintile (ratio 1.79, P < .001 for difference). In contrast, adjusted median OOPEs were not higher in the highest than in the lowest Medicare cost quintile ($795 vs $764 for a Q5:Q1 ratio of 1.04, P = .42). The Q5:Q1 ratio was 1.48 for adjusted mean Medicare payments and 1.04 for adjusted mean OOPEs (both P < .001). Medicare payments vary widely between high- and low-cost regions, but OOPEs do not.

Implementation of patient charges at primary care facilities in Kenya: implications of low adherence to user fee policy for users and facility revenue.

With user fees now seen as a major hindrance to universal health coverage, many countries have introduced fee reduction or elimination policies, but there is growing evidence that adherence to reduced fees is often highly imperfect. In 2004, Kenya adopted a reduced and uniform user fee policy providing fee exemptions to many groups. We present data on user fee implementation, revenue and expenditure from a nationally representative survey of Kenyan primary health facilities. Data were collected from 248 randomly selected public health centres and dispensaries in 2010, comprising an interview with the health worker in charge, exit interviews with curative outpatients, and a financial record review. Adherence to user fee policy was assessed for eight tracer conditions based on health worker reports, and patients were asked about actual amounts paid. No facilities adhered fully to the user fee policy across all eight tracers, with adherence ranging from 62.2% for an adult with tuberculosis to 4.2% for an adult with malaria. Three quarters of exit interviewees had paid some fees, with a median payment of US dollars (USD) 0.39, and a quarter of interviewees were required to purchase additional medical supplies at a later stage from a private drug retailer. No consistent pattern of association was identified between facility characteristics and policy adherence. User fee revenues accounted for almost all facility cash income, with average revenue of USD 683 per facility per year. Fee revenue was mainly used to cover support staff, non-drug supplies and travel allowances. Adherence to user fee policy was very low, leading to concerns about the impact on access and the financial burden on households. However, the potential to ensure adherence was constrained by the facilities’ need for revenue to cover basic operating costs, highlighting the need for alternative funding strategies for peripheral health facilities.

Malodorous consequences: What comprises negligence in anosmia litigation?

Our objectives were to evaluate factors raised in malpractice litigation in which plaintiffs alleged that physician negligence led to olfactory dysfunction. We analyzed publically available federal and court records using Westlaw, a widely used computerized legal database. Pertinent jury verdicts and settlements were comprehensively examined for alleged causes of malpractice (including procedures for iatrogenic causes), defendant specialty, patient demographics, and other factors raised in legal proceedings. Of 25 malpractice proceedings meeting inclusion criteria, 60.0% were resolved for the defendant, 12.0% were settled, and 28.0% had jury-awarded damages. Median payments were significant ($300,000 and $412,500 for settlements and awards, respectively). Otolaryngologists were the most frequently named defendants (68.0%), with the majority of iatrogenic cases (55.0%) related to rhinologic procedures. Associated medical events accompanying anosmia included dysgeusia, cerebrospinal fluid leaks, and meningitis. Other alleged factors included requiring additional surgery (80.0%), unnecessary procedures (47.4% of iatrogenic procedural cases), untimely diagnosis leading to anosmia (44.0%), inadequate informed consent (35.0%), dysgeusia (56.0%), and psychological sequelae (24.0%). Olfactory dysfunction can adversely affect quality of life and thus is a potential area for malpractice litigation. This is particularly true for iatrogenic causes of anosmia, especially following rhinologic procedures. Settlements and damages awarded were considerable, making an understanding of factors detailed in this analysis of paramount importance for the practicing otolaryngologist. This analysis reinforces the importance of explicitly including anosmia in a comprehensive informed consent process for any rhinologic procedure.

Compensation claims for chiropractic in Denmark and Norway 2004¿2012

Adverse events are commonly observed in all parts of health care and have been reported extensively following manual therapy, including chiropractic. The majority of reported adverse events following chiropractic care are mild, transitory and self-limiting. However, little is known about patient filed compensation claims related to the chiropractic consultation process. The aim of this study was to describe claims reported to the Danish Patient Compensation Association and the Norwegian System of Compensation to Patients related to chiropractic from 2004 to 2012. All finalized compensation claims involving chiropractors reported to one of the two associations between 2004 and 2012 were assessed for age, gender, type of complaint, decisions and appeals. Descriptive statistics were used to describe the study population. 338 claims were registered in Denmark and Norway between 2004 and 2012 of which 300 were included in the analysis. 41 (13.7%) were approved for financial compensation. The most frequent complaints were worsening of symptoms following treatment (n = 91, 30.3%), alleged disk herniations (n = 57, 19%) and cases with delayed referral (n = 46, 15.3%). A total financial payment of €2,305,757 (median payment €7,730) were distributed among the forty-one cases with complaints relating to a few cases of cervical artery dissection (n = 11, 5.7%) accounting for 88.7% of the total amount. Chiropractors in Denmark and Norway received approximately one compensation claim per 100.000 consultations. The approval rate was low across the majority of complaint categories and lower than the approval rates for general practioners and physiotherapists. Many claims can probably be prevented if chiropractors would prioritize informing patients about the normal course of their complaint and normal benign reactions to treatment.

Challenges to disability management from an expanding fly-in fly-out workforce

Australia's mineral, resource and infrastructure sectors continues to expand as operations in rural and remote locations increasingly rely on fly-in, fly-out or drive-in, drive-out workforces in order to become economically competitive. The issues associated with employing these workforces are becoming more apparent and include a range of physical, mental, psychosocial, safety, and community challenges. Research evaluating the impacts of fly-in, fly-out operations in Australia has been limited, and in February 2013 the Australian House of Representatives Standing Committee on Regional Australia made 21 recommendations aimed at improving these operations. To date, none of the recommendations have been implemented. The Construction and Mining sectors, in which most FIFO workers are employed, represent 12% of the total Australian workforce. Recent evidence from Safe Work Australia (2013) notes that serious injuries incident rates in both these sectors are well above the national injury rate. In addition the median payment and compensation cost for serious injury in these sectors are considerably higher than the Australian average due to higher employees salary, severity of incidents, lengths of absence from work, and medical expenses. These at risk remote site FIFO employees are further challenged post injury by lack of access to well-regarded disability management processes that have traditionally closely involved the workplace in the rehabilitation process. This paper examines the disparate challenges faced by both employers and employees in workplace wellbeing in remote sites, and raises questions as to how best disability management professionals can design, implement, and evaluate effective rehabilitation processes for injured FIFO workers who are a fast growing segment of the workforce but who work in conditions hitherto atypical of mainstream industry.

Non-spinal musculoskeletal malpractice suits against radiologists in the USA—rates, anatomic locations, and payments in a survey of 8,265 radiologists

The objective of this study was to present the characteristics of non-spinal musculoskeletal malpractice suits with attention to rates, anatomic location, and payments in a survey of 8,265 radiologists. The malpractice histories of 8,265 radiologists from 36 states were evaluated from credentialing data required of all radiologists participating in the network of One Call Medical, Inc., a broker for imaging tests in workmen's compensation cases. Twenty six hundred of the 8,265 radiologists (31.5 %) had at least one suit. Of the 4,741 total claims, 627 (13.2 %) were related to the bones and soft tissues. Four hundred seventeen (66.1 %) of them involved the musculoskeletal system other than the spine. A cause was known for 400. Of these, 91.8 % (367/400) resulted from an alleged failure to diagnose. The foot was the most common site with a rate 6.00 cases/1,000 radiologist's person years (95 % confidence interval (CI), 4.68-7.68), and the hip was second with a rate of 5.30 cases/1,000 person years (95 % CI, 4.15-6.76). The highest median payment related to ankle injuries with a median settlement of $72,500 (interquartile range (IQR), $40,000-$161,250). The state in which the highest median settlement occurred was Maryland ($125,000; IQR, $95,000-$230,000)) whereas Utah had the highest rate of suits (5.24 cases per 1,000 person years; CI, 3.03-9.04). Claims regarding foot and hip injury were the most common, but ankle settlements incurred the highest awards.

Promoting universal financial protection: evidence from the Rashtriya Swasthya Bima Yojana (RSBY) in Gujarat, India

BackgroundIndia’s health expenditure is met mostly by households through out-of-pocket (OOP) payments at the time of illness. To protect poor families, the Indian government launched a national health insurance scheme (RSBY). Those below the national poverty line (BPL) are eligible to join the RSBY. The premium is heavily subsidised by the government. The enrolled members receive a card and can avail of free hospitalisation care up to a maximum of US$ 600 per family per year. The hospitals are reimbursed by the insurance companies. The objective of our study was to analyse the extent to which RSBY contributes to universal health coverage by protecting families from making OOP payments.MethodsA two-stage stratified sampling technique was used to identify eligible BPL families in Patan district of Gujarat, India. Initially, all 517 villages were listed and 78 were selected randomly. From each of these villages, 40 BPL households were randomly selected and a structured questionnaire was administered. Interviews and discussions were also conducted among key stakeholders.ResultsOur sample contained 2,920 households who had enrolled in the RSBY; most were from the poorer sections of society. The average hospital admission rate for the period 2010–2011 was 40/1,000 enrolled. Women, elderly and those belonging to the lowest caste had a higher hospitalisation rate. Forty four per cent of patients who had enrolled in RSBY and had used the RSBY card still faced OOP payments at the time of hospitalisation. The median OOP payment for the above patients was US$ 80 (interquartile range, $16–$200) and was similar in both government and private hospitals. Patients incurred OOP payments mainly because they were asked to purchase medicines and diagnostics, though the same were included in the benefit package.ConclusionsWhile the RSBY has managed to include the poor under its umbrella, it has provided only partial financial coverage. Nearly 60% of insured and admitted patients made OOP payments. We plea for better monitoring of the scheme and speculate that it is possible to enhance effective financial coverage of the RSBY if the nodal agency at state level would strengthen its stewardship and oversight functions.

Clinical drug trials in general practice: a 10-year overview of protocols

BackgroundDrugs predominantly prescribed in general practice should ideally be tested in that setting; however, little is known about drug trials in general practice. Our aim was to describe drug trials in Norwegian general practice over the period of a decade.MethodsThe present work concerns a 10-year retrospective study of protocols submitted to the Norwegian national medicines agency (1998 to 2007) identifying all studies involving general practitioners (GPs) as clinical investigator(s). We analyzed the number of trials, drug company involvement, patients, participating doctors, payment, medications tested and main diagnostic criteria for inclusion. We also analyzed one trial in greater detail.ResultsOut of 2,054 clinical drug trials, 196 (9.5%) were undertaken in general practice; 93% were multinational, 96% were industry funded and 77% included patients both from general practice and specialist care. The trials were planned to be completed in the period 1998 to 2012. A total of 23,000 patients in Norway and 340,000 patients internationally were planned to be included in the 196 trials. A median of 5 GPs participated in each trial (range 1 to 402). Only 0.7% of 831 GP investigators had general practice university affiliations. Median payment for participating investigators was €1,900 (range €0 to 13,500) per patient completing the trial. A total of 30 pharmaceutical companies were involved. The drugs most commonly studied were antidiabetics (21%), obstructive airway disease medications (12%), agents acting on the renin-angiotensin system (10%), and lipid modifying agents (10%). One trial, presented in more detail, had several characteristics of a seeding or marketing trial.ConclusionsOnly one in four drug trials involving general practice were solely general practice trials and almost all were industry initiated without input from academic general practice. There was a large variation in the number of patients, participating doctors, and economic compensation for trial investigators, with some investigators receiving substantial payments.

The Demography of Medical Malpractice Suits against Radiologists

To delimit demographic characteristics of malpractice claims against radiologists in the United States by sex and location and to note the varying percentages of favorable outcomes and award amounts to plaintiffs by state. This HIPAA-compliant study was institutional review board-approved. All radiologists enrolled in One-Call Medical, a specialized preferred provider organization, go through an initial and recurrent credentialing process, which records state of residence, age, sex, and malpractice history. For each radiologist, a record of unfavorable outcomes and payment awards is derived from narratives provided by the National Practitioner's Data Bank. All other suits are self-reported. Rates of malpractice claims per state were calculated with a zero-inflated negative binomial regression model allowing for differences in years at risk. Poisson regression was used to calculate the incidence rate ratio (IRR) for any payment as a result of a malpractice claim compared with the average of all 36 states, adjusted for sex. To determine the association of age, sex, and state with amount of payment, we used a general linear model assuming a gamma family distribution. In August 2010, 8401 radiologists from 47 states composed One-Call Medical's panel. During their careers, 30.9% (2600 of 8401) had been the subject of at least one malpractice claim. Median payment awards varied by 14-fold from Maine ($350 000) to Colorado ($24 105), while mean payments varied ninefold from Oregon ($715 707) to Nebraska ($74 373). Adjusted for age and state, radiologists in Alabama had the lowest rate of malpractice suits per 100 practice-years for men (0.95; 95% confidence interval [CI]; 0.73, 1.28) and women (0.70; 95% CI: 0.52, 0.96) compared with those in New York, who had the highest rate of suits for men (5.65; 95% CI: 5.09, 6.26) and women (4.13; 95% CI: 3.54, 4.80). Overall, male radiologists had a higher rate of being sued than did their female counterparts (IRR = 1.37; 95% CI: 1.20, 1.56). The likelihood of a radiologist being the defendant in at least one suit is 50% by age 60, yet the difference in frequency and average number of suits accrued varies widely by state of residence and sex. Among resolved suits, the percentage of cases in which payment was made to the plaintiff differs markedly by state, as do median and mean award amount. Men are more likely than women to be sued during the course of their careers.

PCV77 Analysis of Hospital-Specific Drg Payments for Stroke According to United States Medicare Perspective

To calculate US-hospital specific DRGs payments for in-patient stays with a primary diagnosis of stroke and assess its variability according to Medicare inpatient prospective payment system (IPPS). The ICD 9-CM diagnosis codes related to stroke were selected. The coding rules and algorithms of the Medicare severity DRG Grouper (version V29) were analyzed to identify the distinct stroke related Diagnosis Related Groups (DRG) depending on co-morbidities and concomitant diagnosis. According to IPPS rules, inpatient hospital services are paid at a predetermined rate. This latter is calculated by multiplying a DRG-relative weight with operating and capital base payments rates. These rates are adjusted on several hospital features such as geographical area, share of low-income patients served, and involvement in medical education. These hospital specific DRG base payments were implemented for each Medicare provider listed in the Federal register, based on their information found in the 2012 PPS Impact files. Weighted average tariffs across DRG, based on discharges rates reported in the Health care Cost and Utilization Project (HCUP) statistics were generated and the variability of DRG payments was also assessed through descriptive statistics. Distinct DRGs are assigned during inpatient stay for stroke and their average payments to Medicare providers ranging from $4,288 to $18,296. Overall weighted mean (median) payments for stroke were $7,193 ($6,728) across all DRGs and Medicare providers. DRG-tariffs distributions by region as well as other hospital characteristics (size, urban versus rural location, teaching status) highlighted the disparities related to each of these factors and their relative impact. These findings were compared with HCUP aggregated statistics related to costs and hospital charges. Calculating hospital specific DRGs according to the US-Medicare prospective payment system enable to get reliable cost inputs for health-economic models and relevant for adaptation to US-local settings (regional or even hospital based).

Paid Malpractice Claims for Adverse Events in Inpatient and Outpatient Settings

Context An analysis of paid malpractice claims may provide insight into the prevalence and seriousness of adverse medical events in the outpatient setting. Objective To report and compare the number, magnitude, and type of paid malpractice claims for events in inpatient and outpatient settings. Design and Setting Retrospective analysis of malpractice claims paid on behalf of physicians in outpatient and inpatient settings using data from the National Practitioner Data Bank from 2005 through 2009. We evaluated trends in claims paid by setting, characteristics of paid claims, and factors associated with payment amount. Main Outcome Measures Number of paid claims, mean and median payment amounts, types of errors, and outcomes of errors. Results In 2009, there were 10 739 malpractice claims paid on behalf of physicians. Of these paid claims, 4910 (47.6%; 95% confidence interval [CI], 46.6%-48.5%) were for events in the inpatient setting, 4448 (43.1%; 95% CI, 42.1%-44.0%) were for events in the outpatient setting, and 966 (9.4%; 95% CI, 8.8%-9.9%) involved events in both settings. The proportion of payments for events in the outpatient setting increased by a small but statistically significant amount, from 41.7% (95% CI, 40.9%-42.6%) in 2005 to 43.1% (95% CI, 42.1%-44.0%) in 2009 (P Conclusion In 2009, the number of paid malpractice claims reported to the National Practitioner Data Bank for events in the outpatient setting was similar to the number in the inpatient setting.

Surgical Malpractice in the United States, 1990–2006

Information about national trends and predictors of malpractice payments can constructively add to the hotly debated topic of medical malpractice. We sought to evaluate predictors of surgical malpractice payments and to explore national trends. Retrospective analysis of surgery-related malpractice payments using the National Practitioner Data Bank from 1990 to 2006. Payments were adjusted to 2006 dollars. We evaluated predictors of payment size and large payments (defined as those >$1 million). Statutory law in the states demonstrating significant predictive values was analyzed. In total, 58,518 surgical malpractice payments met inclusion criteria. Patients were predominantly female (62%) and inpatient (63%), with a mean age of 42 years. The number of payments decreased and payment sums increased during the study period. Median payment was $132,915 (95th percentile $983,263). Claims most frequently cited improper performance (42%). Patient outcomes were the strongest predictor of both payment size and likelihood of a large payment. Children younger than 10 years old were 70% more likely to receive a large payment (p = 0.005); and patients older than 70 years were 80% less likely (p < 0.0005). Large variations across states were seen for both payment size and likelihood of large payment. The likelihood of reaching out-of-court settlement did not appear to be correlated with known factors. Nationwide, surgical malpractice claims show rising payment amounts. Patient outcomes are the strongest predictor of payment size. Considerable variation in payment size between states suggests a profound impact from local legal environments.

Medical Malpractice in Taiwan: Injury Types, Compensation, and Specialty Risk

The authors analyzed all medical malpractice claims from 2000 to 2008 using cases from the national database of the judicial system of Taiwan. The objective was to describe the factors associated with malpractice claims in Taiwan, a non-Western country that does not have a common law heritage. Emergency physicians (EPs) were the most likely to be sued and made the highest median payments. Most lawsuits involved death or permanent injury. Eighty-two percent of the cases were settled in the physician's favor.

How Do the Elderly Fare in Medical Malpractice Litigation, Before and After Tort Reform? Evidence from Texas

The elderly account for a disproportionate share of medical spending, but little is known about how they are treated by the medical malpractice system, or how tort reform affects elderly claimants. We compare paid medical malpractice claims brought by elderly plaintiffs in Texas during 1988-2009 to those brought by adult non-elderly plaintiffs. Controlling for healthcare utilization, elderly paid claims rose from 20% to 66% of the adult non-elderly rate, and mean and median payments per claim converged, although the elderly were far less likely to receive large payments. Tort reform strongly affected claim rates and payouts for both groups, but disproportionately reduced payouts to elderly claimants. We thus find evidence of convergence between the elderly and the adult non-elderly in both claim rates and payouts, which is interrupted by tort reform.

Patterns and predictors of settlement amounts from surgical malpractice claims in the United States, 1990-2006

Introduction Medical malpractice litigation continues to be hotly debated, particularly given recent healthcare reform legislation. In this study the National Practitioner Data Bank (NPDB) data was scrutinized to evaluate predictors of malpractice claims ending in large payments. Methods Retrospective analysis of the NPDB from 1990-2006 involving physicians and/or residents. Payments were adjusted to 2006 dollars. Large payments defined as those exceeding one million dollars. Multivariate regression evaluated predictors of large payments. Statutory law in the states demonstrating significant predictive values was analyzed. Results A total of 58,518 claims were included. Patients were predominantly female (62%) and inpatient (63%) with mean age of 42 years. Claims per year decreased and payment sums increased over the study period. Median payment was $132,915 (95th percentile $983,263). Claims most frequently cited improper performance (42%). Adjusted analysis explored predictors of large settlements. Patient outcomes of quadriplegia/brain damage/life-long care (OR 142), major permanent injury (OR 66), and death (OR 28) increased the likelihood of large settlements. Compared to 20-69 year-olds, claims involving children less than 10 years-old were 1.7 times more likely to receive large payments (p=0.005); and patients over 70 years were 80% less likely (p Conclusions Nationwide, surgical malpractice claims are decreasing in number with rising payment amounts. Patient outcome is the strongest predictor of payment size although significant variation in payments between states exists. Heterogeneity of payment sizes among states suggests a profound impact from the local legal environments.

Paid Malpractice Claims for Adverse Events in Inpatient and Outpatient Settings

An analysis of paid malpractice claims may provide insight into the prevalence and seriousness of adverse medical events in the outpatient setting. To report and compare the number, magnitude, and type of paid malpractice claims for events in inpatient and outpatient settings. Retrospective analysis of malpractice claims paid on behalf of physicians in outpatient and inpatient settings using data from the National Practitioner Data Bank from 2005 through 2009. We evaluated trends in claims paid by setting, characteristics of paid claims, and factors associated with payment amount. Number of paid claims, mean and median payment amounts, types of errors, and outcomes of errors. In 2009, there were 10,739 malpractice claims paid on behalf of physicians. Of these paid claims, 4910 (47.6%; 95% confidence interval [CI], 46.6%-48.5%) were for events in the inpatient setting, 4448 (43.1%; 95% CI, 42.1%-44.0%) were for events in the outpatient setting, and 966 (9.4%; 95% CI, 8.8%-9.9%) involved events in both settings. The proportion of payments for events in the outpatient setting increased by a small but statistically significant amount, from 41.7% (95% CI, 40.9%-42.6%) in 2005 to 43.1% (95% CI, 42.1%-44.0%) in 2009 (P < .001 for trend across years). In the outpatient setting, the most common reason for a paid claim was diagnostic (45.9%; 95% CI, 44.4%-47.4%), whereas in the inpatient setting the most common reason was surgical (34.1%; 95% CI, 32.8%-35.4%). Major injury and death were the 2 most common outcomes in both settings. Mean payment amount for events in the inpatient setting was significantly higher than in the outpatient setting ($362,965; 95% CI, $348,192-$377,738 vs $290,111; 95% CI, $278,289-$301,934; P < .001). In 2009, the number of paid malpractice claims reported to the National Practitioner Data Bank for events in the outpatient setting was similar to the number in the inpatient setting.

Battle Scars? The Puzzling Decline in Employment and Rise in Disability Receipt among Vietnam Era Veterans

Using Current Population Survey and US Army administrative data, we document that between 2000 and 2010, the employment rate of Vietnam era veterans fell markedly relative to non-veterans of the same cohorts while simultaneously their enrollment increased steeply in the Veterans Disability Compensation (DC) program, which provides healthcare and transfer payments to veterans with service-connected disabilities. Thirty percent of Vietnam era Army veterans enrolled in DC in 2006 received benefits for Post-Traumatic Stress Disorder, with median annual payments of $25,500. The declining employment and rising transfer payments to Vietnam era veterans underscore the long-term private and public costs of wartime service, potentially stemming from both adverse health consequences and policies that have expanded benefits eligibility.

319 PAYMENTS FOR OUTPATIENT UROLOGIC CARE IN NON-HOSPITAL-BASED SETTINGS

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Practice Patterns, Cost Effectiveness1 Apr 2011319 PAYMENTS FOR OUTPATIENT UROLOGIC CARE IN NON-HOSPITAL-BASED SETTINGS John M. Hollingsworth, Julie C. Lai, Christopher S. Saigal, Christopher P. Filson, Brent K. Hollenbeck, and Urologic Diseases in America Projectc John M. HollingsworthJohn M. Hollingsworth Ann Arbor, MI More articles by this author , Julie C. LaiJulie C. Lai Santa Monica, CA More articles by this author , Christopher S. SaigalChristopher S. Saigal Los Angeles, CA More articles by this author , Christopher P. FilsonChristopher P. Filson Ann Arbor, MI More articles by this author , Brent K. HollenbeckBrent K. Hollenbeck Ann Arbor, MI More articles by this author , and Urologic Diseases in America Projectc More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.2638AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The delivery of outpatient urologic care within a hospital infrastructure that is designed and maintained for inpatient care may have important implications for payers. Motivated by this, we compared payments made for common urologic procedures that can be performed in multiple ambulatory settings. METHODS Using a 5% random sample of Medicare beneficiaries (1998–2006), we identified elderly adults who underwent one of 20 urologic procedures. First, we determined where each procedure was performed: a hospital outpatient department (HOPD), an ambulatory surgery center (ASC), or a physician office (PO). We then measured payments made between the index date and 30 days post procedure. Finally, we used multivariable linear regression to examine the association between log-transformed payments and the type of ambulatory setting. RESULTS Eight-five percent of the procedures examined were performed in a PO. With the exception of minimally invasive surgical therapies (MIST) for prostate enlargement, median total payments for each procedure type were substantially lower in ASCs and POs versus HOPDs (Table). Across ambulatory settings, same-day admissions and readmissions within 30 days were the largest drivers of median total payments. Even after adjustment for patient demographics, geographic region, and disease severity, log-transformed payments were lower for procedures performed in a PO versus a HOPD (P<0.001). Median Total Payments in U.S. Dollars (25th, 75th percentile) Procedure Type HOPD ASC PO Endoscopic bladder procedures 799(472,1595) 617(412,1373) 197(146,270) Prostate biopsy 1948(490,1254) 1347(482,960) 317(164,272) Urodynamic procedures 1318(843,2187) 1158(673,1864) 351(74,244) Endoscopic urethral procedures 1201(816,1747) 1086(714,1612) 335(202,462) Endoscopic ureteral procedures 1884(1194,3513) 1843(1072,3577) 291(200,538) Urethral dilation/catheter placement 683(264,1210) 255(146,480) 77(55,125) Shockwave lithotripsy 3940(3010,6960) 3178(2863,4038) 822(721,1682) MIST for prostate enlargement 2912(2414,3602) 3094(2479,4179) 3549(3138,3999) CONCLUSIONS These data support payment policies that encourage the provision of outpatient urologic care in less resource-intensive settings. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e129-e130 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information John M. Hollingsworth Ann Arbor, MI More articles by this author Julie C. Lai Santa Monica, CA More articles by this author Christopher S. Saigal Los Angeles, CA More articles by this author Christopher P. Filson Ann Arbor, MI More articles by this author Brent K. Hollenbeck Ann Arbor, MI More articles by this author Urologic Diseases in America Projectc More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

The Role of the Legal Nurse Consultant in Brachial Plexus Injury: A Case Study

Legal action against nurses and physicians regarding obstetrics and neonatal patients remains a significant concern when the outcome of a pregnancy is not as expected. Obstetric-related cases historically have sustained the highest median payment amounts to the person or party harmed. This article will discuss how the Legal Nurse Consultant can play an integral role in gathering, defining, and explaining medical and nursing data to create a clear depiction of events when a medical malpractice claim is presented. A brachial plexus injury case study is used to discuss the responsibilities of the Legal Nurse Consultant.