A Single-Institution's Experience With the CMS Noncervical Spine Fusion Bundle Payments

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Abraham Schlauderaff ◽  
Neel T Patel ◽  
G Timothy Reiter
Keyword(s):  
Healthcare Costs ◽  
Chart Review ◽  
Average Length ◽  
Skilled Nursing Facility ◽  
Retrospective Chart Review ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
Average Length Of Stay ◽  
Cost Metrics ◽  
The Cost

Abstract INTRODUCTION To reign in escalating healthcare costs, multiple cost-containment methodologies have been proposed. CMS has recently initiated bundle payments for certain DRGs during a 90 d global period. These include DRG codes 459 and 460: spinal fusion except cervical with and without major complications or comorbidity, respectively. METHODS The investigators reviewed patients who have been included in the CMS dataset for the aforementioned CMS trial. The data were utilized to analyze our performance in both quality and estimated cost metrics. Data not included in the CMS dataset were obtained via a retrospective chart review. RESULTS A total of 29 patients were included (25 with DRG 460 and 4 with DRG 459). Currently, there are no complete episodes, and final net episode payments are not known. Mean age was 68.9 (SD 9.7) yr. There were 17 males and 12 females. A total of 25 cases were elective and 4 were traumatic. Average length of stay (LOS) was 6 d (2-16 d) with a mean estimated cost of $30,631 (SD $6332). Six patients went to an inpatient rehab for a mean of 14 d (6-21 d) at a mean estimated cost of $28,089 (SD $7372). Two patients went to a skilled nursing facility for 8 and 23 d at a mean estimated cost of $21,906 (5091 and 38,721). Only 1 traumatic case went to rehab/SNF (25%) compared to 7 elective cases (32%). The estimated net episode payment (ENEP) for discharge to home was $36,726 versus that for discharge to facility of $73,100. CONCLUSION From these preliminary data, we conclude that being discharged to Rehab/SNF approximately doubled the ENEP. Of interest, being admitted as a trauma did not increase the risk of being discharged to Rehab/SNF. As patient data mature, we will be able to analyze the cost and expense relationship to obtain a variance to target in our population.

scholarly journals Psychiatric Predictors of COVID-19 Outcomes in a Skilled Nursing Facility Cohort

2020 ◽  
Author(s):  
Steven P. Cercy
Keyword(s):  
Chart Review ◽  
Skilled Nursing Facility ◽  
Retrospective Chart Review ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
Privacy Issues

The author has voluntarily withdrawn this manuscript because of questions raised about privacy issues in the conduct of this retrospective chart review. That issue is being contested by the author. Therefore, pending resolution of this matter, the author does not wish this work to be cited as reference for the project. If you have any questions, please contact the corresponding author.

Abstract 265: A Literature Review of the Direct Medical Costs of Stroke Across the Care Continuum in the US

2020 ◽  
Vol 13 (Suppl_1) ◽  
Author(s):  
Zhiqiu Ye ◽  
Matthew Ritchey ◽  
Kara MacLeod ◽  
Guijing Wang
Keyword(s):  
Ischemic Stroke ◽  
Skilled Nursing Facility ◽  
Index Hospitalization ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
Outpatient Physician ◽  
The Us ◽  
Stroke Type ◽  
Ischemic Attack ◽  
The Cost

Background: The economic burden of stroke is high and expected to increase with the growing stroke incidence among younger adults and the aging population. However, we are unaware of a comprehensive review of the cost drivers across the stroke care continuum. We conducted a literature review and summarized the costs incurred in the inpatient and outpatient settings during the acute and post-acute periods. Methods: A systematic search of MEDLINE, EMBASE, CINAHL was conducted to identify cost-of-illness studies published during January 2000-October 2019 that evaluated the direct medical costs of stroke in the US. We extracted both the index hospitalization costs and the costs incurred thereafter. We summarized the costs by stroke type (ischemic, intracerebral hemorrhage, subarachnoid hemorrhage, transient ischemic attack) and by cost component (e.g., inpatient hospital stays, skilled nursing facility for rehabilitation, physician consultation, medication use). Cost estimates were adjusted to 2019 dollars by using the US Consumer Price Index. Results: Thirty-six studies were included. Thirteen studies (36%) focused on inpatient costs only, twenty-one (58%) estimated both inpatient and outpatient costs, two (6%) examined outpatient costs only. Nine studies (25%) estimated the stroke-attributable costs by using propensity score matching and econometric models. The index hospitalization costed $9,050-$74,525 per admission for ischemic stroke (15 studies), $18,554-$117,991 for hemorrhagic stroke (5 studies), and $9,658-$10,544 for transient ischemic attack (2 studies). Among studies that examined costs beyond the index hospitalization (n=22, 61%), follow-up periods varied from 30 days to 4 years. Sixteen of these studies (73%) estimated total costs only; five (23%) identified costs by period. For ischemic stroke, the total cumulative post-stroke costs were estimated at $15,037 (30-day period), $17,968-$29,704 (90-day), $27,072-$37,611 (180-day), $21,642-$87,135 (1-year), $50,153-$117,683 (2-year), and $70,513-$173,904 (4-year); the proportion attributed to inpatient care reduced from 65% (30-day period) to 46% (4-year). Skilled nursing facility care accounted for 19% of the costs four years post ischemic stroke and for 13% four years post intracerebral hemorrhage stroke. For subarachnoid hemorrhage stroke, inpatient care remained the biggest cost driver four years after the index event (70% of the total cost), followed by outpatient physician services (11%) and skilled nursing facility care (8%). Conclusions: While caution should be taken when interpreting the cost findings due to variation in data sources, study population and analytical methods, the costs of stroke are substantial. Inpatient, skilled nursing facility and outpatient physician costs are the main cost drivers and their contribution to total costs vary greatly over time and by stroke type.

The Impact of a Skilled Nursing Facility on the Cost of Surgical Treatment of Major Head and Neck Tumors

2001 ◽  
Vol 127 (9) ◽  
pp. 1086 ◽  
Author(s):  
Hadi Seikaly ◽  
Karen H. Calhoun ◽  
Jana S. Stonestreet ◽  
Christopher H. Rassekh ◽  
Brian P. Driscoll ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Head And Neck ◽  
Skilled Nursing Facility ◽  
Head And Neck Tumors ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
Neck Tumors ◽  
The Cost ◽  
The Impact

Characteristics of Hospitalized Patients Screening Positive for Delirium

2019 ◽  
Vol 37 (2) ◽  
pp. 142-148 ◽  
Author(s):  
Trinh H. Nguyen ◽  
Rabia S. Atayee ◽  
Katrina L. Derry ◽  
Jeremy Hirst ◽  
Anthony Biondo ◽  
...  
Keyword(s):  
Chart Review ◽  
Average Length ◽  
Retrospective Chart Review ◽  
Patient Characteristics ◽  
Hospitalized Patients ◽  
Screening Tools ◽  
Inpatient Stay ◽  
Tertiary Referral ◽  
Average Length Of Stay ◽  
General Psychiatry

Background: Delirium in the hospitals leads to worse outcomes for patients. There were no previous studies that characterize patients with delirium from multiple hospital locations. Objective: To describe patient characteristics screening positive for delirium and identify any correlations with hospital location and medication use. Design, Settings, Patients: Retrospective chart review of 227 hospitalized patients from a large, academic, tertiary referral, 2-campus health system. Patients were ≥18 years old and had delirium for at least ≥24 hours. Validated delirium screening tools were utilized. Measurements: Patients’ demographics, inpatient stay information, delirium episodes characteristics, drugs, and palliative and psychiatry teams’ involvement. Results: Most patients were older with a mean age of 64.1 years. The most common primary diagnoses were infection, cardiac, and pulmonary. Average length of delirium was 7.2 days (standard deviation [SD] = 8.2), and average length of stay (LOS) was 18.7 days (median = 10.5, SD = 35.1, 95% confidence interval = 14.1-23). Thirty-day readmission rate was 24.8% (65/262 hospitalizations); 12.8% of patients died in the hospital (29/227). Around one-third of hospitalizations had involvement of palliative care, palliative psychiatry, or general psychiatry team. There was a decrease in the number of medications administered 24 hours after the first recording of delirium compared to the immediate preceding 48 hours. Those hospitalizations where delirium first occurred in the intensive care unit (ICU) did have a longer LOS (average = 22.9, SD = 45.7) than those where delirium first occurred outside the ICU (average = 14.8, SD = 20.5). Patients were likely to have received an opioid within 48 hours in 51% of hospitalizations and to have received benzodiazepines in 16% of hospitalizations. Conclusion: In our study, we found that delirium significantly impacted length of delirium episode, number of episodes of delirium, length of hospital admission, and mortality. The population most sensitive to the impacts of delirium were elderly patients.

scholarly journals Characterization of Skilled Nursing Facility Residents Admitted With Substance Use Disorders

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 44-44
Author(s):  
Rhea Sindvani ◽  
Lisa Barry
Keyword(s):  
Substance Use ◽  
Substance Use Disorders ◽  
Skilled Nursing Facility ◽  
Retrospective Chart Review ◽  
Opioid Use Disorder ◽  
Physical And Mental Health ◽  
Opioid Use ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
Admission Screening

Abstract For reasons including the opioid epidemic and more widespread substance use across all ages, the prevalence of individuals meeting preadmission criteria for skilled nursing facility (SNF)-level care and who have substance use disorders (SUDs) is growing. However, little is known about this population. We characterized a sample of residents with SUDs in two SNFs that target admission of difficult-to-place individuals in Hartford, Connecticut. Residents admitted between June 1, 2018 and May 31, 2019 and had an SUD per Pre-Admission Screening and Resident Review (PASRR) were included. Using retrospective chart review, we collected data including demographics, physical and mental health conditions, psychiatric medications, and participation in SNF-provided SUD counseling. Of 163 residents admitted with an SUD, all were admitted following an acute hospitalization. Residents’ average age was 49.9(SD=11.7) years (range 21-79). They were 61% male and racially diverse; 56% Caucasian, 27% Hispanic, 16% Black. SUDs on admission included opioid use disorder (48%), alcohol use disorder (33%), unspecified psychoactive SUD (26%), cocaine use disorder (25%), and Other (20%). Of these, 18% and 16% were taking methadone or suboxone, respectively and 25% were taking an antipsychotic medication. Comorbidities such as bipolar disorder (15%) and viral hepatitis (26%) were prevalent. A total of 40 (25%) residents participated in SUD counseling; none of the aforementioned factors was associated with participation. This is the first study to characterize a sample of residents from SNFs that target individuals with SUDs. Improved understanding of this unique and growing subset of the SNF population may help optimize their treatment.

scholarly journals 1158. Discontinuation of Urine Cultures by Infection Preventionists in Hospitalized Patients with Indwelling Urinary Catheters: Is It Safe?

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S414-S414
Author(s):  
Cherie Faith Monsalud ◽  
Rachel Lim ◽  
Shane Zelencik ◽  
Kamaljit Singh
Keyword(s):  
Chart Review ◽  
Skilled Nursing Facility ◽  
Urinary Catheters ◽  
Post Discharge ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
Tract Infections ◽  
Healthcare Associated ◽  
Urine Testing ◽  
Infection Preventionists

Abstract Background A majority of healthcare-associated urinary tract infections (UTIs) are caused by the use of urinary catheters (CAUTI). Finding of bacteriuria is common in catheterized patients and often leads to unnecessary antibiotic treatment, increased length of stay and additional healthcare costs. We implemented an innovative intervention to improve urine culture (UCx) orders and prevent overdiagnosis of CAUTIs. Methods Orders for UCx in adult patients with short-term urinary catheters at NorthShore University HealthSystem, IL were reviewed daily for appropriateness based on the Infectious Diseases Society of America Guidelines. Appropriate urine testing was defined as: (1) presence of fever ( >38°C) within past 48 hours, (2) new urinary complaints: flank or suprapubic pain/tenderness or dysuria, frequency, urgency or incontinence within 48 hours after catheter removal, and (3) no other reasonable explanation for fever. If UCx was deemed inappropriate, ordering provider was contacted to cancel the order. Chart review was performed at least 30-days post-discharge to determine whether patients developed recurrent UTI, sepsis, were readmitted or expired. Results Between 1 January to 31 March 2019, 65 UCx were submitted. Sixty-four patients (98%) did not meet criteria for testing. Most common reasons for not meeting criteria were absence of fever (60%) and no localizing UTI signs or symptoms (57%). 35 (54%) UCx were canceled after discussion with ordering providers. 21/35 patients (60%) were treated with antibiotics. All 35 patients were discharged, with a majority going to a skilled nursing facility (34%) or home (31%). 4/35 (11%) had a subsequent positive UCx. Two patients developed symptomatic UTI (sUTI) during the index admission. Two patients developed sUTI within 30-days post-discharge; one patient was transitioned to hospice after completion of therapy. All 4 patients were treated for sUTI. Conclusion We were able to safely discontinue UCx in 89% of patients. A majority of patients were already started on empiric treatment and development of subsequent sUTI was infrequent (11% of patients). Our findings suggest that discontinuation of inappropriately ordered UCx is safe with low risk for sepsis or mortality. Disclosures All authors: No reported disclosures.

Comparison of care patterns for hospitalized immune-related adverse events (irAEs) between melanoma patients on combination immune checkpoint inhibitor (ICI) therapy versus ICI monotherapy.

2019 ◽  
Vol 37 (8_suppl) ◽  
pp. 85-85
Author(s):  
RuiQui Chen ◽  
Elliot Charles Smith ◽  
Sze Wah Samuel Chan ◽  
Katrina Hueniken ◽  
M. Catherine Brown ◽  
...  
Keyword(s):  
Chart Review ◽  
Immune Checkpoint Inhibitor ◽  
Average Length ◽  
Retrospective Chart Review ◽  
Standard Of Care ◽  
Readmission Rates ◽  
Admission Rates ◽  
Average Length Of Stay ◽  
Care Patterns ◽  
Melanoma Patients

85 Background: Prior clinical trials in melanoma have demonstrated higher rates of irAEs from combination ICI therapy compared to monotherapy. However, this has not been well studied in the real-world where patients often have greater co-morbidities and less organ reserve. We aim to compare irAEs hospitalizations for melanoma patients on combination vs monotherapy ICIs. Methods: We performed a single centre retrospective chart review (Princess Margaret Cancer Centre, Toronto, ON) for all melanoma patients receiving ICI as standard of care (2012-2017) admitted with irAEs. Data collected include demographics, investigations, management and outcomes of hospitalizations. Descriptive analyses were performed to characterize hospitalizations and compare between ICI combination vs monotherapy groups. Results: Among 381 melanoma patients identified on standard of care ICI, 41 (11%) were admitted for irAE. Among those admitted, 10% received monotherapy with nivolumab, 22% pembrolizumab, 39% ipilimumab and 29% combination ICI. Admission rates were higher among patients receiving combination ICI compared to monotherapy (20% vs 8% p = 0.003). Prevalence of the most common irAEs were similar between combination and monotherapy groups: colitis (58% vs 59%), pneumonitis (8% vs 14%) and hepatitis (8% vs 10%). Less than half received invasive diagnostic tests (i.e, endoscopy) (42% combination vs 35% monotherapy, p = 0.50) with 3 (60%) and 5 (50%) confirming irAEs, respectively. Rates of infliximab use were similar between the combination and monotherapy group (25% vs 21%, p = 0.70). Average length of stay was shorter for patients on combination ICI compared to monotherapy (5 days vs 15 days, p = 0.08). irAE readmission rates were similar between patients receiving combination ICI compared to monotherapy (20% vs 17%, p = 0.65). Conclusions: Despite higher admission rates among patients receiving combination ICI, there was a trend towards shorter hospitalizations. Other outcomes including diagnoses, investigations and management were not significantly different between patients receiving combination vs ICI monotherapy.

Malpractice & Negligence: Cal. Supreme Court Clarifies Negligence Provisions under State’s Elder Abuse Act

1999 ◽  
Vol 27 (2) ◽  
pp. 203-203
Author(s):  
Kendra Carlson
Keyword(s):  
Health Care ◽  
Supreme Court ◽  
Health Care Providers ◽  
Elder Abuse ◽  
Skilled Nursing Facility ◽  
Pressure Sores ◽  
Care Providers ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
The Supreme Court

The Supreme Court of California held, in Delaney v. Baker, 82 Cal. Rptr. 2d 610 (1999), that the heightened remedies available under the Elder Abuse Act (Act), Cal. Welf. & Inst. Code, §§ 15657,15657.2 (West 1998), apply to health care providers who engage in reckless neglect of an elder adult. The court interpreted two sections of the Act: (1) section 15657, which provides for enhanced remedies for reckless neglect; and (2) section 15657.2, which limits recovery for actions based on “professional negligence.” The court held that reckless neglect is distinct from professional negligence and therefore the restrictions on remedies against health care providers for professional negligence are inapplicable.Kay Delaney sued Meadowood, a skilled nursing facility (SNF), after a resident, her mother, died. Evidence at trial indicated that Rose Wallien, the decedent, was left lying in her own urine and feces for extended periods of time and had stage I11 and IV pressure sores on her ankles, feet, and buttocks at the time of her death.

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