Highmark and Allegheny Health Network: Partners in Quality Oncology Practice Initiative (QOPI) measures automation reporting.

2014 ◽  
Vol 32 (30_suppl) ◽  
pp. 41-41
Author(s):  
Kyle Bird
Keyword(s):  
Human Resources ◽  
Operations Management ◽  
Multidisciplinary Team ◽  
Claims Data ◽  
Clinical Decision ◽  
Sensitivity Analyses ◽  
Monthly Report ◽  
Monthly Basis ◽  
Health Network ◽  
Oncology Practice

41 Background: ASCO’s QOPI Participation and Certification processes pose a daunting operational task for oncology practices nation-wide. The standardization and quality improvement initiatives required for Certification involve multiple constituents and often a longitudinal approach to quality and operations management. The human resources required for biannual abstraction can be burdensome given strained resources in an increasingly complex reimbursement environment. Allocating staff for retrospective medical record review requires a steep QOPI learning curve and time away from the clinic. The Allegheny Health Network and Highmark, the Nation’s tenth largest insurer, have partnered to create a monthly QOPI measures automation report which alleviates the burden of a purely human resource-based abstraction methodology. Additionally, 100% of Highmark insured, Allegheny Health Network QOPI qualifying patients are included in a monthly report to allow for near real-time clinical decision support. Methods: A multidisciplinary team was assembled with clinical and administrative representatives from Highmark and Allegheny Health Network. The team worked together in phase I of the project for over eight months to review and select specific QOPI measures that could be tracked through a custom-built, claims processing algorithm. Results: Initial data analysis included over seventy-five automated QOPI measures that would be able to be tracked and trended on a monthly basis – populated from Highmark claims data. The monthly report allows for a larger sample size with data tracking across all QOPI domains and disease sites. The multidisciplinary team has moved on to phase II of the project which will include sensitivity analyses and data refinement. Conclusions: QOPI measures automation is possible through an evolving relationship demonstrated through this unprecedented payer/provider initiative. While some of the QOPI reporting measures could be automated, human resources will still be required for annual abstraction in the on-going QOPI Certification phase. Once refined, automated measures will need to be verified to note changes in claims data and clinical documentation.

scholarly journals Assessing the utility and attitudes toward molecular testing in neuro-oncology: a survey of the Society for Neuro-Oncology members

2021 ◽  
Author(s):  
Shannon Fortin Ensign ◽  
Maya Hrachova ◽  
Susan Chang ◽  
Maciej M Mrugala
Keyword(s):  
Online Survey ◽  
Clinical Decision Making ◽  
Unmet Needs ◽  
Practice Patterns ◽  
Response Rate ◽  
Clinical Decision ◽  
Molecular Testing ◽  
Newly Diagnosed ◽  
Tumor Boards ◽  
Oncology Practice

Abstract Background Molecular testing (MT) is utilized in neuro-oncology with increasing frequency. The aim of this study was to determine clinical practice patterns to acquire this information, interpret and utilize MT for patient care, and identify unmet needs in the practical clinical application of MT. Methods We conducted a voluntary online survey of providers within the Society for Neuro-Oncology (SNO) membership database between March and April 2019. Results We received 152 responses out of 2022 SNO members (7.5% of membership). 88.8% of respondents routinely order MT for newly diagnosed gliomas. Of those who do not, testing is preferentially performed in younger patients or those with midline tumors. 82.8% use MT in recurrent gliomas. Other common indications included: metastatic tumors, meningioma, and medulloblastoma. Many providers utilize more than one resource (36.0%), most frequently using in-house (41.8%) over commercially available panels. 78.1% used the results for clinical decision-making, with BRAF, EGFR, ALK, and H3K27 mutations most commonly directing treatment decisions. Approximately, half (48.5%) of respondents have molecular tumor boards at their institutions. Respondents would like to see SNO-endorsed guidelines on MT, organized lists of targeted agents available for specific mutations, a database of targetable mutations and clinical trials, and more educational programs on MT. Conclusion This survey was marked by several limitations including response rate and interpretation of MT. Among respondents, there is routine use of MT in Neuro-Oncology, however, there remains a need for increased guidance for providers to effectively incorporate the expanding genomic data resulting from MT into daily Neuro-Oncology practice.

scholarly journals Cost of coils for intracranial aneurysms: clinical decision analysis for implementation of a capitation model

2018 ◽  
Vol 128 (6) ◽  
pp. 1792-1798 ◽  
Author(s):  
Gurpreet S. Gandhoke ◽  
Yash K. Pandya ◽  
Ashutosh P. Jadhav ◽  
Tudor Jovin ◽  
Robert M. Friedlander ◽  
...  
Keyword(s):  
Sensitivity Analysis ◽  
Probabilistic Sensitivity Analysis ◽  
Cost Savings ◽  
Clinical Decision ◽  
Sensitivity Analyses ◽  
List Price ◽  
Maximum Dimension ◽  
Total Length ◽  
The Mean ◽  
Mean Cost

OBJECTIVEThe price of coils used for intracranial aneurysm embolization has continued to rise despite an increase in competition in the marketplace. Coils on the US market range in list price from $500 to $3000. The purpose of this study was to investigate potential cost savings with the use of a price capitation model.METHODSThe authors built a clinical decision analytical tree and compared their institution’s current expenditure on endovascular coils to the costs if a capped-price model were implemented. They retrospectively reviewed coil and cost data for 148 patients who underwent coil embolization from January 2015 through September 2016. Data on the length and number of coils used in all patients were collected and analyzed. The probabilities of a treated aneurysm being ≤/> 10 mm in maximum dimension, the total number of coils used for a case being ≤/> 5, and the total length of coils used for a case being ≤/> 50 cm were calculated, as was the mean cost of the currently used coils for all possible combinations of events with these probabilities. Using the same probabilities, the authors calculated the expected value of the capped-price strategy in comparison with the current one. They also conducted multiple 1-way sensitivity analyses by applying plausible ranges to the probabilities and cost variables. The robustness of the results was confirmed by applying individual distributions to all studied variables and conducting probabilistic sensitivity analysis.RESULTSNinety-five (64%) of 148 patients presented with a rupture, and 53 (36%) were treated on an elective basis. The mean aneurysm size was 6.7 mm. A total of 1061 coils were used from a total of 4 different providers. Companies A (72%) and B (16%) accounted for the major share of coil consumption. The mean number of coils per case was 7.3. The mean cost per case (for all coils) was $10,434. The median total length of coils used, for all coils, was 42 cm. The calculated probability of treating an aneurysm less than 10 mm in maximum dimension was 0.83, for using 5 coils or fewer per case it was 0.42, and for coil length of 50 cm or less it was 0.89. The expected cost per case with the capped policy was calculated to be $4000, a cost savings of $6564 in comparison with using the price of Company A. Multiple 1-way sensitivity analyses revealed that the capped policy was cost saving if its cost was less than $10,500. In probabilistic sensitivity analyses, the lowest cost difference between current and capped policies was $2750.CONCLUSIONSIn comparison with the cost of coils from the authors’ current provider, their decision model and probabilistic sensitivity analysis predicted a minimum $407,000 to a maximum $1,799,976 cost savings in 148 cases by adapting the capped-price policy for coils.

scholarly journals The Impact of COVID-19 on the Romanian Hospitals’ Expenses. A Case Study Toward the Financial Resilience after the Pandemic

2021 ◽  
pp. 22-36
Author(s):  
Attila GYÖRGY ◽  
◽  
Liliana SIMIONESCU ◽  
Keyword(s):  
Human Resources ◽  
Slow Growth ◽  
Growth Potential ◽  
High Scale ◽  
Monthly Basis ◽  
Goods And Services ◽  
Almost All ◽  
Medical Infrastructure ◽  
The Impact

The Coronavirus disease 2019 (COVID-19) affect­ed almost all activities worldwide. The medical sec­tor was one of those which were most significantly impacted because the medical infrastructure was not sized for such a high scale shock, specialized human resources and medical infrastructure prov­ing to be much undersized and with slow growth potential. Many changes were required, important financial resources being mobilized in order to mo­tivate medical staff, offer treatments for the most severely affected patients, but also to create new fa­cilities where the increasing number of sick persons could be cured. In our research we want to offer a hospital cost perspective based on empirical analysis of the COVID-19 impact on different categories of expens­es made by Romanian hospitals that treated patients with COVID-19 in different stages of their disease. The period analyzed was January 2019 to December 2020 on a monthly basis. Our results showed that expenses with goods and services, drugs, reagents and human resources are influenced by COVID-19 in a significant manner.

Operations Project and Management in Trauma Centers

2020 ◽  
pp. 481-496
Author(s):  
Thais Spiegel ◽  
Daniel Bouzon Nagem Assad
Keyword(s):  
Decision Making ◽  
Literature Review ◽  
Human Resources ◽  
Organizational Structure ◽  
Conceptual Model ◽  
Operations Management ◽  
Point Of View ◽  
Incentive Systems ◽  
Proposed Model ◽  
Current Stage

Topic of discussions over the last decades, the literature related to the care of patients suffering from poly-trauma, under the assistance point of view, is sufficiently consolidated concerning to the adoption of best practices, what, usually are conducted and disseminated by accrediting organizations. However, expanding the search frontier beyond the assistance dimension, it's noticed the divergences between the recent researches or theoretical shortcomings regarding to the design and management of these operations. In face of this finding, noticed from a literature review in the most important bases of operations management and health, it's adopted a conceptual model which covers relevant elements of the project of an operation, such as: strategy, capacity, human resources, incentive systems, organizational structure and decision making; in order to systematize the current stage of the field, highlighting the differences between recent studies and proposing a set of practices and premises, which are necessary for the operationalization of the proposed model.

Goals of palliative cancer therapy.

1993 ◽  
Vol 11 (2) ◽  
pp. 378-381 ◽  
Author(s):  
F Porzsolt ◽  
I Tannock
Keyword(s):  
Quality Of Life ◽  
Decision Making ◽  
Cost Effectiveness ◽  
Cancer Therapy ◽  
Health Professionals ◽  
Palliative Treatment ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Oncology Practice

The major conclusions of the Workshop on Goals of Palliative Cancer Therapy are as follows: 1. The goals of any cancer therapy should be stated explicitly. 2. If the goal of treatment is palliation, this should be documented according to one of the established and validated methods for assessment of quality of life. Several validated methods are available, and although imperfect, have been shown to give reliable information. 3. The use of simple measures of quality of life (eg, symptom checklists, pain assessment cards) should become routine in oncology practice. The act of introducing such measures improves palliation. 4. Measures of cost-effectiveness should be used more widely in clinical decision making to ensure the appropriate deployment of resources. 5. There must be improved education of all health professionals with regard to the multiple methods for provision of palliative treatment to cancer patients and the assessment of palliation.

An Instrumental Variables Design for the Effect of Emergency General Surgery

2018 ◽  
Vol 7 (1) ◽  
Author(s):  
Luke Keele ◽  
Catherine E. Sharoky ◽  
Morgan M. Sellers ◽  
Chris J. Wirtalla ◽  
Rachel R. Kelz
Keyword(s):  
Instrumental Variables ◽  
General Surgery ◽  
Treatment Effect ◽  
Claims Data ◽  
Average Treatment Effect ◽  
Sensitivity Analyses ◽  
Stochastic Monotonicity ◽  
Emergency General Surgery ◽  
Medical Claims ◽  
Operative Care

Abstract Confounding by indication is a critical challenge in evaluating the effectiveness of surgical interventions using observational data. The threat from confounding is compounded when using medical claims data due to the inability to measure risk severity. If there are unobserved differences in risk severity across patients, treatment effect estimates based on methods such a multivariate regression may be biased in an unknown direction. A research design based on instrumental variables offers one possibility for reducing bias from unobserved confounding compared to risk adjustment with observed confounders. This study investigates whether a physician’s preference for operative care is a valid instrumental variable for studying the effect of emergency surgery. We review the plausibility of the necessary causal assumptions in an investigation of the effect of emergency general surgery (EGS) on inpatient mortality among adults using medical claims data from Florida, Pennsylvania, and New York in 2012–2013. In a departure from the extant literature, we use the framework of stochastic monotonicity which is more plausible in the context of a preference-based instrument. We compare estimates from an instrumental variables design to estimates from a design based on matching that assumes all confounders are observed. Estimates from matching show lower mortality rates for patients that undergo EGS compared to estimates based in the instrumental variables framework. Results vary substantially by condition type. We also present sensitivity analyses as well as bounds for the population level average treatment effect. We conclude with a discussion of the interpretation of estimates from both approaches.

scholarly journals MENTAL HEALTH AMBULATORY: WEAKNESSES POINTED OUT BY PROFESSIONALS

2016 ◽  
Vol 25 (3) ◽  
Author(s):  
Marcelle Paiano ◽  
Mariluci Alves Maftum ◽  
Maria do Carmo Lourenço Haddad ◽  
Sonia Silva Marcon
Keyword(s):  
Mental Health ◽  
Human Resources ◽  
Evaluation Method ◽  
Participant Observation ◽  
Physical Structure ◽  
Fourth Generation ◽  
Health Network ◽  
Healthcare Network ◽  
Fourth Generation Evaluation

ABSTRACT The aim of this study was to identify the weaknesses of the mental health ambulatory service from the professionals' perspective. This was a qualitative study, developed by the Fourth Generation Evaluation method. Data were collected during February and March 2013 with the use of non-participant observation, individual opened interviews and group technique for the negotiation session. The informants were 12 working professionals at the ambulatory. The results pointed out weaknesses in the organizational structure of the healthcare network in mental health, especially regarding accessibility, physical structure and the presence of extensive waiting list for care. Regarding human resources, issues included: ignorance of the operation of the mental health network and of the activities performed, medical turnover, deficiency in training and continuous education and professional devaluation. It is necessary to reflect on the real role of ambulatories within the mental health network and its effectiveness in providing care.

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