Medical care
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The rapid growth in Medicare Part B spending on physicians has sparked a renewed debate on ways of increasing physician productivity. This study concentrates on anesthesiologists, presenting original survey data on the variation in productivity defined in terms of patients, anesthesia hours, base and time units, and revenues. ⋯ Yet, recent manpower trends show a falling nurse-to-anesthesiologist ratio. The failure to achieve substantial gains is ascribed to a flaw in third-party reimbursement that discourages both hospitals and physicians from substituting nurse for anesthesiologist time.
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This study developed a patient classification system for hospital emergency departments. Conducted at three Los Angeles area community hospitals, data collection included coding and abstracting medical records information, patient billing information detailing each patient's utilization of hospital services, and patient-specific provider time measuring each provider's time spent in direct patient care activities. ⋯ Patient visits were classified into 216 homogeneous groups, or patient clusters, using four types of variables: diagnoses, disposition, age, and physician procedures. The Emergency Department Groups (EDGs) appear to represent a clinically coherent system for classifying emergency department visits; moreover, the groups were found to explain 63% of the overall variance in resource use (total direct cost) suggesting that the EDGs may offer a useful tool for hospital cost control and reimbursement reform.
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This study estimated the impact of a $5 copayment on office visit rates in a health maintenance organization. A quasi-experimental design was used to compare the observed changes in visit rates by state government enrollees between the year before copayments and their first year of copayments with changes between the same time periods for a control group of enrollees without copayments. Visit data for 30,415 state enrollees and 21,633 federal enrollees who were enrolled continuously for at least 12 months before and after the start of copayments were obtained from automated data systems. ⋯ The effect of copayments on primary care visits by enrollees under 40 years of age was twice as large for females as for males. Copayments also had a significantly greater impact on enrollees who were high users (greater than ten primary care visits) during the year before copayments. The copayment effect was immediate and did not diminish over the 12-month study period.
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Nurse anesthetists (CRNAs) are a lower cost substitute for anesthesiologists in the delivery of anesthesia services. This article addresses the question of when anesthesiologists delegate in a team approach as opposed to using a solo arrangement. ⋯ Medicare and other third-party payers should eliminate regional variations in provider mix that are due to locational preferences and provider attitudes. Delegation to CRNAs can be encouraged by reducing what anesthesiologists are paid for practicing alone.
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This report describes the development and validation of a computerized system for converting ICD-9CM rubrics to Abbreviated Injury Scale (AIS) scores. In collaboration with the Committee on Injury Scaling of the Association for the Advancement of Automotive Medicine, AIS-85 scores were assigned to 2,062 injury-related ICD-9CM rubrics. To validate the conversion table, AIS and Injury Severity Scores (ISS), derived using the conversion, were compared with those obtained by reviewing the complete medical record for 1,120 trauma cases. ⋯ Grouped ISS scores agree, on average, 75% of the time. The results show that while the computerized conversion is not perfect, it provides reasonably good information on severity that might otherwise be unavailable for large population-based research and evaluation. This paper discusses the potential applications of the conversion table with specific attention to its use in evaluating the extent of trauma care regionalization.