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Martin Herman

Publications and source records attributed to Martin Herman.

3 recordsLinked to original sources
PubMed2006

Visit-level acuity and resource-based relative value unit utilization in a pediatric emergency department.

OBJECTIVE: There is currently limited data on the distribution of evaluation and management (E&M) codes and resource utilization in pediatric emergency departments. We sought to ascertain the following: (1) the distribution of visit-level acuity among patients who sought care in our pediatric emergency department (PED); (2) mean relative value units per physician hour (RVUs/h) as a measure of health care provider productivity; (3) the extent of correlation between the mean number of patients seen per hour and RVUs/h; and (4) the difference in RVU's generated using observation codes versus a higher level E&M code for diagnoses that require an extended level of service. DESIGN/METHODS: The study was conducted at an urban tertiary level, university-affiliated PED in a freestanding children's hospital. After obtaining data from patient encounters during the period from January through December 2004, we calculated total RVUs by using 2004 national Medicare data that pertained to facility coding, adjusted for data from Tennessee. We also reviewed the frequency of 3 diagnoses that usually require extended care to determine disposition (status asthmaticus [International Classification of Disease-9 Diagnosis Code 493.91], volume depletion [276.5], and sickle cell disease with crisis [282.62]). Utilizing a high-level E&M code (99285) and high-level, same day observation code (99236), we compared RVUs generated for each of the earlier said diagnoses. RESULTS: During the study period, 61,444 patient encounters occurred. Of the patients seen, 4678 (7.6%) were admitted. The most common E&M code used was 99283 (53.7%). The mean RVU's/h for pediatric emergency medicine physicians and for pediatricians (and nurse practitioners) were 4.36 and 3.08, respectively. There was high correlation between RVU's/h and the number of patients seen per hour (r = 0.85). The cumulative frequency of the 3 diagnoses that required extended care was 2602. Total RVUs generated when the high-level E&M code 99285 and the high-level observation code 99236 were used was 10,408 and 15,143, respectively. CONCLUSIONS: Our descriptive study provides PED benchmarking data on E&M code distribution and RVU utilization. RVU's/h may serve as a reliable measure of productivity. Although the use of observational codes in the PED requires additional documentation, their use for select diagnoses may appropriately reflect the level of service and have a favorable impact on the total number of RVU's generated.

Child↗
PubMedDate not supplied

Prader-Willi Syndrome: clinical concerns for the orthopaedic surgeon.

BACKGROUND: Prader-Willi Syndrome (PWS) is a chromosome 15 disorder characterized by hypotonia, hypogonadism, hyperphagia, and obesity. Musculoskeletal manifestations, including scoliosis, hip dysplasia, and lower limb alignment abnormalities, are well described in the orthopaedic literature. However, care of this patient population from the orthopaedic surgeon's perspective is complicated by other clinical manifestations of PWS. Osteopenia, psychiatric disorders, and diminished pain sensitivity are frequently noted in PWS but are not discussed in the orthopaedic literature. The authors present a clinical review of an 8-year experience of caring for 31 patients with PWS to highlight all clinical concerns that influence orthopaedic management. METHODS: Thirty-one institutionalized patients diagnosed with PWS were examined and all past medical records were reviewed. Patient demographics, genetic testing, musculoskeletal diagnoses, psychiatric diagnoses, and clinical behaviors were recorded. Radiological studies performed in the course of routine clinical care were evaluated. RESULTS: Twenty-three men and 8 women, with an average age of 22 years (range, 8-39 years), were studied. A chromosome 15q abnormality was confirmed in 18 patients. Scoliosis was clinically detected in 21 of 30 patients and confirmed by radiographs in 14 of these 24 patients (overall with scoliosis, 45%) with an average primary curve of 27 degrees; 3 were braced, and 2 underwent spinal fusion. Radiographs also revealed diminished cervical lordosis and increased cervicothoracic kyphosis in 16 patients, a previously undescribed finding. Hip radiographs of 26 patients revealed dysplasia in 2 patients (13%); no slipped capital femoral epiphysis were identified. Fourteen patients had sustained a total of 58 fractures, with 6 patients sustaining multiple fractures (range, 2-7). Six patients have undergone orthopaedic surgical procedures with one major complication (spinal infection). Fracture management was associated with frequent minor complications. Bone densitometry was performed on 14 patients; 8 patients had osteopenia, and 4 had osteoporosis based on lumbar spine z scores. Twenty-six patients had Axis I psychiatric diagnoses including impulse control disorder (7), organic personality disorder (6), oppositional defiant disorder (5), dysthymic disorder (4), depressive disorder not otherwise specified (3), attention-deficit/hyperactivity disorder (2), and obsessive-compulsive disorder (2). Nine patients exhibited self-mutilating behaviors. CONCLUSIONS: Osteopenia, poor impulse control and defiant behaviors, and diminished pain sensitivity are aspects of PWS that may complicate all facets of orthopaedic nonsurgical and surgical management in this patient population. The treating orthopaedic surgeon must plan carefully and proceed with caution when treating children and adults with PWS.

Adolescent↗