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PubMed1999

Tricare; Civilian Health and Medical Program of the Uniformed Services (CHAMPUS); nonavailability statement requirement for maternity care. Office of the Secretary, DoD. Interim final rule.

This interim final rule implements Section 712(c) of the National Defense Authorization Act for Fiscal Year 2000 (Pub. L. No. 106-65), which requires that a nonavailability-of-health-care statement shall be required for a non-enrolled beneficiary for TRICARE cost-share of maternity care services related to outpatient prenatal, outpatient or inpatient delivery, and outpatient post-partum care subsequent to the visit which confirms the pregnancy. The Act reestablishes a requirement which was previously eliminated under the broad direction of The National Defense Authorization Act of FY 1997, section 734, which removed authority for nonavailability statements (NASs) for outpatient services. Therefore, the Act changes the existing provisions require an NAS for inpatient delivery but do not require an NAS for outpatient prenatal and post-partum care. The change will significantly contribute to continuity of care for maternity patients. In furtherance of that principle, and consistent with the previous policy, an NAS for maternity care shall not be required when a beneficiary has other health insurance for primary coverage. This is being issued as an interim final rule in order to comply with the statutory mandate. Public comments, however, are invited and will be considered in connection with possible revisions to this rule.

Female↗
PubMed2001

Telemedicine: cost-effective management of high-risk pregnancy.

PURPOSE: To evaluate the cost-effectiveness of telemedicine services in patients diagnosed with preterm labor (PTL). DESIGN: Women hospitalized with a diagnosis of PTL during a 3-year study period were identified within a health maintenance organization. INCLUSION CRITERIA: singleton gestation, stabilized after tocolysis and discharged from the hospital, and participation in the HMO's preterm-birth prevention program. After a PTL diagnosis, telemedicine services (home uterine activity monitoring with daily telephonic nursing contact) were authorized by the payer. The decision to prescribe telemedicine services was made by each patient's individual physician. Two groups of patients were identified: those who received telemedicine services (telemedicine group), and those who received standard care without the adjunctive outpatient service (control group). METHODS: Descriptive and statistical methods were used to compare maternal demographics, pregnancy outcome, antepartum hospitalization, delivery, nursery, and outpatient services. PRINCIPAL FINDINGS: One hundred women were identified: 60 in the telemedicine group and 40 in the control group. Gestational age at diagnosis of PTL was similar at 29.4 +/- 3.8 weeks, telemedicine group vs. 28.0 +/- 7.4 weeks, control group (P = 0.252). The telemedicine group had a significantly later mean gestational age at delivery (38.2 +/- 1.4 vs. 35.3 +/- 3.8), higher mean birth weight (3224 +/- 588 vs. 2554 +/- 911), fewer mean total nursery days (2.4 +/- 1.8 vs. 14.9 +/- 26.4), and less frequent admission to the neonatal intensive care unit (6.7 percent vs. 40 percent) than the control group (all P < 0.005). The total mean cost per pregnancy was $7,225 for the telemedicine group and $21,684 for the control group. This represented average savings of $14,459 per pregnancy using telemedicine services. CONCLUSION: Following an episode of PTL, use of telemedicine services can be a cost-effective tool to improve pregnancy outcome.

Adult↗
PubMed2000

APCs: reimbursement implications.

A transition to a new Medicare outpatient prospective payment system (PPS) will begin in July 2000, affecting many of the outpatient services provided by hospitals that participate in the Medicare program. The outpatient PPS will rely on ambulatory payment classifications (APCs) to classify outpatient services. Hospitals should anticipate that discounts and other factors will affect APC payments and take into account the impact that the new system will have on their revenue.

Ambulatory Care↗
PubMed1983

Pharmacists' dispensing accuracy in a high-volume outpatient pharmacy service: focus on risk management.

A 12-day peer-review audit was performed in the outpatient pharmacy of a large teaching hospital. The audit process was not masked, that is, the pharmacists were aware of the peer-review evaluation. During the 12-day period, 9394 prescription forms and their corresponding pharmaceutical products were examined manually before being delivered to the patient. A total of 1165 (12.4 percent) dispensing errors were detected, with 141 (1.5 percent) of these considered potentially serious. Seventy-six prescriptions contained two errors and four prescriptions contained three. A linear relationship (r2 = 0.78; p less than 0.001) existed between the number of potentially serious errors and the total number of prescriptions filled. There were no statistically significant differences in the dispensing-error rate for the eight pharmacists audited. There was a trend for the number of pharmacist-hours containing at least one potentially serious dispensing error to increase as the prescription-filling rate accelerated. Outpatient pharmacies with high volumes should set a limit to the number of prescriptions filled by their pharmacists and should experiment with quality assurance systems to reduce dispensing errors and subsequent legal liabilities.

Clinical Competence↗
PubMed2006

Unmet needs for comprehensive services in outpatient addiction treatment.

Many addiction treatment patients suffer from health and psychosocial problems in addition to substance misuse at the time of their treatment entry. Outpatient treatment programs have attempted to address these problems by providing or facilitating access to comprehensive health and social services. Nevertheless, previous research have suggested high levels of unmet needs for these services in the addiction treatment population. Using data from a large study on community-based outpatient addiction treatment, this article provides additional information on levels of unmet service needs and the relationship between need and receipt of services during treatment. Our results suggest extremely high levels of unmet needs for a wide variety of health and psychosocial services. Specifically, the data suggest that unmet service needs may be far more prevalent than previous estimates and that addiction treatment populations in rural areas may be particularly disadvantaged.

Ambulatory Care Facilities↗
PubMed2001

How capitated mental health care affects utilization by youth in the juvenile justice and child welfare systems.

Examine the impact of Colorado's Medicaid mental health carve-out program on children in child welfare and juvenile justice systems. Medicaid claims and encounter data for two experimental managed care sites and one comparison fee-for-service site are used to estimate a two-part model of inpatient, outpatient, and residential treatment center utilization, controlling for patient characteristics. The study finds that juvenile justice and child welfare populations were more strongly affected by managed care than the general youth population, regarding reduced utilization of inpatient and outpatient services. Increases in Residential Treatment Centers use were greater for juvenile justice than either the child welfare sample or the total sample. Youth in child welfare increase utilization of outpatient services. Most utilization effects are stronger for not-for-profit than for-profit managed care organizations. The experience of Colorado implies that a mental health carve-out affects patterns of care for youth and differentially so for youth in juvenile justice and child welfare systems. Controlling for population characteristics, the effects are stronger for not-for-profit than for-profit managed care organizations.

Adolescent↗
PubMed2005

Hospital and outpatient health services utilization among HIV-infected children in care 2000-2001.

BACKGROUND: The aging of the pediatric HIV cohort and advances in antiretroviral therapy for children may have resulted in recent changes in patterns of healthcare utilization. OBJECTIVES: The objectives of this study were to examine inpatient and outpatient HIV-related health service utilization in a multistate sample of HIV-infected children, and to assess sociodemographic and clinical correlates of utilization. DESIGN: Cohort study of pediatric patients with HIV. Demographic, clinical, and resource utilization data were collected from medical records for 2000 and 2001. SETTING: This study was conducted at 4 U.S. HIV primary pediatric and specialty care sites in different geographic regions. PATIENTS: Three hundred three HIV-positive children with at least one outpatient visit or CD4 test in either 2000 or 2001 were studied. MAIN OUTCOME MEASURES: Mean outcome measures were number of hospital admissions, mean length of hospital stay, and number of outpatient clinic/office visits. RESULTS: Hospitalization rates decreased significantly from 39.2 (95% confidence interval [CI], 28.4-50.1) to 25.3 (95% CI, 16.4-34.3) admissions per 100 patients between 2000 and 2001. Hospitalizations were higher among patients with greater immunosuppression, those 2 years and under, and those with AIDS, but were not significantly related to receipt of highly active antiretroviral therapy. Mean outpatient visits did not change significantly between 2000 and 2001 from 9.09 (95% CI, 8.3-9.9) to 9.06 (95% CI, 8.4-9.7) visits per child per year. Children 2 years and under, those on highly active antiretroviral therapy, those with AIDS, and those with Medicaid had significantly higher outpatient utilization. Those with higher HIV-1 RNA had higher outpatient utilization than those with less advanced disease. CONCLUSION: Inpatient utilization significantly decreased between 2000 and 2001, but outpatient utilization did not change over time. Compared with prior studies, utilization rates appear to be declining over time. Unlike adults, racial/ethnic or gender disparities in healthcare utilization are less pronounced for HIV-infected children.

AIDS-Related Opportunistic Infections↗
PubMed1994

Collection from third party payers of reasonable costs of healthcare services--DoD. Final rule.

This final rule replaces the current method of per diem billings to one based on diagnostic related groups, expands the single outpatient billing category to as many as sixty, and expands the billing for outpatient services to include land ambulance service, air ambulance service and hyperbaric services. This final rule improves billing methods for both inpatient and outpatient care. This expansion creates a greater level of specificity which more accurately reflects the cost of the care provided. In addition, this final rule identifies additional outpatient services for which recovery of costs will be sought.

Accounts Payable and Receivable↗
PubMed1997

Mastering the APG grouping process.

This case history details one company's success in using coding software to handle the requirements of the new ambulatory patient group (APG) system following the implementation of this complex new payment mechanism for outpatient care. Providers and payers are looking to coding software for help in billing and paying for outpatient services. Since the APG system "consolidates," "packages," and "discounts" a facility's payment for outpatient services, the new coding software helps ensure adequate reimbursement.

Ambulatory Care↗
PubMed1989

[Organization of the outpatient referral service for patients with disorders of cardiac rhythm and conductivity requiring surgical treatment].

Under analysis were results of the outpatient aid to patients in the center of surgery during 5 years. Every year the consultative and ambulatory aid was given to 1200 patients. A conclusion was made that organization of the city consultative-diagnostic center for patients requiring surgical treatment of arrhythmia with a special staff and equipment for performing electrophysiological and other investigations, organization of the zone consultation units in large polyclinics for electrophysiological investigations will improve the quality and efficiency of treatment of patients with complex disorders of the heart rhythm and conduction.

Adolescent↗
PubMed1998

Obesity, health services use, and health care costs among members of a health maintenance organization.

BACKGROUND: Obesity is an independent risk factor for a variety of chronic diseases and is therefore a potential source of avoidable excess health care expenditures. Previous studies of obesity and health care costs have used group level data, applying estimates of population-attributable risks to estimates of US total costs of care for each obesity-related disease. OBJECTIVE: To quantify the association between body mass index (BMI) and health services use and costs stratified by age and use source at the patient level, a level of detail not previously reported. METHODS: In 17,118 respondents to a 1993 health survey of members of a large health maintenance organization, we ascertained through computerized databases all hospitalizations, laboratory services, outpatient visits, outpatient pharmacy and radiology services, and the direct costs of providing these services during 1993. RESULTS: There was an association between BMI and annual rates of inpatient days, number and costs of outpatient visits, costs of outpatient pharmacy and laboratory services, and total costs (P < or = .003). Relative to BMI of 20 to 24.9, mean annual total costs were 25% greater among those with BMI of 30 to 34.9 (rate ratio, 1.25; 95% confidence interval, 1.10-1.41), and 44% greater among those with BMI of 35 or greater (rate ratio, 1.44; 95% confidence interval, 1.22-1.71). The association between BMI and coronary heart disease, hypertension, and diabetes largely explained these elevated costs. CONCLUSION: Given the high prevalence of obesity and the associated elevated rates of health services use and costs, there is a significant potential for a reduction in health care expenditures through obesity prevention efforts.

Adult↗
PubMedDate not supplied

Cost comparisons between nafarelin and leuprolide in the treatment of endometriosis.

The objective of this study was to compare the cost and effectiveness of nafarelin versus leuprolide in the treatment of endometriosis. To compare the economic impact of treating endometriosis with leuprolide or nafarelin and to facilitate cost comparisons between the two, we statistically analyzed information concerning the costs of medications for the treatment of endometriosis, outpatient services, and management of adverse effects, as well as other related costs. A national claims database, MarketScan, was used to obtain data on patients with a principal diagnosis of endometriosis who were treated with either leuprolide or nafarelin. During the calendar years 1992-1994, 114 patients with endometriosis had claims for nafarelin, and 343 had claims for leuprolide. There were no significant differences between nafarelin and leuprolide recipients with respect to demographic variables, types of concomitant drug used, types of outpatient service received, or major outpatient diagnostic categorization. In 1994 dollars, the cost of using leuprolide was $326.7 greater than that of using nafarelin. The results of this study suggest that nafarelin is a less expensive alternative to leuprolide for the treatment of endometriosis.

Adult↗
PubMed1990

Outpatient care: a nationwide revolution.

Most CEOs expect outpatient utilization to increase, but are executives planning ahead for what some term a virtual "revolution" in health care delivery? This issue's cover story takes a look at some of the key strategies that outpatient executives are implementing in their markets. Examples range from a large university teaching hospital, to a suburban facility, to a 40-bed rural hospital in Minnesota. Business strategy is only part of the outpatient story, however. One of the key questions that health care executives must answer is where the outpatient management talent will come from. Outpatient executives report that many of the same skills are needed in this setting as are necessary in the traditional inpatient side; however, there are major differences in management expertise that could make or break a hospital's outpatient services. Moreover, some experts say that this emerging definition of what it takes to be a successful outpatient services executive may be shaping the mold for all future health care executives, both inpatient and outpatient.

Education, Medical↗
PubMed1994

Surgical outpatient practices--a time for change?

Outpatient services are becoming increasingly overburdened and delays for appointments are commonplace. The recent NHS reforms have laid down stricter guidelines on waiting times for hospital services and reorganisation of healthcare provision is necessary in order to meet some of these recommendations. The outpatient service is a case in need. Open access referral for minor cases, endoscopy and vascular assessment, for example, may help to utilise more usefully consultations for new referrals. Follow-up in outpatient clinics should become rationalised with clear objectives being made for investigation and reintervention. The long-term follow-up of patients should rest with their general practitioners. Recommendations have been made for a consultant-based service and more patients are expecting to be seen by a consultant. Until an expansion in consultant numbers is forthcoming patients will continue to experience delays in their management. The current service has scope for improvement and some suggestions are made in this paper.

Aftercare↗