Two Midnights, One New Challenge

This report stated: “Medicare beneficiaries had 1.5 million (limited?) observation stays in 2012; an additional 1.4 million long outpatient stays, and 1.1 million short inpatient stays”. Beneficiaries had over 600,000 hospital stays that lasted 3 nights or more but did not qualify them for SNF services.” Clearly a lot of money is on the table here. The report also noted wide variation and inconsistency in hospitals’ use of inpatient and observation/outpatient designation for similar diagnostic groupings. According to the OIG, many beneficiaries treated with observation stays incurred huge bills from SNFs because they did not qualify for coverage of these services under Medicare. The threat of a rejected inpatient stay and the certainty of payment for an extended outpatient visit is a perverse incentive that denies these patients a chance at a ‘qualified inpatient admission’ (3 days) and Medicare coverage for subsequent SNF stays, and also increases their coinsurance costs significantly. Although MAC and RAC auditors had been having a field day denying short inpatient stays3 and demanding millions in recoupments from hospitals, these determinations were frequently overturned by Administrative Law Judges and the Medicare Appeals Council in favor of the hospitals. In response, CMS attempted to clarify the rules, and provided some relief for hospitals by expanding the list of services that they can bill under Part B when a Part A stay is denied...
Source: EPMonthly.com - Category: Emergency Medicine Authors: Tags: Uncategorized Source Type: news

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Authors: Evans ME, Person M, Reilley B, Leston J, Haverkate R, McCollum JT, Apostolou A, Bohm MK, Van Handel M, Bixler D, Mitsch AJ, Haberling DL, Hatcher SM, Weiser T, Elmore K, Teshale EH, Weidle PJ, Peters PJ, Buchacz K Abstract OBJECTIVES: Hepatitis C virus (HCV) and HIV transmission in the United States may increase as a result of increasing rates of opioid use disorder (OUD) and associated injection drug use (IDU). Epidemiologic trends among American Indian/Alaska Native (AI/AN) persons are not well known. METHODS: We analyzed 2010-2014 Indian Health Service data on health care encounters to assess region...
Source: Public Health Reports - Category: International Medicine & Public Health Tags: Public Health Rep Source Type: research
Authors: Salatin S, Jelvehgari M Abstract Cellulitis is a common bacterial infection of the skin and soft tissues immediately beneath the skin. Despite the successful use of antibiotics in the treatment of infectious diseases, bacterial infections continue to impose significant global health challenges because of the rapid emergence of antibiotic resistance. The aim of this work was to develop an in-situ hydrogel forming system containing highly permeable cephalexin-loaded nanotransfersomes (NTs), suitable for antibacterial drug delivery. Response surface design was applied for the optimization of NTs. Cephalexin N...
Source: Drug Development and Industrial Pharmacy - Category: Drugs & Pharmacology Tags: Drug Dev Ind Pharm Source Type: research
Condition:   Endophthalmitis and Orbital Cellulitis Intervention:   Sponsor:   Minia University Completed
Source: ClinicalTrials.gov - Category: Research Source Type: clinical trials
AbstractThe development of Bruton ’s tyrosine kinase (BTK) inhibitors represents a major breakthrough in the treatment of chronic lymphocytic leukemia and other B cell malignancies. The first-generation inhibitor ibrutinib works by covalent irreversible binding to BTK, a non-receptor tyrosine kinase of the TEC (transient erythrobl astopenia of childhood) family that plays a critical role in the B-cell receptor signaling pathway. It also induces an ‘off-target’ inhibition of a range of other kinases including (but not limited to) epidermal growth factor receptor (EGFR), SRC, and other kinases of the T...
Source: American Journal of Clinical Dermatology - Category: Dermatology Source Type: research
CONCLUSIONS: Embolo-sclerotherapy is relatively safe for upper and lower extremity vascular malformations in a high-volume experienced center where our major complication rates were 14.3% and 4.7%, respectively, which compare favorably or similar to those reported in most recent literature. These outcomes will direct treatment strategies to avoid local and systemic toxic complications in the upper and lower extremity, for both HFVM and LFVM, and to improve informed consent. PMID: 32605532 [PubMed - as supplied by publisher]
Source: Vascular - Category: Surgery Authors: Tags: Vascular Source Type: research
Conclusions: Skin NTDsand other poverty related skin infections were common at the dermatology service. Dermatological services could act as a good entry point for integrated management of skin NTDs. Future studies should assess how different preventive strategies like contact tracing, early diagnosis and mass drug administration can be integrated.
Source: The Journal of Infection in Developing Countries - Category: Infectious Diseases Source Type: research
tad S Abstract BACKGROUND: The diagnosis of necrotising soft tissue infections (NSTIs, necrotising fasciitis, myositis and cellulitis) may be clinically challenging, and can result in fatal outcomes. CASE PRESENTATION: A previously healthy woman in her sixties fell and cut her right patella. The wound was complicated by localised infection, which subsequently developed into a bacterial bursitis. She responded to intravenous antibiotics and was followed up at the outpatient clinic. Nineteen days later she was admitted with the same symptoms and clinical presentation as at the previous admission. She was starte...
Source: Tidsskrift for den Norske Laegeforening - Category: General Medicine Authors: Tags: Tidsskr Nor Laegeforen Source Type: research
Abstract Eosinophilic cellulitis is a rare inflammatory skin disease of unknown aetiology, first described by George Wells in 1971 as a recurrent granulomatous dermatitis with eosinophilia. It is typically characterised by recurrent pruritic erythematous plaques, vesicles or bullae usually involving the extremities and trunk. Many cases of eosinophilic cellulitis are difficult to treat and traditionally require long course of oral steroids, resulting in steroid side effects. This case adds to the literature in that we report the use of methotrexate to treat eosinophilic cellulitis, as a safe and efficacious therap...
Source: The Australasian Journal of Dermatology - Category: Dermatology Authors: Tags: Australas J Dermatol Source Type: research
Hand infections can lead to significant morbidity if not treated promptly. Most of these infections, such as abscesses, tenosynovitis, cellulitis, and necrotizing fasciitis, can be diagnosed clinically. Laboratory values, such as white blood cell count, erythrocyte sedimentation rate, C-reactive protein, and recently, procalcitonin and interleukin-6, are helpful in supporting the diagnosis and trending disease progression. Radiographs should be obtained in all cases of infection. Ultrasound is a dynamic study that can provide quick evaluation of deeper structures but is operator dependent. Computed tomographic and MRI stud...
Source: Hand Clinics - Category: Orthopaedics Authors: Source Type: research
AbstractEosinophilic annular erythema (EAE) is a rare condition with a chronic relapsing and remitting course, characterized by the presence of annular or polycyclic erythematous and plaque lesions and prominent tissue eosinophilia on histopathology. There is an ongoing discussion on whether EAE is a subset of Wells syndrome (eosinophilic cellulitis) or a separate entity. To date, few cases of EAE have been reported in the literature; of these, about 40 cases were in adults and fewer than ten cases were in children. Given the rarity of this condition, there are no clear recommendations for its management. Systemic corticos...
Source: Dermatology and Therapy - Category: Dermatology Source Type: research
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