Extend focus beyond hospitals to truly improve healthcare
by Thomas Dahlborg
The healthcare industry focuses on clinical quality outcomes at the hospital level, especially on preventable readmissions. Funders of healthcare implement both carrots and sticks (incentives and disincentives) to improve quality in this area; however, this sole approach is not enough.
Healthcare is a complex, adaptive system (as is each of our patients, practitioners and organizations), so a focus limited to hospital responsibility regarding care quality is not enough to truly make a difference.
For this discussion, let's expand our view to primary care as well.
Primary care physicians miss between ...
Source: hospital impact - March 7, 2014 Category: Health Managers Authors: Wendy Johnson Source Type: blogs
Feel the Burn
Hand burns from thermal injuries are common chief complaints in the emergency department. Sometimes, 2nd- and 3rd-degree burns may need immediate interventions and warrant special attention. These injuries are painful, and often have associated complications such as permanent scarring, cosmetic issues, prolonged pain, and even infection. ED providers can assist with the primary complications related to blistering of the hand or extremity. Careful follow-up and a detailed discharge plan produce better outcomes and minimize overall complications. Full body/surface burns or circumferential burns should always be seen and eval...
Source: The Procedural Pause - February 28, 2014 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
New and Established Patient E/M Definitions (CMS vs. CPT®)
I get lot of requests from readers of The Happy Hospitalist asking how to know if a patient is a new or established patient. Identifying the correct classification will prevent delays or denials of payment. Many evaluation and management (E/M) codes are by definition described as new or established. This lecture will attempt to explain various important clinical aspects related to this determination. Keep in mind while the Centers For Medicare & Medicaid Services (CMS) uses Current Procedural Terminology (CPT) codes, CMS definitions do not always agree with CPT® definitions. This di...
Source: The Happy Hospitalist - February 27, 2014 Category: Internists and Doctors of Medicine Authors: Tamer Mahrous Source Type: blogs
New and Established Patient E/M Definitions (CMS vs. CPT ®)
I get lot of requests from readers of The Happy Hospitalist asking how to know if a patient is a new or established patient. Identifying the correct classification will prevent delays or denials of payment. Many evaluation and management (E/M) codes are by definition described as new or established. This lecture will attempt to explain various important clinical aspects related to this determination. Keep in mind while the Centers For Medicare& Medicaid Services (CMS) uses Current Procedural Terminology (CPT) codes, CMS definitions do not always agree with CPT ® definitions. This discre...
Source: The Happy Hospitalist - February 27, 2014 Category: Internal Medicine Authors: The Happy Hospitalist Source Type: blogs
99225 CPT® Code Description, Progress Notes, RVU, Distribution.
This 99225 CPT® lecture reviews the procedure code definition, progress note examples, distribution and RVU values for this new since 2011 subsequent observation care evaluation and management (E/M) code. CPT stands for Current Procedural Terminology. CPT® 99225 is the middle (level 2) subsequent observation care code in this family of codes that also includes CPT® codes 99224 and 99226. All three codes are part of the Healthcare Common Procedure Coding System (HCPCS). Observation care is considered outpatient care. A patient is considered outpatient until inpatient admission to a healthcare facility occu...
Source: The Happy Hospitalist - January 14, 2014 Category: Internists and Doctors of Medicine Authors: Tamer Mahrous Source Type: blogs
99225 CPT ® Code Description, Progress Notes, RVU, Distribution.
This 99225 CPT ® lecture reviews the procedure code definition, progress note examples, distribution and RVU values for this new since 2011 subsequent observation care evaluation and management (E/M) code. CPT stands for Current Procedural Terminology. CPT® 99225 is the middle (level 2) subsequent observation care code in this family of codes that also includes CPT® codes99224 and99226. All three codes are part of the Healthcare Common Procedure Coding System (HCPCS). Observation care is considered outpatient care. A patient is considered outpatient until inpatient admission to a healthcare facility occurs.&n...
Source: The Happy Hospitalist - January 14, 2014 Category: Internal Medicine Authors: The Happy Hospitalist Source Type: blogs
Healthcare Update Satellite — 10-03-2013
Via @mdaware … ever wonder whether you need to prescribe two antibiotics for patients with uncomplicated cellulitis? EM Literature of Note’s Ryan Radecki pulls an article showing that there isn’t much difference in outcome/cure rates between treatment of uncomplicated cellulitis with only cephalexin versus combination treatment with cephalexin and Bactrim.
This is important. And it’s from Fox News, so you know it’s fair and balanced. Be very careful about how you sign up for the Obamacare exchanges. Experts expect that there will be a lot of hacking/phishing attacks using phony web sites to try to get unsuspectin...
Source: WhiteCoat's Call Room - October 3, 2013 Category: Emergency Medicine Doctors Authors: WhiteCoat Tags: Healthcare Update Source Type: blogs
Medical Mispronunciations and Misspelled Words: The Definitive List.
Hearing medical mispronunciations and seeing misspelled words are an under appreciated joy of working in healthcare. Physicians often forget just how alien the language of medicine is to people who don't live it everyday. The best part about being a physician is not helping people recover from critical illness. The best part is not about listening and understanding with compassion and empathy. Nope, the best part about being a physician is hearing patients and other healthcare providers butcher the language of medicine and experiencing great entertainment in the process. Doctors c...
Source: The Happy Hospitalist - October 2, 2013 Category: Internists and Doctors of Medicine Authors: Tamer Mahrous Source Type: blogs
Cellulitis versus nec-fash
(Source: Notes from Dr. RW)
Source: Notes from Dr. RW - September 7, 2013 Category: Internists and Doctors of Medicine Tags: infectious disease Source Type: blogs
Oh my achin' back....
It was September of 2010 when I went to SWAT school. I had waited 10 years to feel like I was ready and to have the opportunity to go. I couldn't have been more excited. On the first day we did the obstacle course. I will never forget hanging off the side of that 10 foot wall right before I dropped down. I was thinking "oh myGod I'm really here, shut up and get back to work, ready? ok drop" and when the lightening bolts of pain shot up my spine when I landed flat on my feet I thought "no worries I'll be fine". 2 days later I couldn't do a jumping jack. The team doc thought it was a disc. He wanted to know if I was still go...
Source: Ridin' the bus - June 29, 2013 Category: Ambulance Crew Source Type: blogs
Feel the Felon
Last time we discussed some ways to approach and manage the acute paronychia, but yet another unfortunate criminal robs our nail of its fine fettle: the nefarious felon. The felon’s early signs and symptoms may be subtle so don’t be fooled. This tender, fingerpad infection is not to be ignored. The enclosed fascial spaces of the fingertip pulp will be tender, and appear red and hot, which should mimic your aggressiveness and approach to stop it in its tracks. Figure out that felon, be tender, and forge ahead!
Some thoughts before proceeding. Your fingertip has thousands of nerves, and is very sensitive. Consider all...
Source: The Procedural Pause - May 29, 2013 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
