Moderate sedation for chest physicians

Specialists in pulmonary and critical care medicine frequently perform invasive procedures that may require sedation or anesthesia for patient comfort. The number and complexities of interventional pulmonary procedures that can be performed in the bronchoscopy suite or critical care unit continues to expand. Procedures that formerly were done only in the operating room on inpatients are now done routinely in the office, ambulatory surgery center, or hospital outpatient department. No matter the setting, the key to successfully performing these procedures is a safe, pain-free environment for the patient. Anesthesia care and procedural sedation services share the goals of providing the patient comfort during a painful procedure and the operating physician an acceptable working environment. Historically, anesthesiologists have applied the expertise gained in managing anesthesia for major surgeries to sedation care for minor procedures. While the supply of anesthesiologists and anesthetists has shown only a modest increase, the growth in minimally invasive procedures has been explosive in recent years. To meet demand, a service, originally known as conscious sedation and now referred to as moderate sedation, has become common, in which the operating physician supervises a specially trained sedation nurse. This article will provide a clinical definition of moderate sedation and then focus on ways to properly code and bill for pulmonary procedures performed with moderate sedation.     

RBRVS评估系统在医师绩效管理中的实践和体会

从公立医院改革、医院精细化管理的需要两方面分析,引入RBRVS评估系统的背泶,介绍了医院RBRVS评估系统托医师绩效管理中的实践运用,分析其科学性和合理性,认为RBRVS坪什系统在提高医师的工作积极性和成本节约控制方面具有很好的实用性．     

The Near-Term Ramifications of Long-Term Trends in Orthopedic Surgical Reimbursement

BackgroundThere has been 25-year trend of decreasing value for orthopedic surgical work based on the Resource-Based Relative Value Scale (RBRVS) for Medicare reimbursement. This study was undertaken to estimate the time that Medicare payment rates for time spent in the office doing cognitive work will equal time dedicated in the operating room to performing procedural work based on long-term negative payment trends.MethodsThe RBRVS Update Committee database was accessed to extract the time elements for 2 procedures, total knee arthroplasty and total hip arthroplasty (27447 and 27130), on the day of surgery. The evaluation and management code mix for 2 mid-sized orthopedic practice was averaged to create an amalgamated rate for the reimbursement of office work on an hourly rate. A graph of the 25-year trend line in Medicare reimbursement for arthroplasty procedures was used to create a trend line. The trend line was then extrapolated to estimate the time in the future that the hourly rate for office work would equal the hourly rate for surgery.ResultsTime inputs and the Medicare conversion factor for 2021 were used in this analysis. Total procedural time for both 27447 and 27130 was 204 minutes (3.4 hours) on the day of surgery. An amalgamated hourly office rate of 7.9 relative value unit was calculated from the average of the 2 mid-sized private practices for an overall in office Medicare reimbursement of $318.89/h, with $1083.04 for the 3.4 hours allowed in the RBRVS Update Committee database for a joint replacement. When the trend line for reimbursement was extrapolated to the $1083.04 price point, the year corresponding to the point where hourly office reimbursement would equal hourly surgical work was 2024.ConclusionPolicymakers in Washington and practicing orthopedic surgeons need to consider the looming economic parity of surgical and cognitive work for Medicare. Continued negative reimbursement rates are likely to decrease patient access to necessary surgical care and result in de facto rationing of arthroplasty services for Medicare patients. The deployment of the orthopedic workforce is likely to change to accommodate the decreases in the value of surgical work. This trend will have significant impact on the practice of musculoskeletal medicine and patient access to orthopedic services.     

RBRVS评估法在医院绩效分配中的应用探讨

在新医改形势下,医院逐渐实现经营自主权,公立医院进入自由医疗市场后,核心竞争力是医院竞争脱颖而出的重要体现,如何提升医务工作者的工作积极性、创新性及责任感对医院提升整体竞争力具有重要意义。目前医院绩效考核最主要的矛盾是医务人员劳务输出与奖金收入脱钩,如何从收入体现医务工作者的劳务输出,将付出与收入有机结合成为医院绩效分配管理改革的重点。为充分考虑医务工作者的工作强度、难度和风险,将工作尽可能量化,本研究将RBRVS评估法应用于我院绩效分配管理中,现就试行过程中的心得进行总结。     

基于RBRVS的医技科室绩效分配实践与思考

随着医药卫生体制改革的不断深入,公立医院薪酬制度改革也逐步开展。武汉某三甲医院基于RBRVS的理念,以工作量为基础,以可控成本作为重点,综合BSC（平衡积分卡）四个维度进行考评,建立了适合医技科室的绩效方案。该方案能客观反映医务人员的工作强度、工作难度和工作风险,激活了医技科室人员工作的积极性和创造性,有效提升了医院的管理效能     

医疗服务项目成本相对值方法模型及其应用研究

本研究设计了一种用以推算全部医疗服务项目成本的成本相对值方法模型,通过数据调查、计算、模拟、分析和理论探讨,验证了该方法的信度、效度,初步证明成本相对值法科学合理、简便易行,其推算结果真实、合理、可信。     

Continuous bronchodilator therapy

Inhaled bronchodilators are first-line treatment for acute exacerbations of asthma. Continuous bronchodilator administration is a novel option for the treatment of bronchospasm, which may be more effective than intermittent therapy for patients with severe airflow obstruction. For 2007, coding and billing changes for this modality become effective. This article reviews clinical aspects and outpatient practice management of continuous bronchodilator therapy.     

RBRVS的兴起与发展对我国社会医疗保险支付的政策启示

RBRVS具有控制医疗卫生费用过快上涨、以富有激励性的医师费支付消除医务人员行为扭曲的作用,其核心功能与我国当前医改面临的问题十分契合。本文从宏观政策视角对RBRVS展开研究,回顾了RBRVS的兴起背景、发展历程、应用优势及其支撑条件。在对我国学术研究和实践探索展开系统性分析的基础上,明晰当前RBRVS在应用中面临未引起卫生政策制订者的足够重视、对RBRVS的激励相容导向关注不足、运行RBRVS的支撑体系薄弱、缺少基于宏观考量的医务人员薪酬支付体系规划等主要问题,据此提出借鉴RBRVS关于医疗保险支付制度的设计精髄、运用医保支付激励达成卫生政策目标、逐步引入按质量付费导向的支付方式、规划契合我国诊疗服务模式的医师费支付方式以及系统评估将其引入社会医疗保险支付的可行性等对策与建议,旨在为推进我国社会医疗保险支付改革提供参考。     

基于RBRVS评估系统的临床护理工作量化研究

目的 探讨RBRVS评估系统应用于测量护理单元工作量的科学性及合理性。方法 应用RBRVS评估系统以工作时间和医疗风险搭建护理工作量测量维度，运用德尔菲专家咨询法确定各护理服务项目赋值系数，对陕西省某三甲综合医院的46个护理单元工作量进行测量，通过实测数据与专家对护理单元工作量档次评价进行一致性检验与相关分析评价该方法的适用性。 结果 专家对护理单元工作量档次评价结果一致且与实测护理单元人均工作量数值之间存在较强的正相关关系。 结论 基于RBRVS评估系统能够客观合理地反应本院临床护理工作量，为护理人力资源配置和绩效分配提供可靠依据。