The rates are more consistent with the resources used to deliver these services with an increase in wRVU from 0. The CPT codes for stab phlebectomy of varicose veins, 10—20 and more than 20 , were identified in a high volume growth screen and slated for review.
A robust, multidisciplinary survey including all providers performing these procedures was undertaken. As a result, the wRVU saw a reduction in values. CMS also changed the global period for the stab phlebectomy codes from 90 days to 10 days. This change in global period reduced the total clinic visits from two to one, further impacting the wRVUs. However, with the changes in global period, clinicians are now able to bill and be reimbursed for the second visit when performed.
IVUS was re-reviewed due to concerns over increased expenditures driven by increased non-facility utilization. Several angiography codes were flagged by CMS for high utilization: abdominal aortography , abdominal aortography plus bilateral iliofemoral lower extremity , angiography, visceral, selective or superselective , and the add-on code for each additional vessel studied with angiography Finally, there will be significant changes for exploration-without-repair codes for The previous codes for exploration not followed by surgical repair—with or without lysis of artery—have been condensed into three new codes.
Previously carotid artery , femoral artery , popliteal artery and other , they are now: for the neck e. The new codes will be valued at 7. Significant changes are slated for SVS, along with our surgical colleagues, will continue to work diligently to avoid the implementation of this inappropriate proposal. These issues loom large for RUC surveys sent to SVS members are essential to efforts for appropriate reimbursement but often only a minority is completed.
We would ask all members to take them seriously. Francesco Aiello, MD, is associate professor of surgery in the division of vascular and endovascular surgery at the University of Massachusetts Medical School in Worcester, Massachusetts. Write to us Editor: Bryan Kay bryan bibamedical. First Name. Your email. Philips may send me electronic communications about services and events that may be relevant to me based on my attendance history?
Yes - please share my details with Philips No - do not share my details with Philips. Vascular Specialist. News Latest News. Cardiovascular disease is a leading cause of morbidity and mortality in the United States and Canada and is responsible for more than a third of all deaths in North America.
Additional exclusion criteria included age younger than 21 years and transfer in or out of the hospital before discharge. Of the 12 patients whose data were provided by participating hospitals, underwent concurrent procedures such as abdominal aortic aneurysm repair or carotid endarterectomy and were excluded.
These patients were excluded because they were deemed unlikely to have undergone CABG. All data were extracted from the Transition cost accounting system. Data include demographic and clinical information, resource utilization, and in-hospital costs of treatment for each hospital visit.
The methods used by the Transition accounting system to determine cost have been described previously. Direct cost centers are hospital departments that provide direct patient care and may be related to the actual labor of individual employees within the department eg, salaries and fringe benefits of nurses and technicians or to materials costs that become part of the patient care process eg, pharmaceutical products and laboratory tests.
Overhead cost centers are departments whose costs are indirectly related to patient care eg, administration, security, and housekeeping. In the second step, procedures and services within patient care departments are grouped into discrete intermediate products.
These department-specific intermediate products may represent a product or a service or a combination of both. Examples of intermediate products include gauze used in the operating room or physical therapy.
These costs include direct labor and materials costs and are classified as fixed or variable costs, depending on their responsiveness to fluctuations in volume. These RVUs are an expression of the relative direct costs of a specific intermediate product relative to other intermediate products within the same department. In the fourth step, a method for allocating overhead costs to direct cost centers must be determined for each type of overhead cost.
For example, square footage is often used as a method to allocate housekeeping costs. In the fifth step, overhead costs are allocated to direct cost centers using an allocation algorithm. For example, a common overhead cost allocation algorithm is the step-down method, which is a 1-way method. Once the overhead cost center has been closed, no other cost center can assign costs to it, reducing the number of centers in the allocation procedure.
This is repeated until all overhead cost centers are closed. In the final step of the costing method, the overhead costs, now allocated to direct cost centers, are assigned to department-specific intermediate products using the RVUs previously assigned to each intermediate product.
We examined resource utilization and treatment costs at 3 levels of detail in this study. First, we extracted summary cost data, including total direct, total overhead, and total treatment costs for each patient. The total treatment cost is the sum of direct and overhead costs. Second, we extracted department-level costs, which we grouped into the following 5 categories: laboratory, nursing, pharmacy, surgery, and other miscellaneous departments.
Finally, we examined the cost of specific intermediate products ie, specific products and services in both countries. One participating US hospital U5 and 1 Canadian hospital C3 did not provide intermediate product costs and were excluded from this analysis.
Purchasing power parities for through were used to convert Canadian dollar costs to US dollar costs. The statistical analyses consisted of 2 phases.
In the descriptive phase, we compared US and Canadian patients. We first examined demographic and clinical characteristics ie, age, sex, and comorbidities and admission type. Admission types were defined as elective or nonelective ie, urgent or emergent surgery. However, 1 participating US hospital U4 and 1 Canadian hospital C1 were unable to provide these data and were excluded from the admission type analysis.
We then examined hospital course and in-hospital outcomes, including mortality, procedure use, discharge type, LOS, and costs. Two participating Canadian C1 and C2 and 1 US hospital U2 were unable to provide complete procedure use data and were excluded from the procedure analyses. Discharge types were categorized as home care or self-care, or institutional care. Two participating Canadian hospitals C2 and C4 were unable to provide these data and were thus excluded from discharge type analysis.
Dichotomous data are presented as percentages. In the analytic phase, we used multivariable linear regression modeling to examine the independent effect of country of treatment on LOS and in-hospital costs.
Because of the skewed distributions of LOS and in-hospital costs and the presence of heteroscedasticity unequal variance of residuals , the dependent variables for the multivariable analyses were log e LOS and log e cost , respectively. Multiple logistic regression was used to examine differences in in-hospital mortality in the 2 countries.
Potential confounders were selected for inclusion in the regression model using backward selection for both linear and logistic regression. We also examined potential effect modification between country of treatment and sex and between country and age as a categorical variable. We examined data for a total of 12 consecutive patients US and Canadian patients. All participating hospitals used the Transition cost accounting information system.
All hospitals offered tertiary care facilities, and all but 1 had a capacity of more than beds. All Canadian hospitals were public teaching hospitals.
Most of the US hospitals were public teaching hospitals, with the exception of 2 private institutions and 1 nonprofit corporation. The demographic and clinical characteristics of the 12 patients are summarized in Table 1. A number of baseline demographic and clinical differences existed between the US and Canadian cohorts.
Compared with Canadian patients, US patients were older mean age, The US patients also were more likely to have hypertension The US patients were also more likely to undergo a nonelective procedure than were Canadian patients Significant differences in hospital course were evident for patients in the 2 countries Table 2. Compared with Canadian patients, US patients underwent more procedures.
In particular, use of angiograms Compared with Canadian patients, US patients underwent fewer percutaneous coronary interventions 3. Canadian patients also had a significantly longer postsurgical LOS 7. Canadian patients also had lower rates of unadjusted in-hospital mortality 1. However, after controlling for demographic and clinical differences, there was no significant difference in mortality between countries Table 4. Compared with Canadian patients, US patients were more likely to be discharged to home care or self-care than to institutional care After controlling for age, sex, and baseline clinical differences, multivariate analysis confirmed a strong association between country and total treatment cost Table 6.
Compared with treatment in Canada, treatment in the United States was associated with an When a composite end point of nonfatal cardiac complications and mortality was included in a second model, treatment cost in the United States was Finally, after adjusting for demographic and clinical characteristics and in-hospital procedures angiogram, percutaneous coronary intervention, dialysis, and pacemaker or balloon pump , treatment in the United States was associated with a Substantially more US patients had their preoperative workup, including coronary angiogram, during the CABG admission.
To ensure that the cost differences between Canada and the United States were not the result of Canadian waiting lists, the in-hospital costs of patients who underwent CABG on their admission date were also examined. When total costs were broken down into direct and overhead cost components, US costs were higher for both components Table 5.
A greater proportion of total cost was ascribed to overhead cost components in the United States compared with Canada In addition to breaking down total cost into direct and overhead cost components, total cost was also analyzed by department Figure 1. Despite a significantly shorter LOS among US patients, there was no significant difference in nursing costs. This finding was at least partially due to the longer LOS in Canada. The costs of specific intermediate products in Canada and the United States were also examined Table 7.
Compared with intermediate products in Canadian hospitals, most intermediate products in the United States were associated with higher costs. The costs of diagnostic tests, laboratory tests, and medications were all higher at US hospitals. The cost of 1 hour of operating room time and the daily cost of a bed on a surgical ward predominantly nursing costs were also higher in the United States. The daily cost of a bed in an intensive care unit also predominantly nursing costs was similar in the 2 countries.
In both countries, urgency of surgery was a strong determinant of in-hospital cost Figure 2. In Canada, nonelective surgery was associated with a The purpose of this study was to examine in-hospital outcomes and the differences in and determinants of costs of CABG in the United States and Canada.
We also found important differences in in-hospital costs between US and Canadian hospitals. After controlling for patient baseline differences and clinical outcomes, treatment in the United States was associated with an Differences in direct costs of treatment accounted for Our results suggest that higher costs in the United States are not only due to higher overhead costs but to higher direct costs as well. Costs in the United States were higher for all departments except nursing, where despite a significantly shorter LOS in the United States, costs were similar to Canadian nursing costs.
The similar nursing cost indicates that the salary of US nurses is higher that of Canadian nurses. Our examination of the costs of specific intermediate products revealed higher costs in the United States for products and services.
Increased US treatment costs are also partially explained by increased resource utilization compared with treatment at Canadian hospitals.
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