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At least 271 records · Page 15Linked to original sources
PubMedDate not supplied

Denial of hospitalization by insurers for inpatient treatment of medication rebound headaches.

Inpatient treatment with intravenous dihydroergotamine has been remarkably successful in managing chronic daily headaches due to excessive use of analgesics or ergotamine tartrate. Recently we have been denied authorization in appropriate patients for this procedure by third party payers on the grounds that it was "not medically necessary," "based on anecdotal information," or is "an outpatient procedure." Three cases are described in which the insurer's decision was either contested as an issue of substandard care, or the patient elected to pay for the procedure. The outcome in two cases was dramatically favorable, at least from the patient's and the physician's point of view. The third case is currently being appealed. Time and energy spent on combating the position of the third party payer on issues of standards of specialist care should be unnecessary. Publication of standards of care by specialists, and a requirement that these care standards must be provided by third party payers are needed in order that quality medical care can continue in this society.

Analgesics↗
PubMed2004

[No spectacular rise in claims for medical damages in The Netherlands: 1993-'01 compared to 1980-'90].

OBJECTIVE: To acquire insight into the number and nature of claims for damages that were filed in the period 1993/'01 in hospitals insured by MediRisk and to compare this with the period 1980/'90. DESIGN: Descriptive. METHOD: Data were collected from the registration system for insurance claims maintained by MediRisk, an insurer of medical liability risks. The data were processed up to and including 31 October 2002. There were 4058 claims in 3316 closed and 742 open dossiers. The results were compared with those from a comparable investigation into the period 1980/'90 (3970 claims; 1550 dossiers investigated). The number of invasive medical interventions in the period 1990-2001 was obtained from Prismant in Utrecht. Study of the dossiers yielded information about the use of legal procedures. RESULTS: Compared to 1980/'90 there was a 34% increase in the number of claims for damages following medical interventions during the period 1993/'01. This increase was smaller than the growth in the number of high-risk interventions (47%). The percentage of rejected claims for damages was 6o in the period 1980/'90 and 68 in 1993/'01. In both periods, most of the claims pertained to surgical specialisms, in particular general surgery. In 370 of the 3316 closed dossiers (11%) a legal procedure was mentioned: complaints committee (5%; in 1980/'90 hospitals were not required to have a complaints committee), civil court (3%; this was 4% in 1980/'90) and the Medical Disciplinary Board (3%; this was 6% in 1980/'90). CONCLUSION: The increase in the number of claims for damages filed against hospitals insured with MediRisk was limited compared to the number of medical interventions carried out. The number of legal procedures arising from these claims did rise in the absolute sense, but fell in relation to the number of claims for damages.

Humans↗
PubMed1998

Changes in charges and costs associated with hospitalization of patients with mandibular fractures between 1991 and 1993.

PURPOSE: The purpose of the study was to examine the changes in costs, charges, and income related to hospitalization of patients with mandibular fractures treated over a 3-year period. PATIENTS AND METHODS: The study involved retrospective analysis of data on 97 patients treated by the Department of Oral and Maxillofacial Surgery between 1991 and 1993. Biographical data were obtained from the Trauma Registry, and the financial data were obtained from the Financial Services Administration. The study examined the changes in costs and charges of hospitalization, insurance status, reimbursement, total revenue, and income losses from hospitalization of patients admitted with a primary diagnosis of mandibular fracture. In addition, the study examined the changes in costs of major items involved in treatment. Possible variables such as age, gender, and cause of fracture were also recorded. RESULTS: Twenty-nine patients were admitted in 1991, 35 in 1992, and 33 in 1993. These patients were predominantly young males. The average cost of treatment decreased by 2% in 1992 and increased by 58% in 1993. The average charge increased by 12.9% in 1992 and by 76.8% in 1993. The total reimbursement increased by 11.2% in 1992 and by 47.7% in 1993. The average payment per patient to the institution by third-party payers decreased by 7.8% in 1992 and increased by 56.6% in 1993. The loss of income to the institution (cost minus reimbursement) increased by 105.9% in 1992 and by 58% in 1993. The average institution income loss from the care for each patient increased by 70.6% in 1992 and by 67.8% in 1993. CONCLUSIONS: This study showed that there was a continued increase in costs, charges, and income loss for hospitalization of mandibular fracture patients during the years 1991 to 1993, whereas the reimbursement rate decreased from 65% to 47% of the charges. The increase in cost of supplies and use of rigid fixation, the increase in the number of uninsured patients, and the pricing practices of the institution were possible causes of these changes.

Academic Medical Centers↗
PubMed2004

Maternal serum alpha fetoprotein among pregnant females in Alexandria.

UNLABELLED: Maternal serum alpha fetoprotein (MSAFP) was introduced as a screening test for congenital malformations especially neural tube defects (NTDs) two decades ago. However, many factors were known to affect its level. From these are racial differences and maternal weight. The aim of the present work is to illustrate the normal distribution of MSAFP among working pregnant women in Alexandria in gestational age 16-18 weeks, to identify some of its determinants, and to determine the specificity and sensitivity of MSAFP for the detection of congenital anomalies and adverse pregnancy outcome. MATERIAL AND METHODS: A sample of 608 pregnant working women who were 16-18 week gestation was recruited for the study from the antenatal clinic affiliated to Gamal Abdel Nasser Health Insurance Hospital in Alexandria. The enrolled women were interviewed using a structured questionnaire and a blood sample was collected from each of them to measure the level of MSAFP. At the expected time of delivery, Gamal Abd el Nasser Health Insurance Hospital was visited to collect data about the outcome of pregnancy of the enrolled women. RESULTS: The median of MSAFP level for deliveries with no congenital anomalies were 25.5, 33.5, and 53.2 IU/ml, at gestational weeks 16, 17 and 18 respectively. The significant variables related positively to MSAFP level included abortion or stillbirth, congenital anomalies in the index pregnancy, gestational age, bleeding during pregnancy, gestational diabetes, twin pregnancy, consanguinity between maternal parents, history of congenital or genetic diseases in maternal family, and caesarian section deliveries. Fatigue score was negatively correlated to MSAFP level. Using MSAFP multiples of median (MOM), 42.9 % of abortions and stillbirths, 57.1 % of twin pregnancies, 31.25 % of preterm deliveries and 27.3 % of low birth weight had levels of 3 MOM or more. One fourth of the congenital anomalies were below 0.5 MOM and 41.7 % were at or above 3 MOM. The sensitivity of MSAFP test for the detection of NTDs (cutoff point 2.5+ MOM) or Down syndrome (cutoff point <0.5 MOM) among the study sample was 100% (CI: 19.8-100%). Specificity for NTDs was 92.7% (CI: 90.3-94.6%), while the specificity for Down syndrome was 89.1% (86.3-91.4%). The sensitivity for adverse pregnancy outcome (cutoff point <0.5 or 2.5+ MOM) was 41.6, and the specificity was 85.8%. In conclusion, the cutoff points of MSAFP of the study sample are different from those for other populations. Different factors affect the level of MSAFP including adverse pregnancy outcomes. It is recommended to introduce antenatal screening for congenital anomalies as a routine screening test during pregnancy using levels adapted from the local population for cutoff point determination.

Adult↗
PubMed1990

Liability for medical record disclosure is real but rare.

The most recent public concern for patient confidentiality has centered on the medical records of AIDS patients. However, a new confidentiality concern is the liability of the self-insured hospital that reviews medical claims internally. Also, the sometimes conflicting demands of protecting patient confidentiality and being reimbursed in a timely fashion are setting off sparks between the medical records department and the business office.

Confidentiality↗
PubMed1993

Business continuity planning: the hospital's insurance policy.

A comprehensive business continuity plan can prepare an organization for unforeseen circumstances that would otherwise totally disrupt the delivery of healthcare services. Properly planning for such an event can build confidence in the organization and safeguard the assets of the institution. In this article, the authors present a step-by-step plan for creating a business continuity plan.

Disaster Planning↗
PubMedDate not supplied

Evidence from the National Survey of Family Growth. Work during pregnancy and subsequent hospitalization of mothers and infants.

Large and increasing proportions of women work late into pregnancy and resume work soon after delivery. If work in those periods injures their health or that of their infants, this trend would be of public health concern. Data on ever-married primaparas from the National Survey of Family Growth conducted by the National Center for Health Statistics were used to investigate the relationship between working in the last trimester of pregnancy and two indicators of illness--hospitalization of women for complications of pregnancy and hospitalization of their infants during the first year of life. Hospitalization of the mother or child occurred for 15.0 percent of the primaparas. For primaparas who worked in the last trimester of pregnancy, the percentage was slightly higher--17.1 percent. In two groups, black women and women without hospital insurance for delivery, the percentage of mothers or infants hospitalized was much higher among the mothers who worked in the third trimester than among those who did not. The association of working late in pregnancy with higher rates of hospitalization does not mean, necessarily, that working is a cause of hospitalization. It does indicate, however, the need for epidemiologic and medical research on the relationship.

Adolescent↗
PubMedDate not supplied

In the bond insurance game, small hospitals often shut out.

Smaller hospitals have trouble getting their bond issues insured, even if their credit rating is investment grade. Bond insurance companies typically adhere to policies that prohibit insuring hospitals of fewer than 150 to 200 beds.

Capital Financing↗