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Case Study: Wrong Site Surgery Print E-mail
Written by Hall B. Whitworth, Jr., MD | Mutual Matters   
Monday, 09 October 2017 00:00

A 49-year-old man underwent a colonoscopy by a colorectal surgeon who identified a large, firm tumor causing partial narrowing, approximately 60-70 cm from the entry site. Pathology of this tumor was suspicious for carcinoma. In addition, a polypectomy was performed at a different location, and the site was tattooed. Pathology of this second site was consistent with tubulovillous adenoma.
Two weeks later, the same surgeon performed a partial colectomy of the tattooed area, believing it to be the marker for the tumor to be removed. On further consideration, after the procedure, the surgeon reviewed the colonoscopy and pathology reports and realized the wrong portion of the colon had been removed.

Last Updated on Tuesday, 10 October 2017 18:38
New STD Cases Hit Record High in U.S. Print E-mail
Written by FHI's Week in Review   
Monday, 02 October 2017 00:00

Sandee LaMotte reports for CNN on September 28, 2017:

In 2016, Americans were infected with more than 2 million new cases of gonorrhea, syphilis and chlamydia, the highest number of these sexually transmitted diseases ever reported, the Centers for Disease Control and Prevention said Tuesday.
"STDs are out of control with enormous health implications for Americans," said David Harvey, Executive Director of the National Coalition of STD Directors. The coalition represents state, local and territorial health departments who focus on preventing STDs. "If not treated, gonorrhea, chlamydia and syphilis can have serious consequences, such as infertility, neurological issues, and an increased risk for HIV," said Harvey.

Read more in the latest issue of Week in Review>>
Last Updated on Monday, 23 October 2017 11:37
FDA OKs First Duodenoscope With Disposable Cap Print E-mail
Written by Robert Lowes | Medscape   
Thursday, 21 September 2017 00:00

US Food and Drug Administration (FDA) today <9/20/17> approved the first duodenoscope with a disposable, single-use distal cap, which will make it easier to decontaminate the device and thereby reduce the threat of spreading deadly antibiotic-resistant infections.

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Last Updated on Saturday, 23 September 2017 11:50
PURE Shakes Up Nutritional Field: Finds High Fat Intake Beneficial Print E-mail
Written by FHI's Week in Review   
Monday, 04 September 2017 12:14

Sue Hughes reports from Barcelona, Spain for Medscape on August 29, 2017:

A new study of dietary habits in 135,000 people around the world is set to shake up the nutrition field, with results showing high fat intake-including saturated fat-was associated with a reduced risk of mortality. The PURE study, which followed participants from 18 countries for 7 years, also found that high carbohydrate intake was associated with an increased risk of mortality...
Senior author of the PURE study, Dr Salim Yusuf (McMaster University, Hamilton, ON), commented to Cardiology:
My advice to the general population to lead a healthy lifestyle is don't smoke and take exercise...And then I would say maintain a reasonable weight...Eat a balanced diet-a bit of meat, fish, several portions of fruit and vegetables, but you don't have to be vegan or eat an excessive amount of plants to be healthy...This is good old-fashioned advice. When I showed these results to my mother, she said, 'Why did you bother doing this study? This is what our grandmothers and their grandmothers have been advocating for centuries.' And actually she is right.    

Read more in the current issue of Week in Review>>  

Last Updated on Saturday, 23 September 2017 11:23
Population Health Initiative: Examining the Revenue Lines Print E-mail
Written by Mario Espino   
Wednesday, 23 August 2017 17:53

In part I of this series, we took a high-altitude look at a population health initiative. Today we will examine two core revenue lines essential for a successful initiative. These revenue lines are generated from Medicare-allowables but are transferable to other payer models as they all mostly follow traditional Medicare.

Transitional Care Management (TCM), not to be confused with Transformational Care, is the first one to embrace. Properly implemented TCM provides the practitioner the best chance to get started, not only gathering data, but getting those patients recently discharged from an inpatient acute care setting back in front of their primary care physicians (PCPs). This is crucial as we find that many PCPs are not aware of the inpatient stay and the event that caused the admission, let alone the changes and/or additions made to the patient's care plan and medications.

TCM is a fundamental opportunity to coordinate medical treatment plans for better management of the patient’s condition(s). This is done in either a less than 7 day (CPT Code 99496) or a less than 14 day (CPT Code 99495) window, from the date of discharge, for the patient to be seen by the primary care physician after discharge, as a face-to-face encounter. Revenue ranges from $130 to $200 per patient.

Chronic Care Management (CCM) is the second leg of the core data-gathering process that enables a comprehensive population health initiative. This allows for the collection, aggregation, and management of data from across the continuum and converts the same into one care plan that is actionable and can be supervised by the PCP. This is critical because we know that coordination of care provides better outcomes and saves money. But before CCM, there was no incentive to manage and collect patient information from other continuum providers while collaborating with patient and PCP to look for gaps or improvements in care.

The chronic care management market is big and growing. 36 million Medicare patients suffered from two or more chronic conditions in 2016. That number is expected to jump to 80 million by 2030. 

CCM started later than TCM, and it is a non-face-to-face, per month, per patient amount of monies to manage the care for those that meet the CMS chronic care management definition. There were key improvements for 2017: Increased payment and additional codes. The single CCM code in 2016 paid approximately $42. Now there are 3 codes and payment can range from approximately $43 to over $141, depending on how complex a patient’s needs are. There are requirements by CMS that will have to be in place to bill; but the benefits outweigh the requirements.

There are more revenue lines but these should be at the core of a successful population health initiative.

Resources for TCM and CCM

CMS: TCM Services Fact Sheet

Healthcare IT News: Chronic Care Management: $50 Billion Market

WSJ: Moving Away from Fee-for-Service

CMS: Chronic Care Management Services Changes

CMS: MLN Chronic Care Management

About the author:
Mario Espino is the Chief Population Health Officer for Accountable Care Options of Florida, in Boynton Beach. Mr. Espino is the founder of MGM Medical Group as well as a Blogger/Writer for
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