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Implications of miscoding urological procedures in an era of financial austerity - 'Every Penny Counts'.

ABSTRACT: OBJECTIVES: The study aimed to find out any inaccuracy in coding of elective urology procedures and associated financial implications. DESIGN: Retrospective audit and re-audit. SETTINGS: Introduction of payment by results was introduced in the NHS in England in 2002. This meant that hospitals are paid on individual patient basis according to their human resource group (HRG) rather than a block contract. Current coding system uses office of population census and surveys classification. These along with other variables determine the final human resource group code defining final payment. PARTICIPANTS: None. MAIN OUTCOME MEASURE: Retrospective analysis of coding for all inpatient urological procedures was performed over a period of two months. All documented Office of Population Census and Surveys codes were recorded and reviewed by urology trainee along with the head of professional coders. As a result of first analysis the deficiencies were identified and revised Office of Population Census and Surveys codes were used to generate the final human resource group codes. After six months a re-audit was done. RESULTS: In the initial study, 121 cases were reviewed. Twenty per cent of these cases were miscoded. The revised Office of Population Census and Surveys codes led to change of final human resource group code and hence recovery of a payment of £10,716. Analysis after six months showed a considerable improvement with incorrect coding reduced to 11%. CONCLUSION: Our findings highlight potential discrepancies in coding which can lead to significant financial loss. It is important that surgeons involve and train the coding department so that coding errors can be avoided. This will put us in better position to deal with Nicolson Challenge.

SUBMITTER: Cheema ZA

PROVIDER: S-EPMC4527370 | biostudies-other | 2015 Jun

REPOSITORIES: biostudies-other

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Project description:BackgroundDetermining whether members follow guidelines, including guidelines prepared to help direct practice management during the coronavirus disease 2019 (COVID-19) pandemic, is an important goal for medical associations.ObjectiveTo determine whether practice of urologists is in line with guidelines for the management of common urological conditions during the COVID-19 pandemic produced by leading (inter)national urological associations.Design, setting, and participantsSelf-selected urologists completed a voluntary survey available online from March 27 to April 11, 2020 and distributed globally by the Société Internationale d'Urologie.Outcome measurements and statistical analysisResponses to two survey questions on the (1) management of 14 common urological procedures and (2) priority scoring of 10 common urological procedures were evaluated by practice setting and geographical region using chi-square and one-way analysis of variance analyses, respectively.Results and limitationsThere were 2494 respondents from 76 countries. Oncological conditions were prioritised over benign conditions, and benign conditions were deferred when feasible and safe. Oncological conditions with the greatest malignant potential were prioritised over less aggressive cancers. Respondents from Europe were least likely to postpone and most likely to prioritise conditions identified by guidelines as being of the highest priority. Respondents' priority scoring of urological procedures closely matched the priorities assigned by guidelines. The main limitation of this study is that respondents were self-selected, and access to the survey was limited by language and technology barriers.ConclusionsPrioritisation and management of urological procedures during the COVID-19 pandemic are in line with current guidelines. The greatest agreement was reported in Europe. Observed differences may be related to limited resources in some settings.Patient summaryWhen deciding how best to treat patients during the coronavirus disease 2019 (COVID-19) pandemic, urologists are taking into account both expert recommendations and the availability of important local resources.

Project description:Emergency medicine (EM) residency interviews are an important, yet costly process for programs and applicants. The total economic burden of the EM interviewing process is previously unstudied. Graduate medical education funding and student finances are both fragile shifting sources, which appear to fund most of these economic expenditures.The total economic impact of the EM interview season is unknown. This study sought to calculate total dollars spent by EM residency programs and senior medical students (M4) during interview season. Potential solutions for reducing this burden will be outlined.Institutional review board-approved, piloted e-mail surveys were sent to accredited (Accreditation Council for Graduate Medical Education [ACGME] and American Osteopathic Association [AOA]) EM program directors (PDs) and M4 student members of EMRA. PDs were queried after the 2014-2015 interview season. PDs questions included demographics, estimated faculty, and resident and administrative time used, along with dollars spent during the 2014-2015 interview season. M4 questions included demographics and dollars spent during the 2015-2016 season. Results were reported using descriptive statistics. Financial data for EM programs were calculated with academic EM faculty, resident, and administrative assistant salaries along with reported hours used during the interview season.A total of 82 of 223 EM PDs completed the survey, reporting an mean annual cost of $210,649.04 per program to review, screen, and interview applicants based on time spent by faculty, resident, and administrative assistants. A total of 84.6% of EM program costs were due to faculty hours. A total of 180 of 1,425 EM-bound M4 students completed the survey, reporting a mean annual estimate of US$5,065.44 per student to apply and interview. Seventy-two percent of estimated costs were due to airfare and lodging. Loans and credit cards were the top two methods of payments of these interview costs by students. Extrapolating the cost of EM personnel with hours spent, the economic burden of an interview season for EM programs is approximately US$46,974,735.92. M4 students spent US$19,724,823.40 for application fees and interview-related expenses.Emergency medicine residency programs and applicants appear to spend over US$66 million per cycle on the interview process. EM residency programs may save resources by reducing faculty hours associated with the interview process and leveraging administrative and resident resources. Creation of regional or national fixed interview locations may also be appropriate. Applicants may reduce travel costs by participating in video interviews, reducing program applications, and attending regionalized interview days. A full conversation among all specialties and organized medicine needs to take place to reform the systems in place to reduce the economic burden on students and residency programs.

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Implications of miscoding urological procedures in an era of financial austerity - 'Every Penny Counts'.

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