The Calculation of Geographic Practice Cost Index and the Feasibility of Using It in Korean Payment System / 보건행정학회지

The fee-for-service system is used as the main payment system for health care providers in Korea. It has been argued that it can't reflect differences in the medical practice costs across regions because the fee schedule is calculated based on the average cost. So, some researchers and providers have disputed that there is need for adopting geographic practice cost index (GPCI) used in the United States for the Medicare program for the elderly to the fee-for-service payment system. This study performed to identify whether the difference in the practice costs among regions exists or not and to examine the feasibility of applying GPCI to Korea payment system. For this purpose, we calculated modified-GPCI and examined considerations to introduce GPCI in Korea. First we identified available data to calculate GPCI. Second, we made applicable GPCI equations to Korea payment system and computed it based on four types of regions (metropolitan, urban, suburban, and rural). We also categorize the regions based on the availability of the medical resources and the capability of utilizing them. As a result, we found that there wasn't any significant difference in the GPCI by regional types in general, but the indices of rural areas (0.91–0.98) was relatively low compared to the indices of other regions (0.96–1.07). Considering the need to use GPCI floor, the pros and cons of using GPCI, and the concern of the regional imbalance of resources, the introduction of GPCI needs to be carefully considered.

A Study on the Appropriateness of Health Insurance Fee in Main Nursing Practices / 임상간호연구

PURPOSE: This study was to present improvement strategy and the problems of the nursing fee in national health insurance system. METHODS: A total of 23 nursing activities performed by nurses were selected. Data were collected the relative value score and criteria of the Health Insurance Review & Assessment Agency. Sixty clinical nursing experts panels were composed and nursing time surveyed self-reported method. The actual fee was calculated through the nursing time, relative value score and actual labor costs. Nextly, the labor costs analyzed was compared with that in the national health insurance. RESULTS: Although the practices were mainly performed by the nurse, other occupations have been recorded as main practitioners and the time of the nursing activity is partially improperly reflected. Additionally, although the nurse practiced mainly in glucose (semi-quantitative) test, it was confirmed that the principal practitioner was described as a clinical pathologist. The the labor cost gap was estimated that is 9.3 times (median) and 11.9 times (average) in this analysis. CONCLUSION: This study suggests that it is necessary to legislate a policy that can improve the quality of clinical nursing by reinforcing the appropriateness and improving nursing fee through reflection of the actual time spent for nursing care.

Qualitative analysis of the clinical head nurses' recognition of RBRVS / 现代临床护理

Objective To explore the recognition degree of resource based relative value scales (RBRVS) among the head nurses of different clinical departments and provide references for the hospitals to gradually adjust and improve the RBRVS performance allocation program. Method Toally 13 clinical head nurses were recruited and in-depth interviews were phenomenologically conducted. The acquired data were analyzed. Results Six themes were extracted: RBRVS's reflection of the value of nursing operation, avoidance of nonstandard registering and charging, differences in performance distribution across clinical departments, unreasonable allocation between internal medical and surgical departments, small numbers of chargeable nursing items, larger coefficient gap between doctors and nurses and inaccuracy in data collection. Conclusions RBRVS for performance evaluation is concerned about the work strength and technical difficulty, but less attention to quality problems is attached. In implementation, we should reasonably treat differences between the clinical departments, setting up reasonable gap coefficient and increasing their enthusiasm. Moreover, as the direct leaders of nursing teams, the nursing management should master the principles of RBRVS and improve the management ability of head nurses.

Qualitative analysis of the clinical head nurses' recognition of RBRVS / 现代临床护理

Objective To explore the recognition degree of resource based relative value scales (RBRVS) among the head nurses of different clinical departments and provide references for the hospitals to gradually adjust and improve the RBRVS performance allocation program. Method Toally 13 clinical head nurses were recruited and in-depth interviews were phenomenologically conducted. The acquired data were analyzed. Results Six themes were extracted: RBRVS's reflection of the value of nursing operation, avoidance of nonstandard registering and charging, differences in performance distribution across clinical departments, unreasonable allocation between internal medical and surgical departments, small numbers of chargeable nursing items, larger coefficient gap between doctors and nurses and inaccuracy in data collection. Conclusions RBRVS for performance evaluation is concerned about the work strength and technical difficulty, but less attention to quality problems is attached. In implementation, we should reasonably treat differences between the clinical departments, setting up reasonable gap coefficient and increasing their enthusiasm. Moreover, as the direct leaders of nursing teams, the nursing management should master the principles of RBRVS and improve the management ability of head nurses.

Diagnostic value of the Vesikari Scoring System for predicting the viral or bacterial pathogens in pediatric gastroenteritis / 소아과

PURPOSE: To evaluate the diagnostic value of the Vesikari Scoring System (VSS) as an early predictor of pathogens in children with acute gastroenteritis (AG). METHODS: In this retrospective study, the VSS score, absolute neutrophil count (ANC), and C-reactive protein (CRP) levels were analyzed in 107 hospitalized children with AG, aged 6 months to 17 years. Patients were divided into nonspecific, viral, and bacterial groups according to the pathogens detected using a multiplex polymerase chain reaction (PCR) test. RESULTS: Patients in the bacterial group had significantly higher CRP values and VSS scores compared to those in the viral group and significantly higher VSS scores compared to those in the nonspecific group (P<0.05). Patients in the viral group had significantly higher VSS scores than those in the nonspecific group (P<0.05). Logistic regression analysis revealed that VSS was the most effective diagnostic tool for predicting the type of pathogen (P<0.05). The area under the receiver operating characteristics curve of VSS was significantly greater than that for ANC and CRP (P<0.05). At a cutoff point of 10 in the VSS, an acceptable diagnostic accuracy could be achieved for distinguishing between bacterial and viral pathogens in AG. CONCLUSION: VSS can be considered a useful and reliable infectious marker for pediatric gastroenteritis. VSS may be a good early predictor of the type of pathogen, enabling development of a treatment plan before results from a stool culture or PCR test are available.

Diagnostic value of the Vesikari Scoring System for predicting the viral or bacterial pathogens in pediatric gastroenteritis / 소아과

PURPOSE: To evaluate the diagnostic value of the Vesikari Scoring System (VSS) as an early predictor of pathogens in children with acute gastroenteritis (AG). METHODS: In this retrospective study, the VSS score, absolute neutrophil count (ANC), and C-reactive protein (CRP) levels were analyzed in 107 hospitalized children with AG, aged 6 months to 17 years. Patients were divided into nonspecific, viral, and bacterial groups according to the pathogens detected using a multiplex polymerase chain reaction (PCR) test. RESULTS: Patients in the bacterial group had significantly higher CRP values and VSS scores compared to those in the viral group and significantly higher VSS scores compared to those in the nonspecific group (P<0.05). Patients in the viral group had significantly higher VSS scores than those in the nonspecific group (P<0.05). Logistic regression analysis revealed that VSS was the most effective diagnostic tool for predicting the type of pathogen (P<0.05). The area under the receiver operating characteristics curve of VSS was significantly greater than that for ANC and CRP (P<0.05). At a cutoff point of 10 in the VSS, an acceptable diagnostic accuracy could be achieved for distinguishing between bacterial and viral pathogens in AG. CONCLUSION: VSS can be considered a useful and reliable infectious marker for pediatric gastroenteritis. VSS may be a good early predictor of the type of pathogen, enabling development of a treatment plan before results from a stool culture or PCR test are available.

Escala CARE de empatia: tradução para o Português falado no Brasil e resultados iniciais de validação / CARE scale of empaty: translation to the Portuguese spoken in Braziland initial validation results

Objetivos: Traduzir e adaptar para uso no Brasil a escala de avaliação de empatia clínica Consultation and Relational Empathy (CARE). Fornecer resultados preliminares de validação concorrente dessa escala. Métodos: A escala em inglês foi traduzida e adaptada seguindo metodologia recomendada. Vinte pacientes atendidos em ambulatório de pneumologia em hospital público ligado ao Sistema Único de Saúde foram entrevistados quanto ao grau de compreensão da versão final do instrumento. Em uma segunda fase, doze pacientes do mesmo ambulatório responderam a versão brasileira da escala CARE e a Escala de Percepção de Empatia Pelo Paciente (EPEP), logo após término de consulta de rotina. Os médicos responsáveis pelo atendimento desses pacientes também foram convidados, após a consulta, a responder questionário contendo a versão brasileira do Interpersonal Reactivity Index (IRI) e o Inventário de Empatia (IE). Resultados: Dezenove dos 20 pacientes referiram grau elevado de compreensão dos itens da versão brasileira da escala CARE. O escore mediano da escala CARE para outros 12 voluntários foi 44,5 (20-63). O coeficiente alfa de Cronbach para as respostas dos últimos foi 0,867. Os escores CARE correlacionaram-se de maneira significante com os escores EPEP (r=0,699; p=0,01) e com o subitem altruísmo do IE (r=0,744, p=0,01). A escala CARE não mostrou correlações significantes com os escores globais das medidas de empatia IRI e IE informados pelos médicos. Conclusão: A versão brasileira da escala CARE é de fácil compreensão e exibe evidências aceitáveis de validade concorrente e consistência interna. Medidas de empatia referidas pelos médicos tendem a não se correlacionar com as percepções dos pacientes.

Objectives: To translate and to adapt the scale Consultation and Relational Empathy (CARE) for using in Brazil. To obtain preliminary results about concurrent validation of this scale. Methods: The scale was translated and adapted from English by appropriated recommended methodology. Twenty patients from the pulmonology clinic of a public hospital, associated with the Brazilian public health system, were interviewed about the degree of understanding of the scale final version. The second step of the study enrolled twelve patients from the same clinic who answered the Brazilian version of CARE and the Perception Scale of Empathy By Patients (EPEP), shortly after the end of aroutine consultation The physicians responsible for the care of these patients were also approached andasked to answer a questionnaire containing the Brazilian version of the Interpersonal Reactivity Index (IRI) and the Inventory of Empathy (IE). Results: Nineteen of 20 patients reported a high degree of understanding about the items of the Brazilian version of CARE. The median CARE score for other 12 volunteers was 44.5 (20-63). The Cronbach’s alpha coefficient for the answers of these patients was 0.867. CARE scores significantly correlated with EPEP scores (r = 0.699, p = 0.01) and with subsection altruism of the IE (r = 0.744, p = 0.01). CARE scale showed no significant correlations with global scores of IE and IRI reported by physicians. Conclusion: The Brazilian version of CARE is easy to understand and displays acceptable evidences of concurrent validity and internal consistency. Measures of empathy reported by doctors tend to not correlate with perceptions of patients.

Comparative Study of Relative Value for Diagnostic Procedure of Surgical Pathology in Korea and United States

BACKGROUND: Pathologic examination is a very important diagnostic procedure. It is the most important method to decide the therapeutic plan and to predict the prognosis of cancer patients. The Resource-Based Relative Value Scale (RBRVS) is a schema used to determine how much money medical providers should be paid. In Korea, a modified RBRVS has been used since the year 2000. METHODS: We researched the July 2010 RBRVS for Korea and the US medicare. The individual Relative Evaluation Index (REI) is defined as the ratio of an individual RBRVS to the mean RBRVS. The REIs of pathologic examination in Korea and America were compared. RESULTS: For an endoscopic biopsy specimen, the pathologic examination REI in Korea was 55.4% of the American REI. The Korean REI of a prostate biopsy (8 sites) was only 5.7% of the American REI. The Korean REI was 28.1% of the American REI for the hysterectomy for uterine myoma, and the Korean REI was 67.6% of the American REI for resection of stomach or colon cancer. CONCLUSIONS: The RBRVS of pathologic examination in Korea remains undervalued. Considering the importance of pathologic examination in medicine, the RBRVS in Korea should be increased.

Development of an Electronic Claim System Based on an Integrated Electronic Health Record Platform to Guarantee Interoperability / 대한의료정보학회지

OBJECTIVES: We design and develop an electronic claim system based on an integrated electronic health record (EHR) platform. This system is designed to be used for ambulatory care by office-based physicians in the United States. This is achieved by integrating various medical standard technologies for interoperability between heterogeneous information systems. METHODS: The developed system serves as a simple clinical data repository, it automatically fills out the Centers for Medicare and Medicaid Services (CMS)-1500 form based on information regarding the patients and physicians' clinical activities. It supports electronic insurance claims by creating reimbursement charges. It also contains an HL7 interface engine to exchange clinical messages between heterogeneous devices. RESULTS: The system partially prevents physician malpractice by suggesting proper treatments according to patient diagnoses and supports physicians by easily preparing documents for reimbursement and submitting claim documents to insurance organizations electronically, without additional effort by the user. To show the usability of the developed system, we performed an experiment that compares the time spent filling out the CMS-1500 form directly and time required create electronic claim data using the developed system. From the experimental results, we conclude that the system could save considerable time for physicians in making claim documents. CONCLUSIONS: The developed system might be particularly useful for those who need a reimbursement-specialized EHR system, even though the proposed system does not completely satisfy all criteria requested by the CMS and Office of the National Coordinator for Health Information Technology (ONC). This is because the criteria are not sufficient but necessary condition for the implementation of EHR systems. The system will be upgraded continuously to implement the criteria and to offer more stable and transparent transmission of electronic claim data.

Development of a Resource-based Relative Value Scale and Its Conversion Factor for Advanced Nursing Practices in the National Health Insurance

PURPOSE: The purpose of this study was to develop a resource-based relative value scale (RBRVS) and its conversion factor for advanced nursing practices carried out by critical care nurse practitioners (CCNP) in intensive care units. METHODS: The methodology was developed by calculating CCNP's RBRVS for 32 advanced nursing services based on CCNP's workload and time spent in the context of national health insurance. A cost analysis was performed to estimate the conversion factor of CCNP's RBRVS. The share of CCNP's contribution to fee-for-service in intensive care units was also analyzed. RESULTS: Calculation of the RBRVS of 32 advanced nursing practices showed a range of points from 100.0 to 1,181.4 and an average of 296.1 points. The relevant conversion factor for advanced nursing practices in CCNP were estimated at 37.3-48.4 won. The contribution rate of CCNP's advanced nursing practices in the relative value scale of the national health insurance was estimated at 0.1-31.3%. CONCLUSION: Measuring the economic value of advanced nursing services will be a basis for esta-blishing a reimbursement system for CCNP's practices and thus encourage a social demand for advanced nurse practitioners.

Comparison of Nursing Activity Costs of Chronic Otitis Media Surgery Patients among Time, RBRVS, and CP / 간호행정학회지

PURPOSE: The purpose of this study was to compare the cost using different methods of costing nursing activities for patients with chronic otitis media having surgery. METHOD: Data were collected from 30 patients who had mastoidectomy and tympanoplasty. To compare the cost, the researchers used three different costing methods; consumed time, resource based relative value scale (RBRVS), and critical pathway (CP). RESULTS: Twenty-six nursing activities for surgical patients with chronic otitis media were found. Total cost was 83,843.7 won using RBRVS. The costliest activity was recording at 9,734.4 won, followed by confirmation of doctors' orders at 9,302.4 won, and injection with infusion pump at 9,072.0 won. There was a difference in nursing activities performed according to the length of hospital stay, and the cost was highest on the surgery day at 13,417.8 won. Comparatively, the total cost was 72,014.4 won using CP. CONCLUSIONS: Nursing activities are performed in various forms according to the disease and patient's condition, and different nursing activities are executed according to the length of hospital stay. In order to measure the load of nursing activities and distribute it appropriately, it is necessary to analyze the cost of nursing activities by the process of nursing services performed.

Cross-specialty linkage and extrapolation of resource-based relative value scales

This article describes methods used to produce a RBRVS (resource-based relative value scales), a common scale from two specialties (internal medicine and general surgery) and explains the newly developed extrapolation process within each specialty. To produce a common scale, we selected six 'same' services as linking services common to both specialties. Then we used the bi-weighted least squares method to locate all the same services on a single, common scale. By using the same method, we tried to extrapolate all the services within each specialty, not by the method of Kelly et al, dividing all the services within the specialty into families (small homogeneous groups of services) to apply charge-based ratios. To compare both methods, we extrapolated all the services of general surgery according to each method. With the correlation analysis to compare both results to American RVUs, we found that general surgery's RVUs from our own extrapolation method turned out to be more highly correlated with American RVUs than from Kelly's extrapolation method. Consequently, extrapolation with bi-weighted least squares method gave reasonable results.