Subject(s)
Hepatitis B Surface Antigens/blood , Hepatitis B, Chronic/drug therapy , Immunoglobulins/adverse effects , Liver Transplantation/adverse effects , Thrombophilia/chemically induced , Allografts/blood supply , Allografts/pathology , Allografts/surgery , Carcinoma, Hepatocellular/pathology , Carcinoma, Hepatocellular/surgery , Carcinoma, Hepatocellular/virology , Extracorporeal Membrane Oxygenation , Hepatectomy , Hepatic Veins/pathology , Hepatitis B Surface Antigens/immunology , Hepatitis B, Chronic/immunology , Hepatitis B, Chronic/pathology , Hepatitis B, Chronic/virology , Humans , Kidney Transplantation , Liver/blood supply , Liver/pathology , Liver/surgery , Liver Cirrhosis/pathology , Liver Cirrhosis/surgery , Liver Cirrhosis/virology , Liver Neoplasms/pathology , Liver Neoplasms/surgery , Liver Neoplasms/virology , Male , Middle Aged , Renal Insufficiency, Chronic/surgery , Reoperation , Thrombophilia/therapyABSTRACT
In accordance with the Affordable Care Act, Medicare has instituted financial penalties for hospitals with 30-day readmission rates that exceed a predetermined value. Currently, this value only considers "excess" readmissions for myocardial infarction, heart failure, and pneumonia with a maximum fine being one per cent of total Medicare reimbursements. In 2015, this penalty will increase to three per cent and encompass more surgical diagnoses. We retrospectively reviewed a database of adult patients undergoing cardiac surgery treated at our institution in 2012 to establish whether patients with readmissions within 30 days of the index operation could have been managed more cost-effectively without readmission. A calculation of cost efficiency was performed to compare the net hospital profit for two scenarios: admitting patients versus hypothetical preventative measures. Of the 576 patients during the study period, a total of 68 (11.8%) patients with unplanned 30-day readmissions were identified. Outpatient management was determined to have been feasible for 18 (26.5%) patients. Whereas the calculated net profit for readmission was $144,000, inclusion of Medicare's penalty resulted in a loss of $11,950. A readmission reduction program with an annual cost exceeding $11,950 would lead to financial loss. The financial implications of Medicare's readmission penalty alone necessitate the development of cost-effective strategies to reduce rehospitalization.
Subject(s)
Ambulatory Care/economics , Cardiac Surgical Procedures , Economics, Hospital , Medicare/economics , Patient Readmission/economics , Physician's Role , Surgeons , Adult , Aged , Aged, 80 and over , Cost-Benefit Analysis , Databases, Factual , Female , Humans , Los Angeles , Male , Medicare/legislation & jurisprudence , Middle Aged , Patient Protection and Affordable Care Act , Patient Readmission/legislation & jurisprudence , Pilot Projects , Retrospective Studies , United StatesABSTRACT
IMPORTANCE: Benign granulomatous disease may mimic malignant disease in the evaluation of mediastinal or pulmonary lesions. However, histoplasmosis as a cause of cervical lymphadenopathy is relatively rare. We report the first case of Histoplasma infection mimicking malignant adenopathy discovered during diagnostic thyroid lobectomy. OBSERVATIONS: A 2.5-cm, calcified, right paratracheal lymph node intimately involving the recurrent laryngeal nerve was discovered during lobectomy for a follicular lesion of undetermined significance with a positive NRAS mutation. Although metastatic thyroid cancer was the most probable diagnosis, results of gross inspection of the bisected thyroid nodule suggested a benign process. Partial removal of the node, sparing the nerve, established the diagnosis of Histoplasma capsulatum infection. CONCLUSIONS AND RELEVANCE: Histoplasmosis is a rare cause of cervical adenopathy that should be considered in cases in which a discordance arises between the malignant gross appearance of the adenopathy and the benign gross appearance of an associated thyroid nodule.
