Costes en pacientes miopes magnos con y sin neovascularización coroidea miópica / Cost of myopic patients with and without myopic choroidal neovascularisation

OBJETIVO: Estudiar los costes asociados a la enfermedad en pacientes miopes magnos (MM) con neovascularización coroidea miópica (NVCm) y sin NVCm. MÉTODOS: Estudio observacional, retrospectivo, transversal, multicéntrico de pacientes MM adultos con y sin NVCm. Se calcularon anualizados el coste directo médico (CDM) desde la perspectiva del Sistema Nacional de Salud, el coste directo no médico (CDnM) desde la perspectiva del paciente y los costes derivados de la pérdida de productividad laboral. RESULTADOS: Se incluyeron 137 NVCm y a 48 MM pacientes (edad media [DE]: 55,1 [2,8] vs. 54,7 [13,8]; p = 0,2). El 80% fueron mujeres en ambos grupos. El tiempo de observación (meses) osciló entre 17,9 (9,6) en el ojo derecho (OD) y 20,0 (9,7) en el ojo izquierdo (OI) en NVCm y 47,1 (21,5) OD y 45,5 (20,7) OI en MM. Se observó un mayor porcentaje de visitas a urgencias en pacientes NVCm vs. MM (41,7 vs. 25%; p = 0,06) y a especialistas de retina (91,2 vs. 77,1%; p = 0,01). El CDM fue mayor en NVCm: 1.985 € (IC 95%: 1.772-2.198) vs. 356 € (251-480) MM; p < 0,001. El CDnM también fue más alto en NVCm: 256 € (11-524) vs. 19 € (11-26) MM; p > 0,4. El número de ojos afectos, tiempo de seguimiento y NVCm se asociaron con los costes directos. El impacto en la actividad laboral fue mayor en NVCm (bastante/muy afectados): 27,7 vs. 10,4% en MM. La NVCm mostró una asociación significativa con la afectación laboral (OR: 3,47; IC 95%: 10,101-1,195). CONCLUSIONES: La NVCm implica un coste médico más elevado que la MM. Los pacientes con NVCm presentan una mayor necesidad de cuidados y de dispositivos de ayuda, así como un mayor impacto de la enfermedad en su vida profesional (AU) - es OBJECTIVE: To study the costs associated with high myopia (HM) with choroidal neovascularisation (mCNV) or without mCNV. METHODS: Observational, retrospective, cross-sectional, and multicentre study (HM and mCNV) conducted on adult patients. Annualised medical direct cost (MDC) from the perspective of the National Health System, the non-medical direct cost (nMDC) from the patient perspective, and productivity losses were calculated. RESULTS: A total of 137 mCNV and 48 HM patients were included (mean age [SD]: 55.1 [2.8] vs. 54.7 [13.8];P=.2), with 80% women in both groups. The observation time (months) ranged from 17.9 (9.6) right eye (RE) and 20.0 (9.7), left eye (LE) in mCNV and 47.1 (21.5) RE/45.5 (20.7) LE in MM. A higher percentage of emergency room visits was observed in mCNV vs. HM patients (41.7 vs. 25%; P=.06) and retinal specialists (91.2 vs. 77.1%; P=.01). The MDC was higher in mCNV: € 1,985 (95% CI: 1772-2198) vs. € 356 (251-480) HM, P<.001. The nMDC was also higher in mCNV: € 256 (11-524) vs. €19 (11-26) HM,P>.4. The number of affected eyes, the follow-up time, and the mCNV were factors associated with direct costs. The impact on work productivity was higher in mCNV (quite/very concerned): 27.7 vs. 10.4% HM. The mCNV showed a significant association with activity impairment (OR: 3.47, 95% CI: 10.101-1.195). CONCLUSIONS: mCNV involves higher medical costs than HM. In addition, mCNV patients have a greater need of care and assistive devices, and greater impact of the disease in their work productivity

OBJECTIVE: To study the costs associated with high myopia (HM) with choroidal neovascularisation (mCNV) or without mCNV. METHODS: Observational, retrospective, cross-sectional, and multicentre study (HM and mCNV) conducted on adult patients. Annualised medical direct cost (MDC) from the perspective of the National Health System, the non-medical direct cost (nMDC) from the patient perspective, and productivity losses were calculated. RESULTS: A total of 137 mCNV and 48 HM patients were included (mean age [SD]: 55.1 [2.8] vs. 54.7 [13.8];P=.2), with 80% women in both groups. The observation time (months) ranged from 17.9 (9.6) right eye (RE) and 20.0 (9.7), left eye (LE) in mCNV and 47.1 (21.5) RE/45.5 (20.7) LE in MM. A higher percentage of emergency room visits was observed in mCNV vs. HM patients (41.7 vs. 25%; P=.06) and retinal specialists (91.2 vs. 77.1%; P=.01). The MDC was higher in mCNV: € 1,985 (95% CI: 1772-2198) vs. € 356 (251-480) HM, P<.001. The nMDC was also higher in mCNV: € 256 (11-524) vs. €19 (11-26) HM,P>.4. The number of affected eyes, the follow-up time, and the mCNV were factors associated with direct costs. The impact on work productivity was higher in mCNV (quite/very concerned): 27.7 vs. 10.4% HM. The mCNV showed a significant association with activity impairment (OR: 3.47, 95% CI: 10.101-1.195). CONCLUSIONS: mCNV involves higher medical costs than HM. In addition, mCNV patients have a greater need of care and assistive devices, and greater impact of the disease in their work productivity

Mammography coding and reimbursement.

This article describes mammography coding and reimbursement, coding responsibilities for personnel and the importance of coding accuracy. After completing this article, the reader will: Recognize basic terms associated with mammography coding and reimbursement. Explain reimbursement differences between screening and diagnostic mammography. Understand the responsibilities of mammography facility personnel in accurate coding. Recognize the impact of coding, reimbursement and regulation on the economics of mammography practice. Explain basic coding concepts for screening, diagnostic and follow-up mammographic studies. Describe some new breast imaging technologies reimbursed by Medicare.

Medicare program; schedules of limits and prospectively determined payment rates for skilled nursing facility inpatient routine service costs--HCFA. Final notice with comment period.

This final notice with comment period sets forth an updated schedule of limits on skilled nursing facility (SNF) routine service costs for which payment may be made under the Medicare program and sets forth an updated schedule of payment rates for low Medicare volume SNFs that elect to receive prospectively determined payment rates for routine service costs. Section 1888(a) of the Social Security Act (the Act) requires that the Secretary update the per diem cost limits for SNF routine service costs for cost reporting periods beginning on or after October 1, 1995, and every 2 years thereafter. In addition, section 1888(d)(4) of the Act requires the Secretary to establish and publish prospectively determined payment rates at least 90 days prior to the beginning of the Federal fiscal year (FY) to which such rates are to be applied.

Medicare program; adjustments to cost limits for skilled nursing facility inpatient routine service costs--HCFA. Proposed notice.

This notice proposes to eliminate an adjustment that we make to the Medicare cost limits for skilled nursing facility (SNF) routine services if the final rate of change in the market basket index for a calendar year that we use to set the limits differs from the estimated rate of change in the index by at least 0.3 percentage points. Elsewhere in this issue of the Federal Register is a separate final notice with comment period that explains the methodology we use to develop the cost limits and sets forth the cost limits applicable to cost reporting periods occurring on or after October 1, 1997.

Medicare program; schedule of limits for skilled nursing facility inpatient routine service costs--HCFA. Final notice with comment period.

This final notice with comment period sets forth an updated schedule of limits on skilled nursing facility routine service costs for which payment may be made under the Medicare program. Section 1888(a) of the Social Security Act requires that for cost reporting periods beginning on or after October 1, 1992, and every two years thereafter, the Secretary update the per diem cost limits for skilled nursing facility routine service costs.

Medicare program; schedule of limits for skilled nursing facility inpatient routine service costs--HCFA. Final notice with comment period.

This final notice with comment period sets forth an updated schedule of limits on skilled nursing facility inpatient routine service costs for which payment may be made under the Medicare program.

Medicare program; schedule of limits for skilled nursing facility inpatient routine service costs--HCFA. Final notice of schedule of limits.

This notice sets forth a revised schedule of limits on skilled nursing facility inpatient routine service costs that are paid for under Medicare. This schedule applies to cost reporting periods beginning on or after October 1, 1987.