Jeffrey Rakover, Cardiovascular Roundtable
Many institutions still struggle with increased pressure to bill traditionally inpatient care on an outpatient basis. The RAC audit program continues to be controversial in some quarters, even if it’s accepted as an unfortunate fact of life in others.
The most recent proposed inpatient rule only exacerbates the pressure to accurately triage patients between inpatient and outpatient, proposing that patients be in the hospital for at least two midnights to qualify as true inpatients.
The Roundtable has produced a number of resources bearing on the question of increased scrutiny of inpatient stays and the shift toward outpatient payment. Here, we’ve compiled our tools and publications for programs to effectively navigate these pressures.
The resources include triage criteria, case studies and insights to optimize observation status, and strategies to decrease length of stay for procedures where actual care patterns lag behind payment categorization.
Managing the outpatient shift: Roundtable resources
Brian Maher, Cardiovascular Roundtable
For the first time, the American College of Radiology (ACR) and American College of Cardiology Foundation (ACCF) have jointly developed new appropriate use criteria (AUC) for CV imaging in heart failure patients.
The new criteria mark an important step in national efforts to optimize the utilization of CV imaging services for a high-cost, resource-intensive population. However, some questions remain regarding the usefulness of the new criteria in clinical practice.
New CV imaging AUC released, but how much will it help?
Megan Tooley, Cardiovascular Roundtable
There is no denying the critical role non-invasive imaging plays in CV services. From screening and diagnosis to ongoing treatment monitoring, imaging has clear value in ensuring optimal treatment selection and that CV patients receive the most appropriate care.
As we explore in our recently-launched 2012-2013 Cardiovascular Roundtable national meeting series, beyond its clinical value, imaging can also be foundational to CV service line growth, acting as both a revenue generator in itself, and the entry-point for downstream services and procedures.
However, given the high volume and expenditures associated with CV imaging, it is increasingly becoming a target for utilization- and cost-containment measures led by regulators, medical societies, and payers.
How are CV programs responding to imaging appropriateness scrutiny?