Admission source to the medical intensive care unit predicts hospital death independent of APACHE II score

Article Abstract:

The Acute Physiology and Chronic Health Evaluation (APACHE) II is a classification system for the severity of illness. This system has been shown to be a good predictor of risk of hospital death among patients admitted to intensive care units. Consequently, the APACHE II system may be useful in classifying patients for quality-of-care studies and clinical research. The ability of the APACHE II system to predict the outcome of individual patients, however, is equally or less effective than clinical assessment by a physician. A recent study showed that the death rate among patients admitted to a general medical intensive care unit (MICU) was greater than that predicted by the APACHE II system. The excess mortality was accounted for by patients admitted from sites other than the hospital's emergency department. The relation of source of admission, hospital death, and APACHE score was assessed in 235 patients admitted to the MICU. The rate of hospital death as predicted by the APACHE II score was similar to the actual rate of hospital death for patients admitted from the hospital's emergency department. However, the predicted death rate was less than the actual death rate for patients admitted to the MICU from other sources, such as other hospital floors, the medical intermediate care unit, and other hospitals. The source of admission to the MICU was related to the risk of hospital death, independent of the APACHE II score. These results suggest that the APACHE II score does not accurately measure the severity of illness among all patients admitted to the MICU. Hence, the use of the APACHE II system to predict patient outcome may be inappropriate in quality of care studies that compare the outcome of patients admitted to different intensive care units. The APACHE II system should be revised to improve predictions of hospital death rates among patients admitted to MICU. (Consumer Summary produced by Reliance Medical Information, Inc.)

Analysis, Mortality, Statistics, Intensive care units

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Effects of lower surgical fees on the use of physician services under Medicare

Article Abstract:

The changes in physician reimbursement legislated under the Omnibus Reconciliation Act of 1987 (OBRA 87) do not appear to have increased use of physician services by Medicare patients. OBRA 87 lowered Medicare payments for overpriced procedures and tests, especially in the fields of ophthalmology, orthopedic surgery, urology, thoracic surgery and gastroenterology. The Health Care Financing Administration predicted that physicians who lost Medicare revenue would make up for it by increasing the volume and complexity of services. When actual Medicare physician claims were compared from 1987 and 1989 in the five areas most affected by OBRA 87, there was no evidence that the lower fees resulted in increased utilization of physician services by Medicare patients. Furthermore, it was estimated that for every 1% fees declined, there was a 0.09% reduction in the volume and complexity of services provided.

Management, Surgeons, Medical fees

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Impact of the Medicare Fee Schedule on an academic department of medicine

Article Abstract:

Medical departments at large urban teaching hospitals may not be paid as much for their services under the new Medicare Fee Schedule (MFS). Medicare profits in 1991 were compared to projected 1996 earnings under the MFS for the Department of Medicine at the University of Pennsylvania Medical Center (UPMC). Projected 1996 earnings were 25.5% lower than 1991 Medicare earnings. Different subspecialties had different reductions in Medicare earnings. Specialties that perform a large number of surgeries and special tests such as cardiology had a 29.8% decrease. But specialities such as internal medicine that mainly provide visits and consultations had a 24.7% decrease. Internists at UPMC earned a larger percentage of their money from visits, special tests and consultations than community internists.

Hospitals, Teaching, Teaching hospitals

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