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📣 I'm pleased to announce that the topic I worked on regarding expanding ICD-10-CM code Z66 Do Not Resuscitate to include new codes for limited/partial code statuses was accepted by the CDC/NCHS and will be discussed at the ICD-10 Coordination and Maintenance meeting next month. BACKGROUND/DETAILS: ➡️Individuals who elect a limited or partial code status experience higher rates of mortality than those who elect a full code status. The literature for limited/partial code statuses is limited, but typically it is a more "tailored" approach where the patient allows certain resuscitative procedures but declines others. For example, some patients choose to decline chest compressions but allow other resuscitative measures, such as defibrillation, intubation, and/or resuscitative medications. ➡️Some of the reasons for electing this tailored approach may include misunderstanding the meaning and scope of a DNR order, and desiring to avoid complications from chest compressions or prolonged mechanical ventilation. However, it is impossible for a patient or provider to anticipate all scenarios surrounding a pre-arrest or arrest. ➡️Since there are no diagnosis codes to capture limited/partial code statuses, there is an underrepresentation of these types of code statuses and the details of CPR and chest compressions. ➡️Per ACLS guidelines, chest compressions are the most critical component of CPR and are closely intertwined with other resuscitative measures, such as performing compressions before and between defibrillation shocks and during intubation. The hurdle with limited or partial code statuses is when the provider is not performing compressions and providing circulation, from a clinical perspective the patient might as well be a DNR because the provider cannot properly follow ACLS guidelines when this type of code status is in place. Thus, there is a lower likelihood of survival if the healthcare professional deviates from the ACLS guidelines. ➡️Adding new diagnosis codes to capture these code statuses would improve representation, identify populations at risk for increased mortality, and initiate further discussions between clinicians and patients/surrogates regarding ACLS guidelines, treatment goals and advanced care planning decision-making. 👉🏼Register below if you'd like to join in the discussion on March 20. https://lnkd.in/gzeJHqEQ #icd10 #icd10cm #CDC #NCHS #DNR #limitedcode #partialcode #DNI #informedconsent #ACLS #CPR #advancedcareplanning #inhospitalarrest #cardiacarrest #medicalcoding #healthcare #riskadjustment

Questions about LV strain analysis and reimbursement opportunities? Check out this informational blog for your guide to navigating CPT codes. 👇 https://hubs.la/Q02JfJBX0 #Strain #CPT #CMS #Reimbursement

Blue Cross Blue Shield (BCBS) is reducing payments for Evaluation and Management (E/M) services performed on the same day as procedures. Read our latest blog to understand how these changes affect your practice and learn strategies to navigate them effectively. https://bit.ly/3XZzPhL #RCM #RadiologyBilling #BCBS #EandM #radiologynews #StreamlineMD #codingandbilling

Oh the Heartache! Emory University Hospital is one of the preeminent heart transplant facilities in the US. It does about 200 heart transplants a year. Meanwhile, based on data, the hospital treats over 24,000 patients annually for inpatient (another 80,000 outpatient) for cardiac issues.  A mere .08% of all cardiac patients Emory admits end up needing a heart transplant. Question: Do you think that when these 24,000 patients are admitted, the heart transplant team including doctors, nurses, helicopter ambulance, etc. are put on notice and prepare for a transplant? Answer: No. Great cardiac doctors assess the patient and do a “differential diagnosis” to determine if/when the case falls into the .08% category.  99% of the time there is a more economical solution.    So, if say 95% of your cases settle and less than 1% go to trial, why would you hire counsel to “non-strategically prepare every case like it is going to trial?” One would think that the enormous funds being wasted and stress of litigation alone could cause a heart attack!

This article explores the potential benefits of point-of-care testing in the ED. Price and St. John provide a detailed description of how to approach four common aspects of point-of-care testing (POCT) in the ED, specifically, the challenges of adopting POCT, the impact of POCT on clinical decisions, the impact of POCT on operational decision making and outcomes and the impact of POCT on resource allocation decisions. The key to successfully using POCT in the ED lies in demonstrating the diagnostic accuracy of the technology and immediately acting on the results as they become available. With CADScor System physicians can quickly and easily rule-out significant CAD at point of care with 96% Confidence (Negative Predictive Value). #Acarix #CADScorSystem #coronaryarterydisease #CAD #pointofcare #ED #chestpain #digitalhealth https://lnkd.in/djQridkz

One of the professions renowned #HEMS & #EMS physician-leaders wrapped up day 1 of #CCTMC2024. Darren Braude, MD, MPH, Paramedic brought cardiac arrest care back to the basics with a few stark realities for providers: -the truth is good #HEMS and #CCT providers see very few cardiac arrests, partially because we are good at preventing them. The impact is though that we are not great at managing them. -It is time to move on from shockable vs non-shockable rhythms. Reality is that there are 3 and likely 4 buckets you need to consider in your arresting patients. Asystole is NOT PEA and not all shockable rhythms are the same. -You will not do effective CPR in the back of a moving ambulance or helicopter. Not all mechanical devices are equal and if isn’t promoting chest recoil you’re likely not moving blood forward, and if it isn’t moving blood, it doesn’t help! -it is time to stop teaching to take the patient in cardiac off of a ventilator. There is no evidence to support this. Hamilton T1 actually has a cardiac arrest mode. Leaving these patients on a ventilator frees up valuable resources to provide other care! -Nearly all of the data on Asystole is on patients found in Asystole. Shocking a patient into Asystole begs you continue resuscitation and seeking an underlying cause. -Agonal rhythms are not PEA, you need to dig deeper and need to perform better diagnostics. One of the ways to accomplish distinguishing PEA is to get the patient on capnography. Even better is to establish arterial lines. The value of ART lines in cardiac arrest has been known since 1985. Finally, the fastest is to perform a trans thoracic ultrasound. -Ultrasound will also help guide your CPR effectiveness. Ultrasound can demonstrate if your CPR is opening the aortic valve. If it isn’t, you need to adjust your position. -V-Fib arrests are the opportunity for us to do better. We need to evaluate what else we can bring to the table. Consider dual-sequential defibrillation. Keep in mind the VF patient appears to do worse with EPI. -If you wouldn’t administer EPI every 3-5 min to a patient in A-fib with RVR, why would you administer EPI to a patient in VF? -every #HEMS system needs to begin evaluating criteria with their EMS partners to use mechanical CPR to transport appropriate VF patients directly to ECMO centers. -HEMS truly have more to offer for patients in SCA than we realize, but you need to do some work to prepare for these patients. Pre-plan what you can do before marketing the resource! Air & Surface Transport Nurses Association (ASTNA) International College of Advanced Practice Paramedics Air Medical Physician Association

Oh the Heartache! Emory University Hospital is one of the preeminent heart transplant facilities in the US. It does about 200 heart transplants a year. Meanwhile, based on data, the hospital admits over 24,000 patients annually (another 80,000 outpatient) for cardiac issues. A mere .08% of all admitted cardiac patients Emory end up needing a heart transplant.   Question: Do you think that when these 24,000 patients are admitted, Emory notifies the Heart Transplant Team of a potentail heart transplant effectively moving into action doctors, nurses, facilities prep, helicopter ambulance, etc.? Answer: No. Great hospital cardiologists assess the patient and do a “differential diagnosis” to determine if/when the case falls into the .08% transplant category.  And suprise, 99% of the time there is no need to call in the Heart Transplant Team. In litigation, at least 95% of cases settle and less than 1% go to trial. So, shouldn't we be doing Legal Differential Diagnosis in all of our cases as soon as practicable? Instead, due to poor Mindset or Skill Set, many non-strategically prepare every case like they are going to trial--but don't?  The waste in legal fees and stress of litigation is enough to . . . well, cause a heart attack!

The Transforming Episode Accountability Model (TEAM) requires bundled payments for specific episodes of care: lower extremity joint replacement, surgical hip femur fracture treatment, spinal fusion, coronary artery bypass graft, and major bowel procedure. While this is a hospital specific program, it is overlapping with other value-based care models so it is essential to understand how this model can impact ACOs your metrics. https://okt.to/uGJM6i

Our new blog, written by Clare Temple, explores how redesigning GP appointment systems and empowering patients with clear guidance can reduce frustrations, streamline access to care, and help preserve NHS resources. You can read it here: https://lnkd.in/eSa9Eevt #PrimaryCare #NHS #DigitalHealth #DigitalTransformation #PCN #GeneralPractice #GPSurgery

💥GPs in England have initiated a work-to-rule action, capping the number of patients they are willing to see due to a dispute over funding levels💥 The British Medical Association (BMA) has advised its members to limit appointments to 25 per day, although some GPs typically see over 40 patients. This action could have several implications: ⌚Patient Access and Wait Times: By restricting appointments, patients may face longer wait times and increased pressure on emergency services. A&E departments could experience higher demand and patient discharges from hospitals might slow down. ✉️Referrals and Planned Treatments: The work-to-rule action could disrupt referrals into hospitals for planned treatments (such as hip and knee operations). Guidelines on rationing treatments may also be ignored, affecting patients in need. ☎️Communication Challenges: Patients may struggle to access GPs, especially if proactive communication isn’t provided. Uncertainty about whether a surgery is open could deter people from seeking help. 👩⚕️GP Practices Under Strain: The BMA suggests various actions for GPs, including limiting patient numbers. However, the situation remains complex, as only a third of GPs are BMA members eligible to vote. In summary, while the work-to-rule action doesn’t formally count as industrial action, it highlights the challenges faced by GPs and their patients Hannah Alban Misha Shah Jo Berry Joe O’Gorman Nicola Medici Jenny Panes https://lnkd.in/eJ4cHzvR