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Patients with Atrial Fibrillation are a big contributor to Hospital Readmissions for Skilled Nursing Facilities (SNFs)

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By: Avinash Kumar  May. 10, 2019

CMS recently instituted a program to evaluate and incentivize skilled nursing facilities (SNF) based on Hospital 30 day readmissions. For example, if a patient is discharged from a hospital to a SNF on Jan 15th 2019 and is readmitted back to a hospital on Jan 27 2019, then this would be counted as part of the measure for SNF Hospital 30 Day readmissions. Dexur analyzed Medicare claims (Oct 2015 to Mar 2018) for three separate skilled nursing facilities to understand the role of Atrial Fibrillation (AFib) on the overall readmissions for these SNFs.

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Lucentis received higher average payment on professional claims compared to Outpatient Institutional claims from Medicare

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By: Avinash Kumar  May. 09, 2019

Lucentis is a trade name of Ranibizumab indicated for the treatment of conditions such as Wet Age-related Macular Degeneration (wAMD), Diabetic Retinopathy (DR), Diabetic Macular Edema (DME), Myopic Choroidal Neovascularization (mCNV) and Macular Edema following Retinal Vein Occlusion (RVO). Other drugs used for treating Wet Age-related Macular Degeneration (wAMD) are Avastin and Eylea.

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RNS System is associated with lower 30 Day readmission rates in DRG 026

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By: Raj Kumar  May. 08, 2019

RNS system (Neurostimulator system)’s ICD 10 Procedure code 00H00MZ used by Hospitals to get additional payment under NTAP program from CMS. NTAP(New Technology Add-on payment) payment is an additional payment over and above the DRG allowed payment amount.

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Replacement of Aortic Valve Replacement Using Zooplastic is associated with lower 30 Day readmission rates in DRG 220

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By: Avinash Kumar  May. 07, 2019

Hospitals use ICD 10 procedure code X2RF032 to get NTAP payments of Aortic valve replacement from Medicare. NTAP payment is an additional payment over and above the DRG payment amount.

CMS has approved two Zooplastic vendors, Perceval (LivaNova, PLC, London, UK) and Intuity Elite (Edwards Lifesciences, Irvine, US) for Aortic valve replacement payments under NTAP payment program. These Zooplastic Aortic valves are widely used in Rapid deployment aortic valve replacement (RDAVR) and emerged as an attractive alternative to conventional aortic valve replacement because these are sutureless and facilitates quick implantation.

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MitraClip is associated with lower 30 Day readmission rates in DRG 229

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By: Avinash Kumar  May. 03, 2019

MitraClip’s ICD 10 procedure code of 02UG3JZ is used by Hospitals to get NTAP payments over and above the DRG payment amount. The largest use of the MitraClip ICD 10 Code is in DRG 229 - Other Cardiothoracic Procedures without Major Complications and Comorbidities. The all cause readmission rate at the DRG is 16.42% versus 13.92% when MitraClip is used.

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What are major Oncology combination therapies based on claims data?

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By: Avinash Kumar  May. 01, 2019

Dexur analyzed Medicare claims data based on a 5% sample for the time period of Jan 2016 to June 2018, to understand the prevalence of oncology combination therapies. This methodology checked for relevant J codes of HCPCS code set in the claim files across the patient’s history. If a patient used a base drug, it was then checked to see what other drugs were used on the same patient.

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Which DRGs have the highest Kcentra Usage?

By: Avinash Kumar  Apr. 18, 2019

Kcentra’s ICD 10 procedure code of 30283B1 is used by Hospitals to get NTAP payments over and above the DRG payment amount. Diagnosis Related Groups (DRGs) is a classification system which assigns a hospital stay to one of approximately 750 DRG codes. CMS pays a flat payment for a specific DRG to cover all costs associated with a hospital stay. Dexur analyzed medicare claims data (Jan 2017 to Dec 2017) when Kcentra was used a primary procedure and the top DRGs where it was used. The below table lists the top DRGs where KCentra was used.

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Eylea Market Share 2x more Than Lucentis in WMD and 3x more in DME/DR based on Medicare Claims Analysis

By: Avinash Kumar  Apr. 08, 2019

Dexur’s analysis of medicare claims shows that Eylea (Aflibercept) is being used twice as much as Lucentis (Ranibizumab) for Wet Age-related Macular Degeneration (Wet AMD) and three times as much for Diabetic Macular Edema (DME) and Diabetic Retinopathy (DR) causes. The claims analysis was from Jan 2016 to June 2018 based on a 5% sample of all Medicare patients. The claims analysis looked at the J Code usage of Aflibercept (J0178) & Ranibizumab (J2778).

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More New Yorkers are surviving sepsis. What happens when they leave the hospital?

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By: James Pitt  Mar. 28, 2019

Sepsis contributes to up to half of in-hospital deaths. New York State launched the Sepsis Care Improvement Initiative in 2014, after the tragic death of 12-year-old Rory Staunton in Queens.

It's working. Sepsis is killing fewer children and adults at New York hospitals.

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“How are you going to treat your family, how are you going to treat your friends? That's how you should treat your patients”: an interview with Dr. Chris Evanich

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By: James Pitt  Jan. 28, 2019

Dr. Christopher J. Evanich is a top-ranked orthopedic surgeon who practices at the Orthopedic Institute of Wisconsin. James Pitt interviewed Dr. Evanich about his practice, his method of patient education, what's good and bad in EHRs, and how his time as an engineer helped him in medicine. This interview has been edited for length and clarity.

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