Medicare and Medicaid CT scan measure is unreliable according to new BWH study

[ Back to EurekAlert! ] Public release date: 23-Feb-2012
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Contact: Marjorie Montemayor-Quellenberg
mmontemayor-quellenberg@partners.org
617-534-2208
Brigham and Women's Hospital

BOSTON, MAResearchers at Brigham and Women's Hospital (BWH) have published findings that question the reliability of a new Centers for Medicare and Medicaid Services (CMS) quality measure. The study, "Assessment of Medicare's Imaging Efficiency Measure for Emergency Department Patients With Atraumatic Headache" finds that the CMS measurean attempt to reduce computed tomography (CT) scans in emergency departments (ED)does not accurately determine which hospitals are performing CT scans inappropriately.

The study is electronically published in the February 23, 2012 issue of Annals of Emergency Medicine.

With the recent surge of CT use in EDs, comes concern about radiation exposure and cost. CMS developed measure OP-15, "Use of Brain Computed Tomography in the Emergency Department for Atraumatic Headache," to evaluate the use of brain CT in the ED for atraumatic headache in order to improve imaging efficiency. The measure was implemented into the Outpatient Prospective Payment System in January 2012 but was never field-tested.

Jeremiah Schuur, MD, BWH Department of Emergency Medicine, and colleagues at 21 EDs in the United States studied the reliability, validity, and accuracy of measure OP-15. The measure uses Medicare billing records to determine whether a CT was clinically appropriate.

The researchers compared the data reliability of the measure as obtained from CMS administrative data against data from ED medical records. They reviewed 748 patient visits that CMS labeled as having undergone inappropriate brain CTs based on billing data. However, when the patients' medical records were reviewed, they showed that the bills didn't tell the whole story; the researchers discovered that 65 percent of the CT scans actually complied with Medicare's measure and another 18 percent of patients had valid reasons for the CTs documented on their charts. Overall, 83 percent of the patients should not have been labeled as having been inappropriately imaged.

This led researchers to conclude that CMS measure OP-15 may lead to inaccurate comparisons of EDs' imaging performance.

"It is important for physicians, hospitals and payers to work together to develop systems that ensure that every CT that is performed is appropriate," said Schuur. "Our research finds that OP-15 may not be a valid measure of imaging in elders and that when calculated from Medicare claims, can produce unreliable data."

"Further research should focus on developing scientific evidence that could be used to better inform this measure," added Ali Raja, MD, associate director for trauma, BWH Department of Emergency Medicine, and study co-author. According to Raja, "existing guidelines built around solid evidence for the appropriate use of CT for other clinical conditions could serve as a guide for the measurement of these and similar conditions."

###

Data collection efforts at BWH for this study were partly funded by an internal grant from the Brigham and Women's Physicians Organization.

Brigham and Women's Hospital (BWH) is a 793-bed nonprofit teaching affiliate of Harvard Medical School and a founding member of Partners HealthCare, an integrated health care delivery network. BWH is the home of the Carl J. and Ruth Shapiro Cardiovascular Center, the most advanced center of its kind. BWH is committed to excellence in patient care with expertise in virtually every specialty of medicine and surgery. The BWH medical preeminence dates back to 1832, and today that rich history in clinical care is coupled with its national leadership in quality improvement and patient safety initiatives and its dedication to educating and training the next generation of health care professionals. Through investigation and discovery conducted at its Biomedical Research Institute (BRI), www.brighamandwomens.org/research, BWH is an international leader in basic, clinical and translational research on human diseases, involving more than 900 physician-investigators and renowned biomedical scientists and faculty supported by more than $537 M in funding. BWH is also home to major landmark epidemiologic population studies, including the Nurses' and Physicians' Health Studies and the Women's Health Initiative. For more information about BWH, please visit www.brighamandwomens.org.


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AAAS and EurekAlert! are not responsible for the accuracy of news releases posted to EurekAlert! by contributing institutions or for the use of any information through the EurekAlert! system.


[ Back to EurekAlert! ] Public release date: 23-Feb-2012
[ | E-mail | Share Share ]

Contact: Marjorie Montemayor-Quellenberg
mmontemayor-quellenberg@partners.org
617-534-2208
Brigham and Women's Hospital

BOSTON, MAResearchers at Brigham and Women's Hospital (BWH) have published findings that question the reliability of a new Centers for Medicare and Medicaid Services (CMS) quality measure. The study, "Assessment of Medicare's Imaging Efficiency Measure for Emergency Department Patients With Atraumatic Headache" finds that the CMS measurean attempt to reduce computed tomography (CT) scans in emergency departments (ED)does not accurately determine which hospitals are performing CT scans inappropriately.

The study is electronically published in the February 23, 2012 issue of Annals of Emergency Medicine.

With the recent surge of CT use in EDs, comes concern about radiation exposure and cost. CMS developed measure OP-15, "Use of Brain Computed Tomography in the Emergency Department for Atraumatic Headache," to evaluate the use of brain CT in the ED for atraumatic headache in order to improve imaging efficiency. The measure was implemented into the Outpatient Prospective Payment System in January 2012 but was never field-tested.

Jeremiah Schuur, MD, BWH Department of Emergency Medicine, and colleagues at 21 EDs in the United States studied the reliability, validity, and accuracy of measure OP-15. The measure uses Medicare billing records to determine whether a CT was clinically appropriate.

The researchers compared the data reliability of the measure as obtained from CMS administrative data against data from ED medical records. They reviewed 748 patient visits that CMS labeled as having undergone inappropriate brain CTs based on billing data. However, when the patients' medical records were reviewed, they showed that the bills didn't tell the whole story; the researchers discovered that 65 percent of the CT scans actually complied with Medicare's measure and another 18 percent of patients had valid reasons for the CTs documented on their charts. Overall, 83 percent of the patients should not have been labeled as having been inappropriately imaged.

This led researchers to conclude that CMS measure OP-15 may lead to inaccurate comparisons of EDs' imaging performance.

"It is important for physicians, hospitals and payers to work together to develop systems that ensure that every CT that is performed is appropriate," said Schuur. "Our research finds that OP-15 may not be a valid measure of imaging in elders and that when calculated from Medicare claims, can produce unreliable data."

"Further research should focus on developing scientific evidence that could be used to better inform this measure," added Ali Raja, MD, associate director for trauma, BWH Department of Emergency Medicine, and study co-author. According to Raja, "existing guidelines built around solid evidence for the appropriate use of CT for other clinical conditions could serve as a guide for the measurement of these and similar conditions."

###

Data collection efforts at BWH for this study were partly funded by an internal grant from the Brigham and Women's Physicians Organization.

Brigham and Women's Hospital (BWH) is a 793-bed nonprofit teaching affiliate of Harvard Medical School and a founding member of Partners HealthCare, an integrated health care delivery network. BWH is the home of the Carl J. and Ruth Shapiro Cardiovascular Center, the most advanced center of its kind. BWH is committed to excellence in patient care with expertise in virtually every specialty of medicine and surgery. The BWH medical preeminence dates back to 1832, and today that rich history in clinical care is coupled with its national leadership in quality improvement and patient safety initiatives and its dedication to educating and training the next generation of health care professionals. Through investigation and discovery conducted at its Biomedical Research Institute (BRI), www.brighamandwomens.org/research, BWH is an international leader in basic, clinical and translational research on human diseases, involving more than 900 physician-investigators and renowned biomedical scientists and faculty supported by more than $537 M in funding. BWH is also home to major landmark epidemiologic population studies, including the Nurses' and Physicians' Health Studies and the Women's Health Initiative. For more information about BWH, please visit www.brighamandwomens.org.


[ Back to EurekAlert! ] [ | E-mail | Share Share ]

?


AAAS and EurekAlert! are not responsible for the accuracy of news releases posted to EurekAlert! by contributing institutions or for the use of any information through the EurekAlert! system.


Source: http://www.eurekalert.org/pub_releases/2012-02/bawh-mam022312.php

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Home Improvement Increase Worth | Chan Wittaya

Home Improvement Increase Worth

Article by Bill Tanner

When you?re thinking of selling your home, essential considerations must be given attention; such is the fact that home improvement boost value of house. So for the notion that home improvement boost worth, before you sell your house you attempt to get for some preparations to support the claim that residence improvement increase value of house.

The notion that ?home improvement boost value? is really true. Actually home improvement will be the smartest way to take to support the claim that house improvement boost value. Home improvement boost worth inside the sense that the profile of the home will be the very first factor that the buyers will notice. To support the claim that house improvement improve value, here are a few of the samples of returns for a few of the well-known house improvement projects: kitchen remodel (minor) is 125% in Connecticut; basement remodel is 98% in California; bathroom addition is 96% in Missouri; kitchen remodel (key) is 92% in Kentucky; bathroom remodel in Oregon is 90%; exterior paint in Pennsylvania is 90%; and master bedroom in Florida is 86%. These statistics to support the claim that residence improvement improve value are compiled from numerous published surveys, and these are mainly based on key cities inside states.

Usually, given such supports for the notion that home improvement improve worth, the kitchen and bathroom remodeling, as an ally to the claim that residence improvement increase worth, actually provide the highest percentage return on the home owners? investment. Furthermore, the bathroom and family room renovations also support the claim that home improvement boost value for the truth that it provide a fairly high return to the house owner.

Among the notable back up to the claim that house improvement boost worth, repainting is too crucial. Actually, several of the home value experts noted that repainting the exterior of the home will show formal returns in most markets. As such, it?s actually true that home improvement increase worth.

Along those supports for the claim that house improvement increase value, contemplating of the original design of the home in mind is extremely necessary. ?Home improvement boost value? is true when you stick with either similar materials for remodeling or complementing ones. It?s just crucial which you know how you can make your residence appealing and inviting for the buyer to totally submit his attention and interest. It as well important that to aid the claim that residence improvement improve worth, you need to try to feel for some color scheme and decors for your residence.

To further support the claim that house improvement boost worth, certain researches noted that if there are some crucial things to be put up just to agree that house improvement improve value, such as putting extra deck or spacious basement for the children to play, and then go for it. Such will not only back up the notion that home improvement improve worth but will make your house look excellent and inviting.

So for those who desire to experience the truth about the claim that residence improvement improve value, then you start remodeling your house as soon as feasible.

More Home Improvements Articles

-->

Source: http://www.chanwittaya.net/home-improvement/home-improvement-increase-worth

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gE Blog Series: Global Real Estate Part 3 - Green Construction ...

In many of the leading construction markets, the market for sustainable construction is expanding rapidly. This standard started in the mid 2000?s with the introduction of the LEED certification for buildings. LEED stands for Leadership in Energy and Environmental Design and was developed by the United States Green Building Council. This standard has started to transform the construction industry and is now taking off elsewhere in the world as well.

The benefits and opportunities green construction provided were realized by larger clients and in order to stay competitive, many contractors had to become LEED certified. Many benefits for an economy can be realized using green construction. Operating costs for businesses are reduced due to decreased energy consumption, and multiple jobs and revenue sources are created. From 2000 through 2008, green construction generated $173 billion in economic activity and supported 2.4 million jobs; the LEED building standard generated $830 million in economic activity and 15,000 jobs. This boom in green construction is improving the environment, and creating jobs ? a win, win in anyone?s book.

The processes used to construct a green building vary. Using different roofing tiles, implementing water heating instead of air heating, and growing gardens on roofs are only scratching the surface of green construction techniques. An example of another method includes Calera Corp, a company who produces cement globally and creates two and a half billion tons of carbon dioxide annually. A new process by Calera absorbs half a ton of harmful greenhouse gases for each ton of cement produced. And fresh water is created as a by-product. Additionally, if cement factories were placed next to coal-fired power plants, they could absorb the power plants carbon as raw material.

Geographically speaking, more green construction projects are being executed in the United States, but more countries are becoming involved. Dow Corning is getting involved with these projects in Asia, Europe, and the Americas. In the last five years, 50 states and seven countries (India, China, Brazil, Canada, Mexico, Spain, and Sri Lanka) have taken part in 2,000 LEED certified building projects. Green building is revolutionizing the way builders around the world design construction projects. The health of our planet and communities demands that we push markets to continue to innovate these sustainable options for construction.

Source: http://globaledge.msu.edu/Blog/Post/1240/gE-Blog-Series--Global-Real-Estate-Part-3---Green-Construction-Business-Impacts

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Carissa Verkaik Named Capital One Division III Academic All ...

Carissa Verkaik Named Capital One Division III Academic All-American in Women?s Basketball

Tuesday, February 21, 2012

Division III Capital One Academic All-American Women's Teams

Calvin College junior Carissa Verkaik has been named a Capital One Division III Academic All-American in women?s basketball. Verkaik has been named to the Division III Capital One Academic All-America Third Team. Verkaik is the second individual in Calvin women?s basketball history to receive the prestigious accolade as Lisa Winkle was an Academic All-American in both 2006 and 2007 in women?s basketbal

A native of Holland and a graduate of Holland Christian High School, Verkaik is averaging 18.5 points and 8.5 rebounds a game while connecting on 56.5 percent of her field goal attempts. She has also blocked 100 shots for an average just over over four blocks per game. She is ranked nationally in both field goal percentage and blocked shots per-game average.

She has been a two-time MIAA Player of the Week this year and has tallied 10 double-doubles during the season including 34 over the course of her career. She has been a two-time MIAA MVP and a two-time first team All-MIAA selection.

Verkaik carries a 3.67 grade point average while majoring in education. A year ago, she was a member of the MIAA Academic Honor Roll.

Verkaik has also found time to be a two-sport athlete at Calvin. Last spring, she was a member of the Calvin women?s track and field team and captured the league title in the high jump to earn a spot on the All-MIAA women?s track and field team. She later competed in the high jump at the NCAA III Outdoor Track and Field Championships.

The Calvin women?s basketball team is currently 23-1 overall and recently captured its second straight MIAA regular season title with a 15-1 conference record. The Knights are currently ranked fifth by both d3hoops.com Top 25 poll and by the USA Today/ESPN Division III Coaches Top 25 poll.

Source: http://www.calvin.edu/sports/news/comments/carissa-verkaik-named-capital-one-division-iii-academic-all-american-in-wom/

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LIVE: Veterans and Active Duty Military March For Ron Paul : Truth ...

The Intel Hub
February 20, 2012

Today upwards of a thousand veterans and active duty military troops will take to the streets in Washington DC to show their support for Ron Paul?s bid for president.

The group, Veterans for Ron Paul, has planned to march from the Washington Monument to the White House and back to the monument in the hopes that the corporate media might actually cover the fact that Ron Paul has overwhelming support from our nations military.

After the march a concert is planned which will feature the likes of Jordan Page, Aimee Allen, Former Misfits front-man Michale Graves, and many more.

You can view numerous Livestream feeds here:

Streaming video by Ustream

?

Streaming video by Ustream

Filed Under: ACTIVISM ? US NEWS

Tags: march ? military ? ron paul ? veterans

Source: http://truthfrequencynews.com/live-veterans-and-active-duty-military-march-for-ron-paul/

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How To Stop Junk Faxes From Wasting Your Paper and Toner ...

Junk faxes waste the resources of every business. It is estimated that they cost businesses tens of millions of dollars a year in wasted paper, toner and fax machine maintenance. There is nothing more aggravating then coming into the office each morning to find a pile of junk faxes promotion everything from mortgage refinancing to septic tank solutions. I don?t even have a septic tank!

Junk fax companies have been fined by the federal government and sued repeatedly, but has anyone noticed a reduction in the number of junk faxes? I certainly haven?t. The question for most businesses is whether there is a practical way to beat the daily waste of resources caused by junk faxes? Many businesses are using the fax-to-email solution provided through online unified messaging systems.

What is Unified Messaging?

Unified Messaging is a highly flexible communication system that ties all of your communications together. It has the capacity to centralize your voice mail, faxes and email messages in one online area through an email address and single phone number. These systems use their own phone lines and provide you with a separate number, so you don?t have to tie up your own or have an additional line installed.

Fax to Email Conversion

One of the best aspects of Unified Messaging systems is the fax-to-email conversion feature. You are provided with a phone number where people can send you faxes and leave voice mail messages. The beauty of the system is that the faxes are then automatically converted to text files and emailed to an inbox.

So, how does

this save you money? You simply delete the junk faxes unless, of course, you need to ?maximize the potential of your septic tank.? You then read or print out the faxes that are germane to your business. No wasted paper, no wasted toner and no smoke coming out of your fax machine!

An added advantage of the fax-to-email conversion element of unified messaging is the flexibility it gives you. Since the faxes are available to you online, you can print the ones you need at any location. You no longer have the frustrating situation where you are working at home, but need to see a fax that was just sent to your office. You just access your inbox and print it out.

The cost of using unified messaging is very low, particularly when compared to the cost of wasted paper, toner and fax machine maintenance. Depending on the service you use, you may be charged a monthly signup fee, by the minute for phone line usage or both. The best option for your business is entirely dependent upon the number of faxes you expect to receive each month.

Despite the lawsuits and fines issued by government agencies, there is little doubt that junk faxes will continue to bombard your fax machines. Unified messaging provides an inexpensive and practical way to eliminate the cost of junk faxes.

About The Author

Barry Waxler is the President of http://3in1box.com ? your unified messaging solution. Visit http://www.3in1box.com to get your FREE unified messaging box or contact Barry at BarryWaxler@3in1box.com

Source: http://www.ytwxedu.com/2012/02/How-To-Stop-Junk-Faxes-From-Wasting-Your-Paper-and-Toner/

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Bobby Brown Leaves Whitney Houston Funeral Early, Releases Statement


After days spent arguing with Whitney Houston's family over whether or not he'd attend his ex-wife funeral, multiple sources confirm that Bobby Brown continued arguing with his former in-laws today.

And actually left the memorial after just 20 minutes as a result.

Bobby Brown at Whitney Houston Funeral

Both E! News and TMZ report that Brown brought an entourage of nine people in to the Newark church. It's unclear exactly what happened from there, but the singer was spotted exiting the house of worship shortly after the service began.

"I am at Whitney's funeral. I spoke with Bobby Brown trying to calm him down and not distract from the services. Today is about Whitney!" Al Sharpton Tweeted, while Access Hollywood's Shaun Robinson says a "seating arrangement" dispute was at play.

Brown also has a concert gig tonight in Connecticut with New Edition, but it's believed this disagreement with Whitney's family is the reason why he left the premises so quickly.

UPDATE: Brown has released the following statement:

“My children and I were invited to the funeral of my ex-wife Whitney Houston. We were seated by security and then subsequently asked to move on three separate occasions. I fail to understand why security treated my family this way and continue to ask us and no one else to move. Security then prevented me from attempting to see my daughter Bobbi-Kristina.

"In light of the events, I gave a kiss to the casket of my ex-wife and departed as I refused to create a scene. My children are completely distraught over the events. This was a day to honor Whitney. I doubt Whitney would have wanted this to occur. I will continue to pay my respects to my ex-wife the best way I know how.”

[Photo: WENN.com]

Source: http://www.thehollywoodgossip.com/2012/02/bobby-brown-exits-whitney-houston-funeral-early-entourage-disput/

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Law Of Attraction In Business Guide | Self Improvement Blogs from ...

?The Secret? and the legislation of attraction are great and many people are quite excited to use it. However how are you going to use it virtually in business. I?m going to show you a step-by-step guide how I use the regulation of attraction to improve my enterprise by 300%. These are the 7 steps:

Step 1: Realize the law of attraction in business.

To start using the legislation of attraction, it is advisable to?walgreens coupon understand the law of attraction is already working in your business. Will not be one thing new however something already there! Your gross sales figures, clients, prospects, size of enterprise, employees, system and all the pieces is the results of the law of attraction. It seems easy to start out but it surely is perhaps quite powerful in reality. This is a very powerful step to start.

Step 2: Set clear objectives in your business.

Set clear goals. ?Clear aim? that I imply is particular, measurable, attainable, realistic and timely. If you do not have these 5 elements in your aim, it?s onerous to make use of the regulation of attraction. Visualizing and attracting ?extra gross sales? may be very hard and confusing. If you are visualizing and attracting ?$10,000 extra sales every month?, will probably be more easy to get excited and ship out optimistic thoughts to the universe.

Step three: Visualize it often.

Spend every morning to sit or lie in a chill out posture and visualize. Visualize means ?To see yourself already residing a life which your targets are met.? First, see how what you are promoting, suppliers, prospects, workers, your life and household around you?ll look in picture. Second, experience and really feel it along with your emotions.

Step 4: Take action.

Take motion to realize your goals. Utilizing the law of attraction is just not a follow which you visualize 5 minutes within the morning and wait success to fall from the sky. You should take action. If you begin to use the law of attraction, you will understand there?s a change in your action, mindset and perspective towards things and people. You may get new ideas and take new motion that is completely different from what you did before.

Step 5: Sustain the attraction.

Law of attraction doesn?t exist only within the morning. If you assume that using the law of attraction is nearly visualizing within the morning and complain or worry for the rest of your day, you are doubtless going to fail. The legislation of attraction is a common law that exists every second in life. It?s going to be powerful to draw what you need by simply attracting it 5 minutes and spending the rest of your day attracting it to the opposite. Visualize your targets and maintain constructive ideas and feelings for the whole day.

Step 6: Share with people.

Share your targets with people who will likely be influenced by the goal. For instance: If you enterprise grow greater, you may have the ability to profit your customers. Share your targets with as many customers as possible. Once they get inspired and excited by your objectives, they?ll send out constructive thoughts and feelings that entice enterprise success for you too. You can share your goals with workers, suppliers, household and enterprise companions too.

Step 7: Repeat it everyday.

The ability of the attraction is highly effective only whenever you use it constantly and repeat the practice. You did not make one sale to construct a huge business, you make many and ongoing gross sales to construct a huge and steady business. Identical with the regulation of attraction. If you use the regulation of attraction constantly and on-goingly, your targets will develop into closer and closer to you.

These are the 7 steps which I use to grow my enterprise and get sudden results. Hope you could have enjoyable using it and benefit from the business progress! Take motion and apply these 7 steps!

--> Leon Edward helps people in Personal and Career Growth, leadership Development, Goal Setting, Success, Motivation, Self-Improvement, Happiness, Memory Improvement, Stress Reduction and more through his articles, blog posts and special reports . Join Leon Edwards Awesome Success Free, Get his personal success, development and growth weekly newsletter as well as success classics and tips on attracting success and wealth. Visit his Success-Leadership Library, Articles at http://www.AwesomeSuccess.org Leon Edward also helps people improve IQ, focus, memory, concentration, creativity, speed reading, public speaking , time management and reducing stress. Download his IQ Mind Brain Memory Self-Help library at his website http://www.IQMindBrainLibrary.comLeon Edward helps people improve in Leadership Development, Goal Setting, Success, Motivation, Self-Improvement, Happiness, Memory Improvement, Stress Reduction and more through his articles, blog posts and special reports . Join Leon Edwards Awesome Success Free, Get his personal development training, success and growth weekly newsletter as well as success classics and tips on attracting success and wealth. Visit his Success-Leadership Library, Articles at http://www.AwesomeSuccess.org

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Source: http://awesomesuccess.org/self-improvement-blogs/self-improvement/attraction-self-improvement/law-of-attraction-in-business-guide/

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