Part IV (61-81) Flashcards
Case 61
T or F: Regarding communication, timely receipt of the report outweighs the method of delivery
True
Case 61
T or F: Electronic or rubber-stamp signature devices, instead of a written signature, are acceptable unless contrary to state law, if access to such devices is secure
True
Page 61
T or F: When feasible, a copy of the final report accompany the transmittal of relevant images to other healthcare professionals, when such images are requested.
True
Page 62
Three levels of results based on urgency with regards to communications are present: define Level 1
New or unexpected findings that are life-threatening or would require immediate change in patient management (eg. PE, DVT, dissection, etc.)
Includes Critical Tests and Critical Results
Must be reported within 30-60 minutes
Case 62
Define Critical Result
Define Critical Test
Critical Result
- any result or finding that may be considered life-threatening or that could cause severe morbidity and require urgent or emergent clinical attention
Critical Test
- those tests that require rapid communication of results, whether normal, abnormal, or critical
Page 62
Three levels of results based on urgency with regards to communications are present: Define Level 2
New or unexpected findings on an imaging study that could result in mortality or significant morbidity if not appropriately treated urgently within 2-3 days
Eg. Abscess, impending pathological hip fx
Must be reported within 6 to 12 hours through a direct call or call service
Page 62
Three levels of results based on urgency with regards to communications are present: Define Level 3
New or unexpected findings that could result in significant morbidity if not appropriately treated
Not particularly time-sensitive but report shouldn’t be overlooked (eg. New lung nodule, renal mass)
Can be reported electronically but must be documented (who reported and who received it)
Page 63
What are the inherent risks associated with curbside consults or wet reads (eg. During clinical conferences, outside studies, when involved in other activities)?
Suboptimal reading conditions
No comparison studies
No prior reports
Inadequate access to patient records
It is encouraged to document these interpretations in some system of reporting to keep a record of it
Page 61
What 3 qualities should an effective method of communication have?
Be created to meet the need for adequate response
Promote the interpreting physician as a consultant and support physician-physician communication
Diminish the likelihood of communication errors
Page 63
What percentage of abnormal radiographic findings are missed?
What about pulmonary nodules?
30%
20% of lung nodules on CXR
Page 63
What percentage of radiologic interpretations rendered by radiologists in daily practice contain errors?
5%
Page 63
What is the most common cause of malpractice suits against radiologists?
Errors in diagnosis
Page 63
What are the four categories of diagnostic errors?
Failures in detection
Failures in interpretation
Failures in communication of results
Failures in suggesting an appropriate follow-up test
Page 63
Define cognitive errors
Usually errors a visual perception that occurred during scanning, recognition, and interpretation.
An example is missing a pulmonary nodule
Page 63
Define system errors
Errors that are usually attributed to health system issues or context of care delivery problems.
Example is failure to communicate the presence of a pulmonary nodule
Page 63
T or F: radiologic errors often result from a combination or interaction between cognitive and system errors
True
An example is a preliminary report by a resident that is revised in a final report but not fully communicated to the caregiver
Page 63
What are five cognitive biases that are particularly likely to lead to diagnostic errors in radiology?
MAPS F Multiple alternative bias Anchoring Premature closure Satisfaction of search
Framing
Page 64
T or F: The physician should keep inquiries and history taking, especially those of the sensitive nature, minimum during the course of a chaperoned examination
True
If a chaperone is provided, a separate opportunity for private conversation between the patient and the physician should be allowed
Page 65
Who regulates the marketing of drugs and devices?
Who regulates the use of drugs by physicians?
FDA
The states
Page 65
T or F: A physician’s free to use a drug or device for any purpose he feels is appropriate or necessary for patient care
True
Page 65
Define “off-label” use of a drug
The use of a drug or device in a manner that does not conform to the FDA approved labeling
Eg.
MRI contrast isn’t approved for pediatric use
Page 66
T or F: physicians are permitted to use any drug in whatever manner they choose in order to address the needs of the patient. This generally poses no medicolegal difficulty, especially if that particular to use has become commonplace.
True
Page 66
T or F: A physician or manufacturer may advertise off-label use of a particular drug or device per FDA-regulations.
False
Page 66
T or F: Drugs or devices used as part of a research study must be disclosed and may not be used for research without approval from the hospitals institutional review board
True
Page 67
What is the fundamental purpose of an institutional review board (IRB)?
To assure, both in advance and by periodic review, that appropriate steps are taken to protect the rights and welfare of humans participating as subjects in research
Page 67
Do IRBs have to register with?
Department of Health and Human Services
Page 67
What must an institution without an IRB do if it wants to conduct research?
Arrange for an outside institution IRB to do initial and continuing review of studies conducted
Page 67
If an institution provides emergency use of a test drug without prospective IRB review, when must this action be reported to the IRB?
Within 5 days
Page 67
What must occur for a subject of a study to be considered having given informed consent?
Give adequate information concerning the study
Provide adequate opportunity to consider options
Respond to the subject’s questions
Ensure the subject comprehends the information
Obtain the subject voluntary agreement
Continue to provide information as the subject requires
Page 68
What is a CPT Code?
Current Procedural Terminology
Information about medical services and procedures that provides uniformity across physicians, coders, patients, pears, and accreditation organizations
Page 68
What is ICD-9 or ICD-10
International Classification of Diseases
A medical classification list formulated during an international conference sponsored by the World Health Organization that in concordance with CPT codes defines medical necessity
Page 68
Define bundling as it pertains to ICD
A process by which individual components of a complicated procedure are combined into one code for the purpose of billing
Page 68
What is PQRS?
Physician Quality Reporting System
Medicare incentive system that provides cash incentives to physicians who report quality clinical data on prescribed treatments for certain medical conditions
Page 68
What is Meaningful use?
Certified electronic health record technology will be used to improve quality, safety, and reduce health disparities
It will engage patients and their families, improve patient care coordination and population health, and maintain privacy and security of patient health information
Page 68
What are the three stages for implementation of Meaningful use?
1: 2011-12: Data capture and sharing
2: 2013: Advance clinical processes
3: 2015: Improved outcomes
Page 69
What was the goal of the Harvard Resource-based relative value scale?
Created a payment schedule for physicians that:
Narrowed specialty and geographic differences
Continued limits on balance billing for patients
Created a system for monitoring expenditure increases for the government
Page 69
What three congressional subcommittee’s have jurisdiction over the Medicare program?
The Health Subcommittee of the House Ways and Means Committee
The Subcommittee on Health and the Environment of the House Energy and Commerce Committee
The Subcommittee on Medicare and Long-Term Care of the Senate Finance Committee
Page 69
What 3 components comprise the Medicare payment schedule based on RBRVS?
Relative physician work involved in providing a service
Practice expenses
Professional liability insurance costs
Page 69
OBRA 89 defined what three key features of Medicare’s new payment system for physician services?
Eliminating specialty differences in payment for the same service
Process for determining the annual update in the conversion factor
Adjusting each of the three components of the RBRVS for each service takeout for geographic differences in resource costs
Page 70
What is the geographic practice cost indicator?
A multiplier of practice expense to correct for geographic variations
Page 70
What is balance billing, when is it allowed and what is the
Medicare limit?
Retaining the right to charge patients the difference between the Medicare approved amount and the physicians full fee for the service
Balance billing is allowed by Medicare
The limit is 15% greater than the Medicare approved amount
Page 71
The Harvard RB RVS study defined what four elements for physician work?
Time required to perform the service
Technical skill and physical effort required
Mental effort and judgment needed
Psychological stress associated with the physicians concerned about iatrogenic risk to the patient
Page 71
T or F: Work RVUs are based on direct estimates of physician work; no separate measures of time are used?
True
Page 72
What three components of work comprise total work involved in a medical service?
Preservice work
Intraservice work
Postservice work
Page 72
What is the RUC and what do they do?
AMA/Specialty RVS Update Committee
Make recommendations to CMS on the relative values assigned to new or revised codes in CPT
Page 73
What is the RUC process for developing relative value recommendations?
CPT Editorial Panel transmit new/revised codes
AMA staff develop surveys to specialty societies
Specialty Societies survey at least 30 members
Specialty advisers send recommendations to RUC
Recommendations must obtain 2/3 RUC vote
RUC recommendations sent to CMS
Medicare Fee Schedule published
Open for public comment for 1 year before final
Page 74
How often is CMS required to comprehensively review all relative values and make needed adjustments?
Every five years
Page 74
Why is the RUC important for the medical profession?
It represents an important opportunity for the medical profession to retain input regarding the clinical practice of medicine
Page 74
What are three key factors defined the Medicare payment schedule for physician payments?
Resource-based relative value scale (RBRVS)
Geographic practice cost indexes (GPCIs)
Monetary conversion factor
Page 74
What is a fee schedule?
What is a payment schedule?
The fee schedule is what physicians establish as the fair price for the services they provide.
The payment schedule is what Medicare approved as the reimbursement level for the service provided by a physician.
Page 75
What six items comprise the formula for calculating the payment schedule?
Physician work RVUs Physician work GPCI Practice expense RVUs Practice expense GPCI Professional liability insurance RVUs Professional liability insurance GPCI
Page 75
What is the purpose of credentialing?
It is a verification process or background check conducted through a formal application process whereby one gains admission to a medical staff
Case 76
Who must review and approve an application for credentials?
Department Chair
Credentials Committee
Medical Executive Committee
Board of Directors
The Board of Directors are the only group authorized to actually grant membership in the medical staff.
Page 76
What is the purpose of privileging?
The process by which a physician’s experience and skills are evaluated to determine what clinical activities he/she will be permitted to perform.
This requires a delineation of privileges request itemizing what procedures he/she wishes to perform based on previous proven experience.
Page 77
What is an FPPE?
What three ways are FPPEs used?
Focused Professional Practice Evaluation
For initial appointment to medical staff: Proctoring
For existing members who want to add a privilege
For existing members when there is quality concerns
Page 77
Who gets the FPPE reviewers’ report and recommendations?
Department Chair and the Credentials Committee
Page 77
What is an OPPE?
Ongoing Professional Practice Evaluation
Process by which one’s practice performance is continually monitored with a report every 6 months
The information is provided to the practitioner and used at the time of reappointment
Page 78
What is the ACR Task Force on Appropriateness Criteria
Guidelines to assist referring physicians in making appropriate imaging decisions for given patient clinical conditions
Page 78
The ACR Appropriateness Criteria is divided into 10 clinical imaging topics (eg. Breast, GI, Thoracic, etc.) and the topics contain a variable number of clinical conditions, which are then subdivided into a variable number of variants. How are these variants rated?
1 (low) to (9) high based on the appropriateness of the imaging modality for the variant
Eg. CT chest for hemptysis and dyspnea
1-3: usually not appropriate
4-6: may be appropriate
7-9: usually appropriate
Page 78
Imaging modalities are assigned a “relative radiation level” based on an adult or pediatric effective dose estimate range. What is the scale?
1-6 point scale
Page79
What are RBMs?
Radiology Benefit Managers
Private companies that contract with insurers to provide prior authorization for imaging services using proprietary and non-publicly accessible algorithms.
Page 79
What did the Lee study find with regards to RBMs?
While RBMs decrease costs for the insurer, costs to the providers were increased in order to meet the requirements of the RBMs.
Page 80
ACR practice guidelines and technical standards had their name changed in 2014 to what?
Practice PARAMETERS and Technical Standards
Page 80
What is the purpose of ACR Practice Parameters?
Recommend conduct in specific areas of clinical practice.
Parameters are not intended to be legal standards of care or conduct and may be modified as determined by individual circumstances and available resources
Page 80
What is the purpose of ACR Technical Standards
Technical parameters that are quantitive or measurable and often include specific recommendations for patient management or equipment specifications or settings
Intended to be a minimum level of acceptable technical parameters and equipment performance
