Jeffrey F. Linzer

Application of the resource-based relative value scale system to pediatrics.

The majority of public and private payers in the United States currently use the Medicare Resource-Based Relative Value Scale as the basis for physician payment. Many large group and academic practices have adopted this objective system of physician work to benchmark physician productivity, including using it, wholly or in part, to determine compensation. The Resource-Based Relative Value Scale survey instrument, used to value physician services, was designed primarily for procedural services, leading to current concerns that American Medical Association/Specialty Society Relative Value Scale Update Committee (RUC) surveys may undervalue nonprocedural evaluation and management services. The American Academy of Pediatrics is represented on the RUC, the committee charged with maintaining accurate physician work values across specialties and age groups. The Academy, working closely with other primary care and subspecialty societies, actively pursues a balanced RUC membership and a survey instrument that will ensure appropriate work relative value unit assignments, thereby allowing pediatricians to receive appropriate payment for their services relative to other services.

Efficacy and safety of deep sedation by non-anesthesiologists for cardiac MRI in children

BackgroundCardiac MRI has become widespread to characterize cardiac lesions in children. No study has examined the role of deep sedation performed by non-anesthesiologists for this investigation.ObjectiveWe hypothesized that deep sedation provided by non-anesthesiologists can be provided with a similar safety and efficacy profile to general anesthesia provided by anesthesiologists.Materials and methodsThis is a retrospective chart review of children who underwent cardiac MRI over a 5-year period. The following data were collected from the medical records: demographic data, cardiac lesion, American Society of Anesthesiologists (ASA) physical status, sedation type, provider, medications, sedation duration and adverse events or interventions. Image and sedation adequacy were recorded.ResultsOf 1,465 studies identified, 1,197 met inclusion criteria; 43 studies (3.6%) used general anesthesia, 506 (42.3%) had deep sedation and eight (0.7%) required anxiolysis only. The remaining 640 studies (53.5%) were performed without sedation. There were two complications in the general anesthesia group (4.7%) versus 17 in the deep sedation group (3.4%). Sedation was considered inadequate in 22 of the 506 deep sedation patients (4.3%). Adequate images were obtained in 95.3% of general anesthesia patients versus 86.6% of deep sedation patients.ConclusionThere was no difference in the incidence of adverse events or cardiac MRI image adequacy for children receiving general anesthesia by anesthesiologists versus deep sedation by non-anesthesiologists. In summary, this study demonstrates that an appropriately trained sedation provider can provide deep sedation for cardiac MRI without the need for general anesthesia in selected cases.

Conscious Sedation: What You Should Know Before and After

Abstract Conscious sedation is a means to allow a child to tolerate an otherwise painful procedure with minimum risk and maximum tolerance. Various definitions of conscious sedation, more appropriately termed sedation with or without analgesia , exist iii the literature (the term conscious sedation will be used for ease of reference I. In the simplest terms the patient is sedated to the point where response to, and awareness of, pain are reduced. However, the patient can maintain his own airway and he easily aroused to consciousness. The term deep sedation is applied when the patient may not be able to independently maintain airway control and cannot be easily aroused to consciousness but can respond with purposeful movement when stimulated. This article reviews the various published guidelines dealing with conscious sedation for procedures performed without au anesthesiologist and outside of the operating room, including indications, patient preparation, staffing and documentation guidelines and billing and coding issue. Guidelines published by the American Academy of Pediatrics and the American Society of Anesthesiologists s provide an important basis for the discussion.

Collaboration between specialties for respiratory allergies in the International Classification of Diseases (ICD)-11.

BackgroundThe International Classification of Diseases (ICD) has been grouping the allergic and hypersensitivity disorders involving the respiratory tract under topographic distribution, regardless of the underlying mechanisms, triggers or concepts currently in use for allergic and hypersensitivity conditions. In order to strengthen awareness and deliberate the creation of the new “Allergic or hypersensitivity disorders involving the respiratory tract” section of the ICD-11, we here propose make the building process public.MethodsThe new frame has been constructed to cover the gaps previously identified and was based on consensus academic reports and ICD-11 principles. Constant and bilateral discussion was kept with relevant groups representing specialties and resulted in proposals submission into the ICD-11 online platform.ResultsThe “Allergic or hypersensitivity disorders involving the respiratory tract” section covers 64 entities distributed across five main categories. All the 79 proposals submitted resulted from an intensive collaboration of the Allergy working group, relevant Expert working groups and the WHO ICD governance.ConclusionThe establishment of the ICD-11 “Allergic or hypersensitivity disorders involving the respiratory tract” section will allow the dissemination of the updated concepts to be used in clinical practice by many different specialties and health professionals.

The Sedation Service Reimbursement Dilemma

There are many misconceptions with billing for sedation services. It is not the setting or the type of provider or medication used, but the depth of sedation provided, that determines the type of sedation service that should be reported. Any qualified physician or nonphysician provider may report anesthesia services for deep sedation. Advanced negotiation with the hospital and third-party payers is the key to successful reimbursement for a sedation service.