Daniel Crespin

Upcoding Linked To Up To Two-Thirds Of Growth In Highest-Intensity Hospital Discharges In 5 States, 2011–19

Daniel Crespin, Michael Dworsky, Jonathan Levin, Teague Ruder et autres

Diagnosis-based payment systems can create incentives to upcode patients to a higher level of severity to increase payment. In some instances, upcoding can be a form of fraud if providers code patients to a higher complexity than is appropriate, whereas in other …

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Methodologies to Measure Upcoding in Provider Settings: A Scoping Review

Jonathan Levin, Daniel Crespin, Jin Kim, Rachel O. Reid et autres

Upcoding is a practice in which hospitals code more secondary diagnoses or complications so that admissions or visits are coded at higher complexity levels. There is no standardized methodology used to measure upcoding; consequently, researchers and policymakers have a limited understanding of …

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The effect of hospital discharge price increases on publicly reported measures of quality

Daniel Crespin, Christopher Whaley

OBJECTIVE: To determine if increases in hospital discharge prices are associated with improvements in clinical quality or patient experience. DATA SOURCES: This study used Medicare cost report data and publicly available Medicare.gov Care Compare quality measures for approximately 3000 short-term care general …

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Variation in Estimated Surgical Procedure Times Across Patient Characteristics and Surgeon Specialty

Daniel Crespin, Teague Ruder, Andrew Mulcahy, Ateev Mehrotra

Importance: The time involved in performing a procedure is a key factor in determining physician payments by Medicare. However, there are long-standing concerns regarding the accuracy of the time estimates generated by the American Medical Association/Specialty Society Relative Value Scale Update Committee …

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Ticagrelor versus Genotype-Driven Antiplatelet Therapy for Secondary Prevention after Acute Coronary Syndrome: A Cost-Effectiveness Analysis

Andrea K. Biddle, Joseph S. Rossi, Daniel E Jonas, Daniel Crespin et autres

Clopidogrel’s effectiveness is likely reduced significantly for prevention of thrombotic events after acute coronary syndrome (ACS) in patients exhibiting a decreased ability to metabolize clopidogrel into its active form. A genetic mutation responsible for this reduced effectiveness is detectable by genotyping. Ticagrelor …

Smartphone Application Allowing Physicians to Call Patients Associated with Increased Physician Productivity

Christopher Whaley, Daniel Crespin, Tisamarie B. Sherry

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Claims-Based Reporting of Post-Operative Visits for Procedures with 10- or 90-Day Global Periods: Updated Results Using Calendar Year 2018 Data

Daniel Crespin, Ashley M. Kranz, Teague Ruder, Ateev Mehrotra et autres

Medicare payments for most surgical procedures cover both procedures and post-operative visits occurring within a global period of either 10 or 90 days following procedures. There have been concerns that fewer post-operative visits are provided than the number of post-operative visits considered …

Claims-Based Reporting of Post-Operative Visits for Procedures with 10- or 90-Day Global Periods: Updated Results Using Calendar Year 2019 Data

Daniel Crespin, Ashley M. Kranz, Teague Ruder, Ateev Mehrotra et autres

The Centers for Medicare & Medicaid Services (CMS) bundles payments for post-operative care within 10 or 90 days after many surgical procedures. Congress mandated that CMS collect data on the number and level of post-operative visits to enable CMS to assess the …

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Using Claims-Based Estimates of Post-Operative Visits to Revalue Procedures with 10- and 90-Day Global Periods: Updated Results Using Calendar Year 2019 Data

Andrew Mulcahy, Teague Ruder, Susan L. Lovejoy, Daniel Crespin et autres

Medicare payment for many health care procedures covers not only the procedure itself but also most post-operative care over a fixed period of time (the ""global period""). The Centers for Medicare & Medicaid Services (CMS) sets payment rates assuming that a certain …

Practice Expense Data Collection and Methodology: Phase II Final Report

Lane F. Burgette, Joachim O. Hero, Jodi Liu, Catherine C. Cohen et autres

Each year, Medicare allocates tens of billions of dollars for indirect practice expense (PE) across services on the basis of data from the Physician Practice Information (PPI) Survey, which reflects 2006 expenses. Because these data are not regularly updated, and because there …

Ticagrelor versus Genotype-Driven Antiplatelet Therapy for Secondary Prevention after Acute Coronary Syndrome: A Cost-Effectiveness Analysis

Joseph S. Rossi, Daniel E Jonas, Daniel Crespin, Andrea K. Biddle et autres

Clopidogrel’s effectiveness is likely reduced significantly for prevention of thrombotic events after acute coronary syndrome (ACS) in patients exhibiting a decreased ability to metabolize clopidogrel into its active form. A genetic mutation responsible for this reduced effectiveness is detectable by genotyping. Ticagrelor …

Stress Imaging Use and Repeat Revascularization Among Medicare Patients With High-Risk Coronary Artery Disease

Sally C. Stearns, Jerome J. Federspiel, Daniel Crespin, Timothy S. Carey et autres

The optimal use of stress testing after coronary revascularization remains unclear, and over-utilization of stress testing may increase rates of repeat revascularization. We analyzed the relationship at both the patient and regional level between the use of stress testing and repeat revascularization …