Search

Objective: Serological screening for celiac disease (CD) can detect a large number of otherwise undiagnosed patients based on the sequential evaluation of serological tests and intestinal biopsy. The aim of this study was to compare the screening value for CD of two different protocols for the same community-based population., Methods: We screened 1,000 consecutive subjects (497 women, age range 16-71 yr) attending a centralized laboratory for obligatory prenuptial blood tests. Serum samples obtained from all subjects were processed using two different protocols: I) a three-level classic screening consisting of the parallel use of IgG and IgA antigliadin antibodies as first level, followed by endomysial antibodies and total serum IgA for positive patients, and finally, intestinal biopsy of positive patients; and 2) a study screening protocol consisting of the parallel use of a commercial guinea pig antitissue transglutaminase antibody and total serum IgA as first line, endomysial antibodies (type IgA and/or IgG) for positive patients, and finally, intestinal biopsy., Results: The classic screening protocol identified five subjects who were eligible for intestinal biopsy, which confirmed the presence of CD in all (prevalence 5.0 x 1,000, 95% CI = 1.6-11.6). Using the study algorithm, we detected seven new patients including the five patients detected by the first protocol (prevalence 7.0 x 1,000, 95% CI = 2.8-14.4). The two additional patients diagnosed using the proposed algorithm had positive IgG antigliadin antibodies and normal total serum IgA and were not detected by the classic protocol. Both patients were endomysial antibodies positive. The comparative analysis showed that the classic approach was more expensive (U.S. $4,687 per new patient detected) compared with the proposed study algorithm (U.S. $3,006)., Conclusions: Our data showed that a new screening protocol using antitissue transglutaminase as first line followed by endomysial antibodies is a cost-effective screening and yielded more realistic figures of prevalence for CD in a community setting than the classic three-level sequential evaluation using antigliadin antibodies.

How we deliver healthcare in the U.S., and how that care is paid for, is evolving. Reimbursement and payment issues now directly impact patient care and clinical decisions. Comprehensive documentation is essential to receiving reimbursement. Therapeutic positioning used by therapists is considered a skilled service. The key to Medicare reimbursement for therapeutic positioning and other services is documentation which clearly outlines the required skills of the professional, the medical necessity and reasonableness of the service, and the significant functional and safety goals that have been met, along with the progress over time. Medicare coverage and payment policies for surgical dressings and support surfaces have been revised in the last few years. The current surgical dressings policy has a number of points that must be understood: X1 modifiers, border versus non-border dressings, wound fillers and covers, solutions (saline), wound fillers (amorphous), dressing kits, staging, sterile versus non-sterile gauze, and normal utilization parameters. Many restrictions in both surgical dressings and support surfaces policies are efforts to curb fraud and abuse. The future of reimbursement depends of the involvement of healthcare professionals by developing research-based protocols, comprehensive documentation, education of both peers and patients, and political empowerment.

Healthcare is a business. As healthcare professionals and clinicians, we must accept this fact. Regulatory issues and reimbursement mechanisms have an enormous impact on the quality of care, the introduction of new technology, utilization of products and services, patient access to care, and the actual outcomes of care delivered. An understanding of these issues is necessary for the wound care clinician who must be adequately reimbursed for his/her services. This Chronic Wound Care Preview gives an overview of Medicare and Medicaid, and reimbursement essentials necessary in the acute care, subacute care, skilled nursing facility and home health care setting. Basic reimbursement tenets, along with wound care documentation guidelines, are discussed. The message is clear: the single, most critical factor to favorable coverage decisions is complete, accurate, and descriptive documentation. It is the clinician's responsibility to educate third-party payers on the cost benefits, safety and efficacy, and positive outcomes of the many treatment and management approaches for wound care.