Roles for Specialty Societies and Vascular Surgeons in Accountable Care Organizations
In this review, first, we will explore the development of ACOs within the context of prior attempts to control Medicare spending, such as the sustainable growth rate and managed care organizations. Second, we describe the evolution of ACOs, the demonstration projects that established their feasibility, and their current organizational structure. Third, because quality metrics are central to the use and implementation of ACOs, we describe current efforts to design, collect, and interpret quality metrics in vascular surgery. And fourth, because a "seat at the table" will be an important key to success for vascular surgeons in these efforts, we discuss how vascular surgeons can participate and lead efforts within ACOs.
Controversy Over the Use of Intraoperative Blood Salvage Autotransfusion During Liver Transplantation for Hepatocellular Carcinoma Patients
Intraoperative blood salvage autotransfusion (IBSA) is used in various surgical procedures. However, because of the risk of reinfusion of salvaged blood contaminated by tumor cells, the use of IBSA in hepatocellular carcinoma (HCC) patients undergoing liver transplantation (LT) is controversial.
Encouraging Value-Based Insurance Designs in State Health Insurance Exchanges
One of the main goals of the Affordable Care Act (ACA) is to control the costs of US healthcare. Channeling patients toward more effective services is one of many approaches being used to control costs while improving health outcomes. This paper reviews value-based insurance design (VBID) concepts and discusses options for states to encourage these designs in the new health insurance exchanges (HIEs).
Peripartum Use of Cell salvage: A University Practice Audit and Literature Review
The rising rate of obstetrical hemorrhage attributed to the repeated cesarean sections and invasive placental disorders, requiring blood transfusion has emphasized the need for alternatives to allogeneic blood donation.
Taking Our Medicine — Improving Adherence in the Accountability Era
The Affordable Care Act aims to shift reimbursement from fee for service toward rewarding of improved quality, outcomes, and efficiency. Payment and delivery-system models such as patient-centered medical homes (PCMHs), accountable care organizations (ACOs), and bundled payments encourage greater care coordination by holding providers accountable for total costs and outcomes in their patient populations.
Impact of ABO Compatibility on Outcomes after Heart Transplantation in a National Cohort During the Past Decade
To our knowledge, this is the first large cohort study investigating the impact of ABO-compatible versus identical blood type matching on post heart transplantation survival.
Weaning of Extracorporeal Membrane Oxygenation Using Continuous Hemodynamic Transesophageal Echocardiography
During the academic year of 2011, hTEE-guided ECMO weaning was performed in 21 patients on VA ECMO. Left and right ventricular function and volume status were assessed by continuous hTEE, while attempting to wean ECMO after a standardized protocol.
Comparison of Hemolysis Between CentriMag and RotaFlow Rotary Blood Pumps During Extracorporeal Membrane Oxygenation
The purpose of this investigation was to compare the hemolysis levels for patients on extracorporeal membrane oxygenation (ECMO) incorporating two different rotary blood pumps (CentriMag [CMAG] and RotaFlow [RF]) in identical circuits otherwise.
Successful Repair of Aortic Annulus Rupture During Transcatheter Aortic Valve Replacement Using Extracorporeal Membrane Oxygenation Support
We describe a case of aortic annular rupture with involvement of right coronary artery ostium leading to cardiac tamponade and cardiac arrest, successfully managed by extracorporeal membrane oxygenation support, open drainage of the pericardial space, pericardial patching of the defect and bypass of the affected vessel with excellent post-procedural results.
Two Cases of Asystolic Cardiac Arrests Managed with Therapeutic Hypothermia
Therapeutic hypothermia might have a potential role in even in non-shockable arrests and should be considered in every successful cardiopulmonary resuscitation with poor neurological status.
The Role of Platelet-Rich Plasma in Inducing Musculoskeletal Tissue Healing
The aim of this manuscript is to review current literature regarding the biology of PRP and the efficacy of using PRP to augment healing of tendon ligament and muscle injuries, as well as early osteoarthritis.
Platelet-Rich Plasma: Underlying Biology and Clinical Correlates
Platelet-rich plasma (PRP) has recently become the focus of intensive interest and discussion, in part because of the expanding understanding of platelet function.