Increasing Post-Acute and Long Term Care Coding for Advance Care Planning in an Outpatient Setting

Today’s healthcare landscape is saturated with an aging U.S. population that is living longer and with more chronic conditions. One way to manage care for this aging population, especially those with chronic conditions, is through advance care planning (ACP). Healthcare providers are capable of engaging patients in these important healthcare discussions, yet use of methods to appropriately document and code for these services are lacking. There are Current Procedural Terminology (CPT) codes in existence that would be applicable for these services; however, they are not widely understood nor routinely used in clinical practice. Administrators at a large Midwestern healthcare organization’s home based primary care program (HBPC) recognized this gap in care delivery and were open to a quality improvement initiative to address this clinical problem. The purpose of this project was to close this practice gap by establishing a standardized documentation protocol using CPT codes for ACP services. A retrospective chart analysis of all patients enrolled in the HBPC program (N=430) determined that ACP is a major aspect of care delivery at HBPC, with a total of 98% (n=419) of the total patient population having a documented resuscitation order and 81% (n=347) of patients having a documented durable power of attorney; two crucial aspects of any ACP discussion. A second chart audit (n=28) based on a simple random sampling of patients enrolled in HBPC in the last 60 days was completed to focus on CPT code utilization and associated documentation for ACP services. None of the charts in the second chart audit included the use of ACP CPT codes or the associated documentation. Ten charts did include documentation on time spent on ACP services, and therefore were used to create a projected return on investment (ROI) for ACP CPT codes. The projected ROI for ACP CPT codes found that HBPC missed opportunities on 22 relative value units and reimbursement of $1,234.30 on 10 single face-to-face patient encounters where ACP was discussed because ACP CPT codes and correct documentation were not utilized. The second chart audit strengthened the need for an educational session with clinical staff to promote the use of a standardized documentation protocol using CPT codes for ACP services. An educational session was completed with staff to identify staff knowledge and attitude regarding ACP services codes and included a pre/post-education survey. The mean score for the pre-survey was 9.4; with one being strongly disagree to five being strongly agree for a total of five questions adding up to 25. The mean score for the post-survey was 19.3. In comparing the two scores, the post-survey score increased by 39.6% representing a small to medium effect size statistically. This revealed that staff knowledge and attitude regarding CPT codes for ACP services had a positive change following the educational session. A final chart audit using a convenience sample of patients with an ACP discussion three weeks after the education session (n=55) was completed to assess for changes in documentation for ACP services. Documentation requirements that align with the CMS (2016) requirements for ACP CPT codes did not significantly improve following the educational session. Despite the lack of significant change in documentation, the educational session was still beneficial for staff knowledge regarding ACP CPT codes. Additionally, both chart audits identified three variables (consent, explanation of advance directives, and time spent on ACP discussions) that were most likely to be missed in documentation. This strengthened the need for continued employee education regarding implementation of CPT codes for ACP services as well as a standardized documentation protocol to guide providers through the implementation process in the future. Upon completion of this project, a standardized documentation protocol for ACP services now exists at the HBPC practice. This scholarly project has major implications for practice. The estimated return on investment from the use of CPT codes for ACP services highlighted the potential increase in relative value units for provider productivity as well as increases in reimbursement (for a standard fee-for-service model) captured by utilizing these codes. The educational session received support from the staff, and educational materials from the session can be utilized for future practice. Finally, the protocol will help to standardize workflow around ACP services, which are a large component of routine patient care delivery at HBPC. A standardized documentation protocol using CPT codes for advance care planning is one way to address the current gap in practice and promote quality, cost-effective care delivery at a home based primary care program

Self-assembling Ultrashort NSAID-Peptide Nanosponges: Multifunctional Antimicrobial and Anti-inflammatory Materials

This paper outlines the design, synthesis and characterisation of innovative NSAID-peptide gelators which demonstrate antimicrobial and anti-inflammatory properties and have potential use as multifunctional materials for biomedical applications.</p

The Grizzly, April 17, 2008

Owen Gingerich Discusses Religion and Evolution at UC • Breakaway Presents P.S. We\u27ve Missed You at UC! • Kennedy Speaks • Achievement Gap: An Issue Left Behind? • All Dogs Go to Heaven: Review of Black Lab Bistro • UC Theater Dances in an Irish Spring • Opinions: Want Change? Vote Obama; Elitists in Government? Yes Please! • A Swingin\u27 Season for UC Tennishttps://digitalcommons.ursinus.edu/grizzlynews/1762/thumbnail.jp

The Grizzly, November 13, 2008

Berman Expands to Envelop Art and Imagination • Election Night Brings Cheer to Liberal Ursinus College • Changes Expected for This Year\u27s New Member Education • Passage of Prop 8 Leaves Same-Sex Couples Concerned • Days After Election: Obama Gets to Work • Forensics: Not the Science, but the Ursinus Debate Team • Escape Velocity\u27s Eternalmotion Strikes a Chord at UC • Finding the Phillies Parade: An Unforgettable Adventure • History Attached to a Philly Row Home • Opinions: Barack Obama: Our Next President • Kait Sutherland Finishes Out Hockey Reign at Ursinushttps://digitalcommons.ursinus.edu/grizzlynews/1775/thumbnail.jp

Contributions and future priorities for soil science: comparing perspectives from scientists and stakeholders

Soils are a fundamental natural resource but intensifying demands and increasing soil degradation necessitate focussed research into the sustainable use of soils. Since soil functioning is critical for the operations and performance of multiple industries, businesses and municipalities, soil scientists need to actively engage with these bodies to orientate research goals towards stakeholder needs. To achieve this, stakeholder views about the current and potential contributions of soil science to different sectors need to be taken into account when setting the future research agenda. Here, we assessed whether the current and future research priorities of soil science match the needs of four major industrial and environmental sectors: agriculture, ecosystem services and natural resources, waste management, and water management. We used an online questionnaire, distributed to 192 organisations and via social media, to compare stakeholders' and scientists' perceptions of (a) the contributions of soil science to date, (b) the areas not currently served by soil science and (c) future research needs in soil science. Stakeholders generally rated the contributions of soil science to date as ‘great’ or ‘fundamental’, but scientists rated the contributions more highly. Respondents identified numerous areas that soil research has not yet sufficiently addressed, which were mostly sector-specific and often overlapped with perceived future research needs. Importantly, stakeholders' and scientists' views of future research priorities differed strongly within sectors, with the notable exception of agriculture, where views were generally consistent. We conclude that soil science may hold unexplored potential in several industrial and environmental sectors. We call for improved research communication and greater stakeholder involvement to shape the future soils research agenda and ensure the sustainable use of soils across multiple areas of society

The Grizzly, October 9, 2008

Biden and Palin Hold Their Ground in 2008 Debate • Pimps Up, Ho\u27s Down: Hip-Hop Music and Modern Women • Indian Temple Stampede Kills Hundreds, Injures Others • Hollywood Mourns Legend Paul Newman • Earth Shattering Stock Market Fall Shakes Nation • Spotlight on Sally Rousse: Dance Artistry at its Finest • Ursinus in Tuebingen Students Travel to Berlin, Munich • Introducing the Gender Wage Gap • Opinions: Democratic and Republican Extremes at Ursinus College; Zack\u27s Dining: Why Wait? • Women\u27s Rugby in for Incredible Season • UC Men\u27s Rugby: Sport with Quickly Growing Popularityhttps://digitalcommons.ursinus.edu/grizzlynews/1771/thumbnail.jp

The Grizzly, November 20, 2008

Adding Machine Makes Explosive Debut on UC Campus • Active Minds Encourages Students to Relax: Stop Stressing! • Creative Writing Author John Holman Visits UC Students • Is the Economy Affecting Your Waistline? • More Bailout News: AIG • Inside the Busy Life of Senior Laura Ng • Plummer Speaks About Importance of Election • Ottinger Fights Child Illiteracy in Cold • Play n Trade: New Store for Gamers • Letter to the Editor • Sunny Review • Dracula\u27s Ball Recap: Ideal Halloween Destination • Hockey Prepares for On-Campus Nationals This Weekendhttps://digitalcommons.ursinus.edu/grizzlynews/1776/thumbnail.jp

The Grizzly, October 2, 2008

Lighting Up Laws: New Smoking Policies on College Campuses • Sexual Perversity Comes to Ursinus • Water, Water Everywhere • Users to Delete Profiles? Student Reactions to New Facebook • U.S. Credit Crisis Hits Home for Some Ursinus Students • College Students Hurt by Economic Woes • Banned Books Week • Lethal Filler Found in Chinese Dairy • Texting Responsible for Train Crash? • Hispania Dances Their Hearts Out for an Ursinus Audience • Tribute to Sub Connection Employee Patro • A Look Into the Past with the Sophomore Class President • Women in Science: Progress in the Scientific Community • Kabuki Dancer to Choreograph at UC • College Students Targets for ID Theft • Opinions: Presidential Debate 2008: The Battle in Mississippi; Open Your Eyes to the Truth About Senator Barack Obama; Political Messages Overtake Television More Than Ever • Cross Country Senior Spotlight: Christa Johnson • Cosmic Sucker Punch: UC Ultimate Frisbee Scores • Could New Turf Field be the Key to Football\u27s Future Success?https://digitalcommons.ursinus.edu/grizzlynews/1770/thumbnail.jp

Theses on Social Art History in the Age of Computational Methods

This essay, which sets forth 8 theses accompanied by the scholarly debate that informs them, developed out of a workshop, Grand Challenges of Art History: Digital/Computational Methods and Social Art History, sponsored by the Research and Academic Program of The Clark (26-27 April 2019). The essay was collaboratively written by the contributing authors, whose voices are signified by the colors designated. The contributors to this article all responded to an invitation to address what we self-consciously described as a “Grand Challenge” of art history. For art history, we saw the co-joining of digital and computational methods and the social history of art as one of those grand challenges. While differences of interpretation and even strong disagreement emerge (and are evidenced in this text), these scholars share an interest in analyzing the intellectual anxiety that comes with the destabilizing speed of digital changes to art-historical practice as well as the urgency to critique the systemic power relationships of our moment of production. These shared interests intersect with the ongoing project of the social history of art