In today’s health industry there are many new technologies emerging. Those technologies are shaping how medicine is being defined. There are so many new devices and techniques being invented which will change the way hospitals and physicians are reimbursed. MS-DRG’s are Medicare severity- diagnosis related groups. There are two emerging technologies that really caught my eye, the 3D organ printing and Telehealth. Both of these emerging technologies are new concepts to the world today that I hope will in a few years help to shape a brighter and better future for the health of all people.
First off, I would like to explain what MS-DRG’s are and how they work. As I said before, MS-DRG stands for Medicare severity- diagnosis related groups and for each inpatient stay one MS-DRG is given. MS-DRG’s range from 001-999 with some unused numbers in-between to be used in the future for expansion purposes. There are 25 Major Diagnostic categories (MDC), and the first step in discovering a MSDRG is to look at the primary and admitting diagnoses, then to decide the major diagnostic category. Diagnosis codes that start with the same three characters are usually grouped to the same MDC, making an exception for “unspecified” codes.
There is a tool called a MS-DRG grouper. With this tool a technician will enter in the admitting and primary diagnosis codes, procedure codes and secondary procedure codes, sex, and discharge status. Then it will automatically calculate the correct MS-DRG. The reimbursement system is updated annually on October 1st every year. This ensures an accurate and complete medical record that complied with the Uniform Hospital Discharge Data Set (UHDDS). This is important when configuring the codes to put into a MSDRG grouper.
Without a complete record, you might not fully comply with your facility’s standards and other different standards, such as the UHDDS. MS-DRG’s can be split into a few different ways. The diagnosis’ can be categorized as a MCC, (major complication or comorbidity) a CC or no CC. Major complications and comorbidities(MCC’s) are the highest level of severity, and CC’s are the next level of severity. For example MS-DRG 467 – Revision of Hip or Knee Replacement with CC, Revisions of Hip or Knee Replacement with MCC, 468 – Revisions of Hip or Knee Replacement without CC/MCC.
Regardless of the resources used for a patient, hospitals are typically paid a set amount determined by MS-DRG’s. Each MS-DRG is assigned a different weight, and the weight is used to adjust the different types of patients who might consume different resources and lead to different expenses. Groups of patients who are expected to require above average resources have a higher weight than those who require fewer resources. The first emerging technology I researched was the 3D printer for organs and tissues.
Before getting completely into the 3D printer, I will discuss why the 3D printer was created and the statistics on the transplantation and organ donation list. In the U. S alone there are over 121, 678 people waiting for a lifesaving organ transplant. Of these 121, 678 people 100, 791 of them need kidney transplants. In 2014 only 17, 107 kidney transplants took place. On average 22 people die on every day because they did not receive a transplant. Finding an organ donor for someone is very tricky because their body can reject the organ, which creates complications.
That is one of the major reasons transplants are hard to come by. That is where the 3D organ printer comes into play. With 3D printing hopefully the numbers can go down exponentially. The 3D organ and tissue printer is a new technology that has only recently come into play in the health field, but scientists have been working on it since the 1980’s. Previously known as Rapid Prototyping, the original processes were fast and a more cost-effective method for creating prototypes for product development within the industry. In 2012 3D printing was introduced at entry level and also the year that media got ahold of the emerging item. 013 is the year where the printer really took off.
A lot of research was done in 2013. A printer from the company called Organovo produced a human liver, but it was not used for transplantation. The first ever transplantation using a 3D printed kidney was done in January of 2016, and they are still living today. Charles Hull, in 1984, invented stereolithography. This allowed a physical 3D object to be created from digital data. The technology was used to a create 3D model from a picture which enabled testing of the design before advancing it into a larger industrial program.
Then, in 1996 a different scientist, Dr. Gabor Forgacs, made an observation that cells stick together during embryonic development and move together in bunches with liquid-like properties. In 2003, Thomas Boland’s lab at Clemson University modified an inkjet printer to accommodate and distribute cells in scaffolds. Scaffolds are soluble factors, such as proteins and other smaller molecules. Then in 2004, Dr. Forgacs discovered and developed a new technology that engineered 3D tissues with only cells. This technology did not using any scaffolds.
Using the research these doctors have provided, Organovo created the first ever 3D organ and tissue printer, which he called the NovoGen MMX Bioprinter in 2009, and later that year he created the first ever human blood vessel using only cells, no scaffolds using the bioprinter. (Organovo) The first organ transplant was done to a three year old in Ireland to save her life in January of 2016. Now that we have the history of the 3D organ and tissue printer let’s get into how it works. 3D printing is created using additive manufacturing.
Additive manufacturing adds cells layer by layer to objectively create the organ or tissue that a scientist is trying to create for transplant. The first step is creating the cells needed for the production to be made. This can be done using cells from the patient’s own human body, or scaffolds. If cells are cultured from the patient themselves then the cells will grow and multiply on their own once they are regenerated. Think of this process kind of like a cotton candy machine. Using biomaterial, a 3D printer weaves the biomaterial into a structure that mimics those in your body, such as a vessel.
The biomaterial is spun just like the sugar in the cotton candy machine until it creates what is needed to perform the same duties your own body performs. Now, if you think of this new biomaterial vessel as a bridge when it is transplanted into the human body it may be easier. As a bridge, the cells could walk on the bridge and repair and replace their damaged tissue. The tissue would then be regenerated. Cells alone can also be used. Scientists can take stem cells and have them multiply and use them to create organs for patients.
Using a 3D printer is kind of like baking a layered cake. The cells are placed into an “oven” which is the printer. Then cells are layered on top of each other multiple times. Then they are “baked” to create an organ or tissue to replace or repair a different organ in the patient. Patients that need to receive biomaterial organs just get an organ like this sutured into them. Since they are using their own cells as the basis for their new organ, their body will not reject the new organ. MS-DRG’s have 25 major diagnostic categories, as previously stated.
These are used for reimbursement purposes, when using a 3D printed organ for transplant, the reimbursed amount will depend on what organ and system of the body surgery was performed on to tell what MS-DRG a physician would receive. For example, a kidney transplant using a donor kidney has an MS-DRG of 652, which would be a reimbursement of about $19,658. A liver transplant has an MS-DRG of 006, and a reimbursement of $28,862. Since there is room to add new MS-DRG’s I would say there should be a new MS-DRG added as “Kidney transplant, using 3D biomaterial printer,” or “Live transplant using 3D biomaterial printer.
So, for each organ or tissue replacement there would be a new MS-DRG added that said a 3D biomaterial printer was used in the process of the procedure. This would result in a higher reimbursement because of the cost of the printer, material being used to create the organ, and the time it took to harvest cells and have them multiply. With each MS-DRG a procedure code is connected to it. In PCS there will need to be an option to add that a 3D printer was used, also. That way the MS-DRG can be generated in the correct manner, and will result with an accurate MS-DRG.
Another emerging technology that caught my eye was Telehealth. Telehealth or “telemedicine” is often used when referring to traditional clinical diagnosis and monitoring that is delivered by technology. However, the term “Telehealth” is now more commonly used to describe the wide range of diagnosis and management, education, and other related fields of health care. These include dentistry, counseling, physical and occupational therapy, home health, chronic disease monitoring and management, disaster management, and consumer and professional education. NTPRC)
Health Resources and Services Administration defines Teleheath as: “The use of electronic information and telecommunications technologies to support long-distance clinical health care, patient and professional health-related education, public health and health administration. ” (NTPRC) There are four different ways Telehealth can be carried out. Those four ways include: Live video, Store-and-forward, Remote patient monitoring, and mobile health. Live video is a conference call over the use of technology with a patient and provider.
This is the most popular way as it is in “real time. ” This can be used for both consultative and diagnostic treatment. Store-and-forward method lets the physician gain access to all of the patient’s medical charts and data through a secure communication system. This is not in real time, and it is mostly used through email. This can be a nice tool for people who live in the country and other rural areas because there might not be a lot of specialists in the area to be available to see. Centers for Connected Health Policy describes remote patient monitoring as, Personal health and medical data collection from an individual in one location via electronic communication technologies, which is transmitted to a provider (sometimes via a data processing service) in a different location for use in care and related support.
This type of service allows a provider to continue to track healthcare data for a patient once released to home or a care facility, reducing readmission rates. ” Mobile health, or mHealth, is health care delivered via tablets, cells phones or PDA’s. Text messages can be sent to tell patients to be aware of healthy behavior, or alerts of appointments can be sent to their phones as well.
One of the case studies I looked at was of a patient who was comatose, and had diabetic ketoacidosis. It was in a town of 5,000 people where specialists were very rare to come by. In a case like this, the specialists this patient needed were three hours away. The specialists he needed were able to turn on a webcam and speak to the patient’s family and also the doctors that were treating him to come up with a solution in how to treat his diabetic ketoacidosis. If it wasn’t for telehealth and the ability to speak to doctors who were three hours away this patient may not still be alive.
Some patients they need to take off work in order to get the quality of care they need to treat their disease. With telehealth they can make an appointment to suit their timeframe and turn on a webcam and speak to their specialist’s right from the comfort of their home. For example, if a patient is in a rural area and cannot access a dermatologist because there are no specialists within hundreds of miles of them, then they are able to email a picture of their skin condition right to the specialist and receive a reply by the end of the business day.
Doctors can prescribe medicine via the internet now, and will soon be able to treat patients via the internet as well. In the same way that patients can communicate with different specialists, doctors can also communicate with each other via the internet. If one doctor has a question about a certain disease, for example a certain skin rash, they can take a picture of that rash and send it to a specialist and that specialists can give their opinion. It is a way to further education and better serve communities with more expertise.
Since MS-DRG’s have to do with reimbursement, there are some issues that happen with telehealth and reimbursement. First off, not all telelhealth services get reimbursed. The Health Resources and Services Administration says, “Medicare, which has to some extent set the standard, reimburses for telehealth services when the originating site (where the patient is) is in a Health Professional Shortage Area or in a county that is outside of any Metropolitan Statistical Area, defined by HRSA and the Census Bureau, respectively. This originating site must be a medical facility and not the patient’s home.
Medical facilities include practitioners’ offices, hospital, and rural health clinics. This reimbursement is not affected by the location from which the telehealth services are being delivered (the “distant” site). Medicare will only pay for “face-to-face”, interactive video consultation services wherein the patient is present. That is, Medicare will cover telemedicine services that mimic normal face-to-face interactions between patients and their health care providers. ” (HRSA) In the HCPCS code book there are some codes that cover telehealth already.
Some G codes such as G9482, States it uses real time video communication technology for a remote in-home visit for a patient. These codes are basically the same as evaluation and management codes that range from 99201-99215. They have a history, examination, and a medical decision making portion to the code. So, for MS-DRG purposes the type of evaluation and the type of telecommunication used will affect the MS-DRG. Since MS-DRG’s use ICD 10 CM and ICD 10 PCS some codes may need to be added to ICD 10 CM for the diagnosis of disease via telecommunication.
Since CPT codes have modifiers, a modifier signifying that telehealth or telecommunication was used may need to be also added. There will be a set amount connected to that modifier calculated by third party payers. According to CMS, “a practitioner who furnishes a telehealth service to an eligible telehealth individual will be paid an amount equal to the amount that the practitioner would have been paid if the service had been furnished without the use of a telecommunications system. ” Hopefully within the next few years telehealth will be the future of medicine.
It is more comfortable for patients to sit at the comfort of their home and receive medical attention than it is to wait at a doctor’s office. If patient’s are just receiving psychiatric help then there really isn’t a need to leave home when they can just put on a webcam and visit with their psychiatrist. With the inventions of the 3D biomaterial organ printer and telehealth, the health field is emerging into something very great. In the movie Something the Lord Made doctor’s did not want to perform any heart surgery because they thought it was too invasive and life threatening.
To think that scientists have now created a machine to make organs and tissues made from biomaterial and place them into patients is extraordinary. With telehealth doctors can diagnosis and treat patients via telecommunication. It is a big improvement in medicine due to the fact that more people can be treated on an everyday basis without the wait time at the offices. If the health field continues to grow at the rate it has been, our future health is in good hands.
