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Computer Economics: IT metrics and best practices for the strategic and financial management of information systems. Focus on IT spending, IT staffing, IT security. Economics, Insurance and Moral Hazard. Pauly, “THE ECONOMICS OF. Although paying for TCM will mean additional outlays from Medicare over the short term, both CMS and medical groups expect that it will produce savings over the long term, says Shari Erickson, MPH, director of regulatory and insurer affairs for the American College of Physicians (ACP). The 2. 01. 3 CPT codes also include three new codes covering complex chronic care coordination (CCCC) services. CMS did not include the codes in its 2. Medicare will not yet reimburse for them. Types of covered services for staff members (under the physician’s direction). The older code, however, is worth 4. RVUs, or between $1. Moreover, she says, the face- to- face visit in the newer codes is not “exam- intensive.”. It’s more of, ? How can I help you better manage this disease to keep you from going back into the hospitals?’ ” she says. In practice, however, Seyfried says the primary care physician (PCP) is the most likely to submit the bill. They just want to do their procedure and be done with the patient.”. According to Erickson, CMS’ initial draft of the codes did not require a face- to- face visit. Now we’re contacting . It’s great public relations. The patients love it, and it gives them the chance to ask, . It is available on the organization’s Web site at www. And is it even the hospitalist’s responsibility to notify the PCP? I don’t know how that’s going to be resolved.”. Seyfried says she has fielded calls from PCPs asking how they will know when their patients are discharged. The patient is hospitalized frequently due to his multiple comorbidities. Our office saw him for a follow- up visit within a week of discharge; it was an extended visit of an established patient (CPT 9. Our office received $1. Medicare participation in Connecticut. The 2. 01. 3 rate would be $1. The physician placed a brief telephone call to his house within 2 business days of the hospital discharge and had a discussion with one of his family caregivers concerning the plan of care, including diet, medication, blood glucose, and medical follow- up appointments. The medical decision- making level was deemed high complexity due to his several comorbidities. CPT code 9. 94. 96 was used. Reimbursement was $2. Case history 2: CCCCPatient: An 8. History: December 1. She woke up after a brief period of unconsciousness. She declined to go to the hospital and instead had a friend drive her to my office. After a brief examination, I insisted she go to the emergency department (ED) for a computed tomography scan and further evaluation. A routine chest x- ray performed because of the syncope, however, revealed a 3- cm right upper lobe mass not present on her last chest x- ray a year earlier. She was admitted to the hospital for observation and underwent a needle biopsy of the lung mass. Further testing was scheduled, along with a referral to a thoracic surgeon. The patient returned to my office January 7 with a new cough and was treated for bronchitis. I ordered a chest x- ray to exclude pneumonia or a delayed pneumothorax from the recent needle biopsy. A call to the patient confirmed this fact, and one of our clinical staff members spoke with the pulmonary function lab and again with the patient to get her spirometry test rescheduled. These calls took 1. I also called the surgeon to update him on the patient’s acute bronchitis and the need to delay things a bit. This call lasted 3 minutes. We spoke for 5 minutes. We spoke for 5 minutes. The same day, one of her daughters came to the office to discuss her mother’s case. We discussed the respiratory symptoms, whether her illness could be influenza, and the possible treatments of the cancer. I spent 1. 0 minutes with the daughter. Once again, her spirometry test was rescheduled. We also discussed her visit with the surgeon. I spoke to her for 1. The Centers for Medicare and Medicaid Services considers the included services to be bundled services and thus will not pay for them separately, but it is studying them for possible separate implementation in the future. The reporting individual provides or oversees the management and/or coordination of services, as needed, for all medical conditions, psychosocial needs, and activities of daily living.”Specific applications of the codes: 9. Complex chronic care coordination services; first hour of clinical staff time directed by a physician or other qualified healthcare professional with no face- to- face visit, per calendar month. Complex chronic care coordination services; first hour of clinical staff time directed by a physician or other qualified healthcare professional with one face- to- face visit, per calendar month. 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Lionheart: Legacy of the Crusader is an action role-playing game, developed for the PC by Reflexive Entertainment. Lionheart met a lukewarm response by critics, only achieving a ranking of 64% on Game Rankings and 57/100. Lionheart - Legacy of the Crusader is role-playing game developed by Black Isle Studios and Reflexive Entertainment (Zax: The Alien Hunter, Star Trek Away Team makers). Lionheart takes place in an alternate history Earth. Lionheart - Legacy of the Crusader ( 13 August 2003) . Vinci, you find yourself in the proud city of Nuevo Barcelona, trying to find out who wants your head, amongst other things. The first act of the game is spent in the city, meeting various 1. Europe's major power groups. The reliance on real- world history is what makes Lionheart unique. The politics of the time- especially the looming war between Spain and England- are significant. Later on you'll cross swords with Assassins and Druids. You meet various 1. Lionheart: Legacy of the Crusader Widescreen Patch Patch Lionheart: Legacy of the Crusader Widescreen Patch Feb 2014 4,115. The Widescreen Patch allows Lionheart: Legacy of the Crusader to be played at previously unsupported resolutions, like those of widescreen monitors. Tested on patch 1.1 (single player only). Shakespeare, Torquemada, and Cortez, and they're all pretty well realized. On the minus side, the dialogue is also pretty underwritten. It's pretty obvious that every line of dialogue is either directly related to some quest, or just general exposition. Persuasion is a matter of having a high enough diplomacy skill, nothing more. Still, there is some style and flair in the writing, and the characters are interesting. Overall, the plot is on the high side of average. The characters and setting of the previous act are all but ignored, and the game instead becomes one overlong dungeon after another. It all leads up to an ending that is a total cop- out, postponing all but the most simplistic answers until the sequel. Now, this isn't a bad approach per se- in fact, the Baldur's Gate games did much the same thing- heavy character development and sidequesting in the first half, followed by one epic confrontation after another, finishing with a hook for the next game. But Lionheart gets it wrong. There's no appreciable narrative thread running through the second act- mainly you're fighting whichever army happens to hold the area you're currently trudging through en route to the next plot point. Since the fights aren't tied heavily to the main plot, the story is effectively put on the back burner, forcing the combat engine and level design to carry the game. And these areas are where Lionheart is weakest. Lionheart's stat system has been copied, with some fanfare, from Fallout's SPECIAL system- skill- based with levels and character traits, plus special perks every three levels. It's implemented very well- the system accounts for a number of different approaches, all of them with advantages and disadvantages. You can use brute force, stealth, diplomacy, and several different kinds of magic. Magic is a big part of Lionheart- more than half the skills you have to work with are magical skills. Mostly they're buffs, attacks, and the odd summon, but there are some nifty ones- raising enemy corpses as undead soldiers, a Shaman's Eye to scout out areas, and of course the all- important healing spell. There are even divisions within different philosophies of magic, making for a wide variety of characters. For example, a Pyromancer- type character will attack his opponents directly with magic, and can pick up perks and bonuses to do extra damage. A Thunder Wizard will also attack his opponents directly, doing less damage, but getting a paralysis effect that will leave them open to melee attacks. There's quite a bit of variety among the viable character types, and advancement is very smooth as well. Only two issues prevail. One, the perk lists aren't anywhere near as extensive and varied as in Fallout. Two, magic items are almost universally blah- randomly- generated enchantments with uninspiring names. An accurate sword is a . A sword that deals extra damage is a . A sword with both enchantments is a . The problem is, even the best characters mean nothing if they're boring to play. In Lionheart, you have only one hero. Others will join you occasionally, but usually just until one specific quest is completed. Even when you do have a companion, they're often more trouble then they're worth. They don't have inventories, so you can't give them potions or new equipment. You can't give them orders either, and while the combat AI isn't horrible, it's pretty one- dimensional. Retreating to recover, sniping with distance weapons, or charging and eating the damage while you snipe, are all strategies that are alien to them. So you generally fight alone. With a party, you can specialize characters and divide the various jobs. But the solo adventurer has to do everything himself. If your game has multiple paths or simple enemies, this is no big deal. But in a game like Lionheart, you'll find the game either impossibly difficult, or you'll fall back on the same strategies endlessly. In this particular case, there are five strategies you have to know: 1) buff up, charge the enemy, waste them all, loot, heal, repeat. Sneak around and backstab. Pick one or two of these, depending on the type of character you're playing, and that's all you'll be doing for the rest of the game. There is little, if indeed any, creativity put into the various strategic situations you encounter. Enemies move fast and attack repeatedly. Although the controls are intuitive enough, you can't issue commands while paused, meaning battles are very much a matter of fast reflexes. More seriously, the screen shows too little of the playfield. Although the sprites are pretty much in the same proportions as, say, Baldur's Gate, the characters move a lot faster, you can go from one side of the screen to the other in a third of the time. Ergo, the area displayed is functionally much smaller. Jerky, inconsistent panning is another annoyance. Not only are they all 1. Oh, yes, the motivation in making large dungeons in completely understandable- give the player more bang for his buck, so to speak. But the equation doesn't really work in such a linear fashion. See, in essence, a dungeon is an action scene between two important plot points. You enter it with a purpose, and resolve that purpose, or find a new one, at the end. If it goes on too long, it's like the talky scenes in a Jackie Chan flick- the player starts wanting to just get on with it. A crypt will have skeletons, coffins, traps; a giant spider's lair will have webs and smaller spiders, etc. This means that as the challenges come on, there's a point by which the player can handle the dungeon with few problems. After which, the dungeon becomes tedious. You can't run a dungeon that goes on for three or four maps, because by the end of the first, the player has figured out how to rise to the challenges and wants something new. Another idea which doesn't really work out is the fact that you can't rest in dungeons. In fact, you can't rest anywhere. On paper, this might seem like a good thing. It never really made sense in games like Morrowind that you could just pitch a tent in a dungeon and hang out for a few hours, recovering your health. But another problem, just as silly but more annoying, arises when you don't have this option. Instead of resting with a click of a button, you find a safe corner somewhere and twiddle your thumbs for a few minutes. Or, more commonly, find a safe corner then leave the keyboard and do something else for five minutes are so. Both graphics and sound are okay, but nothing memorable. Voice acting for the characters is okay, but overdone. The player doesn't have to hear every word printed onscreen, usually he just skips past it once he's done reading. Unless you're doing a real dramatic moment, you should go easy on the voice clips. Your choice of spirit is not just cosmetic- the three spirits have distinct personalities, and each adds a different feel to the game. Likewise, your choice of faction is not purely cosmetic either- you get stat bonuses for your rank. There are other items, mainly quest rewards, which will likewise give you bonuses and special perks. The game is uncommonly friendly to thief characters. 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