Autopsy: Management

1. return organs to body and suture

2. family makes arrangements with the funeral home 

3. funeral home contacts the hospital or ME to schedule pick up

   1. state laws vary on who can pick up and transport (funeral home directors vs. private contractors)

4. ALWAYS maintain chain of custody

   1. security must be involved

   2. verify ID on the remains and personal belongings with the transport

   3. release authorization form

5. usually handled by appropriately trained staff

6. documentation:

   1. document deceased with the local county recorder

   2. death registration form

   3. burial permit form

OUTLINE THE PROCEDURE FOR RELEASING A BODY AFTER AN AUTOPSY IS COMPLETE

1. Final anatomic diagnosis = concise summary of anatomic diagnosis

   1. Gross + histological examination

   2. Most serious to least serious to include cause and mechanism of death

2. Clinical summary = brief synopsis of all hx gathered

   1. Pertinent clinical issues and pathologic findings relating to the FAD

3. Grossing findings = external and internal findings; include photographs and radiographs; NO DX OR INTERPRETATION

4. Microscopic findings

5. Additional findings = tox, micro, molecular or chromosomal studies

6. Clinicopathological summary = “final note” that sums up the entire case and states the COD

DESCRIBE THE COMPONENTS OF AN AUTOPSY REPORT (6)

1. Staff can provide QA for the hospital by thoroughly reviewing medical history

2. Autopsy can provide QC by providing definitive dx and comparing clinical to autopsy findings - any notable variations must be documented

   1. Unexpected pathologies are not uncommon, but could mean life vs. death!

DESCRIBE THE ROLE AUTOPSIES CAN PLAY IN HOSPITAL QUALITY MANAGEMENT

1. Training (initial and continuing)

2. Turnaround time - respect among health care professionals

   1. PADs in 2 days, FADs in 60 days

3. Improving rates - fully staffed and well-trained team

4. Regional autopsy centers - create centralized area for data collection as well as training

IDENTIFY WAYS TO MAINTAIN QUALITY IMPROVEMENT IN AUTOPSY PRACTICE (4)

1. National Association of Medical Examiners (NAME) = primary accredidation body for ME and coroners

2. American Board of Medicolegal Death Investigators (ABMDI) = individual certificates of death investigators and medicolegal investigations

3. ANSI National Accreditation Board (ANAB) = international standard; crime labs, law enforcement agencies, ME offices

IDENTIFY ACCREDITING BODIES FOR AUTOPSY PRACTICE (3)

1. Autopsied generally not covered by medicare, medicaid, or most insurances

2. Private, non-forensic can cost a family 5000

3. Forensic autopsies - government service (taxes) and not charged to families

   1. Drug overdose costs taxpayers ~2600

   2. Shooting victims ~6000

4. Medicare payments are bundled into overall service payments for hospital autopsies

5. Hospitals receive full payment, whether or not an autopsy is performed

   1. ~$1200-$1300

   2. Not seen as cost effective or necessary

ARGUE THE DIFFICULTIES THAT EXIST WHEN IT COMES TO AUTOPSY BILLING