We’re back to our “normal” routine after attending HIMSS last week in Orlando, Florida. The show is growing every year, and the number of cities capable of handling its size seems to be down to 3: Orlando, Las Vegas, and Chicago.
As usual, the 3M booth and its staff were kept busy with a steady stream of walk-up visitors interested in our terminology, computer-assisted coding, consulting, and other products and services. We also had many productive, scheduled meetings with vendor partners and potential customers. Stage 2 of Meaningful Use and ICD-10 seemed to be on many people’s minds. Continue reading
In January the Minnesota RARE campaign received the prestigious Eisenberg Award for reducing avoidable readmissions. Over an 18-month period, the campaign helped hospitals and community partners prevent more than six thousand hospital readmissions.
Although each hospital faces its own unique challenges in managing readmissions, the RARE campaign demonstrates what a supportive and collaborative effort can achieve. It involves 82 hospitals, 100 community partners, and 3 operating partners, including the Minnesota Hospital Association. Continue reading
An alien watching a 500 meter relay would think the race is all about the baton. Why else would these beings dedicate themselves to getting this object to its destination as quickly and flawlessly as possible? A relay race would not exist without the baton to bind the individuals together and create a team event. Although each team member’s leg of the race is important, the requirement that the baton be handed from one team member to the next turns four separate runs into a single, unified performance that can be evaluated and rewarded for its overall excellence.
In the relay that is the U.S. healthcare system, the patient is the baton—and the patient baton is not as fortunate as the white plastic one. In the current healthcare set-up, the hospital discharges its responsibility for the patient’s care once it discharges the patient. Then the patient is passed like a baton from one set of provider hands to the next, wobbles and all. Continue reading
I’ve started reading a book by William Baumol called The Cost Disease, which raises an interesting question. Why in 2014 can I buy a laptop computer that is smaller, more powerful, and most of all, much cheaper than one I could have bought just ten years ago, but healthcare costs have risen from ten years ago? Why are some industries able to become more efficient, and produce more of their goods or services, faster and cheaper, while other industries are stuck in a spiral or are continually raising costs with stagnant efficiency?
I won’t give a full, in-depth review of the book, but in short, the analysis lays out the premise that in some industries, such as with computers or automobiles, manufacturers are able to continually improve on both their manufacturing processes and the quality of the goods they are manufacturing. This enables these manufacturers to produce better goods at lower costs. These lower costs then enable them to pass some of these savings on to their customers, as well as to pay their employees more money. Continue reading
In Part 8 we translated a policy by looking up each ICD-9 code in the policy in the “10-to-9 singles map with reverse index” and entered into our ICD-10 version of the policy the ICD-10 codes that were found there. We discovered that not all of our ICD-9 codes were found, and we put them on an “ICD-9 Orphan” list. Now we consider what to do with those ICD-9 codes.
Start by looking them up in the 9-to-10 singles table. If there are one or more entries for the ICD-9 code, it means one or more ICD-10 codes might be appropriate for the policy, given the definition of the ICD-9 code. The emphasis is on “might be” because the GEMs do not know the information in a patient’s chart used to assign the ICD-9 code. Those ICD-10 codes could contain additional meaning that may have been true for a patient, or not, and the ICD-9 code doesn’t specify either way. Continue reading
As more and more hospitals and healthcare organizations convert more and more of their paper medical records to electronic health records (EHRs), an interesting dynamic has begun to emerge, as well as an interesting challenge.
The dynamic is that while the conversion from paper to electronic records was promised to provide time and cost savings for healthcare, the adoption of EHR systems by physicians has led to a number of perhaps unforeseen consequences. One of the chief consequences, which could also be considered a chief complaint, is that physicians who document on their patients electronically make less eye contact with their patients and have lower patient satisfaction ratings, vs. physicians who document on paper. Continue reading
If you need a coronary artery bypass graft, India might not be the first place you’d think of to have the surgery done, but you might want to think again. A coronary bypass graft in the U. S is likely to cost $88,000 dollars. The same treatment in a JCAHO accredited hospital in India only costs $9,500. Both the U.S. and India meet world-class quality standards, so why does the surgery cost so much less in India? It’s simple: Innovation in the healthcare delivery process.
A recent Harvard Business Review article studied seven hospitals in India that are delivering world-class care at a fraction of the cost in the U.S. These hospitals are able to deliver affordable, high quality care largely because they have adopted a hub-and-spoke model for delivery. They concentrate the most expensive equipment (PET scanners, cyberknives, and cyclotrons) and specialized physicians in the Hub. In the spokes, they keep general practitioners and lower cost equipment. Patients are diagnosed and care plans are created in the hub, and the treatment is delivered in the regionalized spokes. Continue reading
When I recently read that a former hospital Chief Financial Officer (CFO) had been charged with health care fraud for falsely attesting to Meaningful Use, I could not believe the corners that he decided to cut. My first thought was that he had not been aware of the Centers for Medicare and Medicaid Services (CMS) track record for auditing to stop improper payments. In fact within a few months of his alleged fraud, CMS announced their pre-payment audits for the Medicare Electronic Health Records Incentive Program which would audit the meaningful use attestations. (See my April 2013 blog on CMS Follows the Money with New Audits.)
Then I wondered, “What must his Chief Executive Officer be thinking of such behavior?” Continue reading
Donna: Sue, do you know what the UHDDS definition is for a significant procedure?
Sue: Of course! I hate to admit it but I was actually involved with coding issues in 1986 when the UHDDS revision occurred. The UHDDS definition of a significant procedure is a procedure that is one, surgical in nature, two, carries a procedural risk, three, carries an anesthesia risk, or four, requires specialized training. Why do you ask?
Donna: Well because some hospitals are assigning ICD-9 procedure codes for every procedure performed during an inpatient stay. Continue reading