In a legislative report on the Accountable Care Collaborative (ACC), the Colorado Department of Health Care Policy and Financing details how the program helped the state avoid $44 million in costs during the 2012-2013 fiscal year. That’s less than one percent of the total federal and state spending for Colorado Medicaid this year.
The ACC program has assigned about 350,000 Medicaid clients to patient-centered medical homes. These clients make up about half of Colorado’s Medicaid population. Primary care medical providers and case managers coordinate medical and non-medical care and services within seven regional care collaborative organizations.
The goal is to improve health outcomes within a sustainable care delivery system. Continue reading
In DIY Part 2 we digressed from learning how to convert a policy to answer, “What is a code?” We continue with:
Common confusion 2: What is ICD-10?
Wikipedia says , “ICD-10 is the 10th revision of the International Statistical Classification of Diseases and Related Health Problems” developed by the World Health Organization (WHO) and released in 1992. Countries, including the U.S., use it to report mortality and morbidity statistics to the U.N. and other international bodies.
Hold on. This isn’t the ICD-10 we’re talking about. What comes out of WHO is viewed as insufficiently detailed to support payment systems, so countries extend it. Continue reading
We’ve just returned from our trip to the Annual AMIA Symposium held November 16-20 in Washington, DC. 3M sent one of our largest groups ever to the conference, with a total of thirteen 3M’ers attending. It was great to re-connect with old friends, meet new people, conduct business, and have fun.
The conference kicked off with a keynote by Dave deBronkart, also known as “e-Patient Dave,” discussing the empowerment of the patient consumer and how the Internet has facilitated that. His interesting anecdotes and charisma really brought home the importance of patient engagement in the healthcare process. Continue reading
I attended two AHIMA events this fall – the Health Information Integrity Summit back in September, and the Annual Convention and Exhibit in October. These events have prompted me to think about data governance – the people, processes, and technology that are put in place to create a framework for capturing data. My background in document creation workflows and technology makes me keenly aware of how quality issues can make or break the success of documentation processes further downstream in the cycle such as coding, analytics, and system interoperability.
I often hear the cliché “garbage in, garbage out,” being used to describe how bad content capture practices can lead to a myriad of problems when attempting to use captured data and documentation for decision making and quality improvement. Continue reading
Donna: Sue, time is flying and I am surprised at how many questions we hear regarding who should be involved in ICD-10 education and awareness programs.
Sue: I heard that all staff except for housekeeping and maintenance need to be aware of ICD-10.
Donna: One hospital I visited told me that they discovered that the housekeeping staff used ICD-9 codes to determine how thoroughly the rooms should be cleaned. Continue reading
Read any healthcare journal or newsletter and you’re likely to find a discussion about “big data.” As industry experts weigh in on what constitutes big data and how best to use it to improve healthcare, two important questions must be asked: Is the data clinically meaningful? Is the objective realistic?
A recent issue of Medical Care featured a lead commentary by Greg de Lissovoy, PhD, that trumpets the accomplishments of big data in a study reported in the same issue. In the article “Identifying Patients at Increased Risk for Unplanned Readmission,” researcher Elizabeth Bradley, PhD, and her co-authors describe the Rothman Index (RI), a predictive analytic tool that they claim is able to predict readmissions at the individual level. Continue reading
I was asked recently if the medical necessity data files that 3M calls ‘medical necessity dictionaries’ are the same as products that have medical necessity checking capabilities. It’s really a great question and if you are not in the software or data creation business it certainly can be confusing.
The medical necessity dictionaries are data files that 3M creates to mirror the CMS National Coverage Determinations (NCD) policies. Data is also created to represent Local Coverage Determination (LCD) policies created by the MAC (Medicare Administrative Contractors) vendors. The data files are content used in vendor, payer and hospital software systems. Continue reading
Recent events have reminded me that most of the time people want to do the right thing. Some examples include the bus driver in Buffalo, New York who stopped his bus and calmly encouraged a woman to come with him instead of jumping off a bridge. Although he was later rewarded, his actions were independent of any personal gain. Another event was the Connecticut Rabbi who had bought a desk from Craigslist, found $98,000 that had fallen behind the drawers and returned it to the former owner of the desk. He too was rewarded, although he accepted the reward reluctantly. His actions were based upon motives to do the right thing, not for a potential gain.
If people are willing to extend themselves to others in these ways, why not extend themselves to their organization where they spend the bulk of their time? This is a follow up to my blog on Why Unethical Behavior Goes Unchecked in which I discussed how studies have shown that employees are reluctant to report misconduct because they fear retaliation or expect no follow through on their concerns. How can organizations change to help employees decide to not only report misconduct, but offer recommendations for a better workplace? Continue reading
If you are a provider, you probably put ICD-9 codes on claims in order to get paid. If you are a payer, you receive claims with ICD-9 codes on them. (The “you” in those sentences has to be taken very broadly – it could mean, for example, “the software used by the coders employed by the company you outsource your revenue management to – or your claims adjudication to.”) In any case, I’m not going to talk just now about the ICD-9 codes on your claims.
So where else do you have ICD-9 codes? You might be surprised. They can turn up anywhere someone wants to identify a set of patients clinically and isn’t satisfied just using English and trusting that everyone will interpret it consistently. Continue reading
I don’t like math; numbers are not my friends. And statistics? Let’s not even go there – but Office of Inspector General (OIG) is already barreling down that road leaving hospital administrators shaking their heads.
Consider: In October, OIG fined the University of Miami Hospital $3.7+ million for extrapolated (assumed) medically unnecessary short stay admissions. To determine the fine, OIG used data mining techniques coupled with ‘statistical sampling ‘methodology. They then extrapolated to determine a total likely error rate. It works something like this: If Hospital A has X number of errors identified on Y number of claims, then Z likely represents the total number of medical necessity errors in their entire universe of short stay claims for a given date range. Using statistics, OIG determined a number of claims they believe were likely to have contained errors. This technique – according to OIG – is not new: Continue reading