Singapore Ranks #1 in Healthcare Efficiency, but Not Primary Care – What Are the Lessons for the U.S.?

In 2014, Singapore achieved the top rank among 54 industrialized countries for healthcare efficiency. The United States ranked 44th. Singapore’s average life expectancy of 82.1 years and a per capita healthcare cost of only $2,426 (4.5% of GDP) earned it top billing. The average life expectancy in the United States is 78.7 and the U.S. reluctantly boasts the highest per capita healthcare expense of $8,895, accounting for 17.2% of GDP.

Should the U.S. adopt Singapore’s approach to the financing and delivery of health care, and if it did, would it achieve the same outcomes and similar quality? First, we need to understand what makes Singapore so different. Continue reading

E&M Coding: Promoting the Value of Coders

Because this is a new year, my mind turns to the things I’d like to change. Rather than making the tried and true, or tried and failed “New Year’s resolutions,” I like to set goals for myself. Since 2014 was difficult in terms of my health, one of my goals is to return to my previous fitness. But, I also like to think about my professional life and the goals I’d like to set within that realm. What sort of fitness can I improve on in my professional life?

The world of professional coding is changing fast. I don’t mean ICD-10. The new code set has been imminent since I started coding many, many years ago. I’m talking more about ACOs, HCCs, PBCs, and the ever present EMRs. Continue reading

Dumb Ways to Die: The 8 Not Dumbest ICD-10 Codes

Yes, there are ICD-10 codes for exceedingly rare ways to die, and yes, they are easy to parody. This does not matter at all, since not many people are admitted to the hospital for a prolonged stay in a weightless environment.

What does matter is that preventable errors in hospital care are the third leading cause of death, after cancer and heart disease. Updated estimates in a 2013 study in the Journal of Patient Safety say that between 210,000 and 440,000 people die in US hospitals every year because some preventable harm was done to them. Continue reading

Complexity Adjustment: CMS Updates I/OCE Specifications and Software

Last week, CMS published updated I/OCE specifications and software. The changes revolved around calculations of the complexity adjustment for the comprehensive APCs (C-APCs).

Bypassing the code pair ranking

The specific language change in the specifications is in Appendix L where there is a note added: “In some instances, code pair combinations specified for complexity-adjustment may have a secondary procedure with a higher rank than the primary procedure. In these cases, the rank is ignored and the complexity-adjusted APC remains assigned to the primary procedure of the code pair.” Continue reading

HIMagine That! Dual Coding

Sue: Happy New Year, Donna! Did you enjoy the holidays?

Donna: The holidays were wonderful, and you know I always feel reenergized in the new year!

Sue: Me, too! Instead of making New Year’s resolutions though, I focus on cleaning, straightening and getting organized.

Donna: Speaking of getting organized, I started making a list of what needs to be accomplished before ICD-10 goes live in October. Continue reading

Gaining Value from Post-Acute Care: Incentives, Structure or Management?

It is well known that a viable source of health dollar savings is the efficient use of post-acute care (PAC) services. MedPAC has identified widespread variation in post-acute care utilization, with limited control over the reasonableness and quality of service provided. This situation has resulted from three factors: confusion as to what constitutes PAC (defined by program benefit), fragmentation of PAC payment (which tends to be site rather than service specific) and the absence of comprehensive risk-adjustment to determine the relative intensity and need for PAC services. Substantial opportunities to improve risk-adjustment will be available after the implementation of ICD-10 (which contains significant numbers of continuation of care codes), particularly if the Continuity Assessment Record and Evaluation (CARE) is also implemented across PAC settings. Continue reading

Why Would Anyone Care about Solo and Small Primary Care Practices?

 

Maybe solo primary care practices are dying, but so what?

This question led some folks at Mathematica Policy Research to look into solo primary care practice and the results are interesting

They looked at a handful of states and found that the ratio of solo and very small practices varies quite a bit but represents a significant proportion of practices.  While on average 13 percent of primary care physicians practice solo, this represents 46 percent of practices.  65 percent of practices have one or two physicians. Continue reading

Taking a Closer Look at the December ICD-10 Coding Challenge

CHALLENGE QUESTION:

 A 72 –year old male was admitted to the hospital with a chief complaint of a  fever with a temperature of 101° F and feeling ill with worsening chills, cough, nasal congestion and body aches that began two days prior to admission. A chest x-ray revealed bilateral infiltrates in both lower lobes of the lungs. A viral culture was positive for AH3N2 influenza.  The patient received antiviral medication and supportive care.  The patient recovered enough to be discharged three days later with a diagnosis of pneumonia due to AH3N2 influenza.

Assign ICD-10 diagnosis codes for the inpatient hospitalization. Continue reading

Three Resolutions Any Hospital Can Follow for Better Performance in 2015

There is plenty of speculation about the fate of hospitals and healthcare IT. The uncertainty could make it difficult for hospital executives to set strategies for the coming year. Yet, there are a few near-certainties as we go into 2015. Here are three resolutions hospital executives should make to keep pace with 2015 trends. Continue reading

ICD-10: Defining Clearer Boundaries

What makes a species distinct enough that it gets its own unique name? In my last blog, I discussed the taxonomy of living things developed by Carl Linnaeus in the 18th century. Like any classification system, Linnaeus’ conceptual framework for organizing and naming living things is an exercise in drawing boundaries. Similar things are grouped together, initially by laying out general boundaries—is it animal, vegetable, or mineral?—and making progressively finer distinctions.

All classification systems work in basically the same way, because all classification systems are products of the human mind. Classification is a profoundly human endeavor. We invent systems that allow us to organize and codify our understanding of the world and ourselves. Continue reading