HIMagine That! ICD-10: Continuing the Journey

Donna: Sue, where were you when you first heard the news?

Sue: Well, our D.C. office sent me a heads-up message, so I quickly turned on C-Span and watched the House vote live. It all happened so fast. Within minutes, the bill had passed the House and was moving on to the Senate.

Donna: I was on break at a conference when I got your urgent email. Incredulous is the word that describes my reaction. All I could think about was the years of work providers, payers, and vendors have invested in ICD-10 implementation. And I couldn’t help but think about the time you and I have put into it too. So, where do we go from here?

Sue: There’s nothing left to do but think positive! Continue reading

The ICD-10 delay: Three steps to take right now

The death of the October 2014 implementation date for ICD-10 unfolded faster than the plot of a 30-minute sitcom. It started in the House of Representatives on a Wednesday when a provision to delay ICD-10 was quietly attached to bill H.R. 4302, also known as the SGR “doc fix” bill, and it was all over by the following Tuesday when President Obama signed the bill into law. If you blinked, you missed all the action.

Hospitals, payers, providers, and vendors have all invested millions of dollars and countless hours over the past several years getting ready for the transition, and then without notice someone moved the finish line – to October 1, 2015 maybe? Those hospitals who prepared early feel like they are paying a penalty for acting in good faith, while those who procrastinated are feeling vindicated and hopeful ICD-10 will never happen. Continue reading

ICNP/SNOMED CT Nursing Terminology Collaboration

In January, the International Health Terminology Standards Development Organization (IHTSDO) and the International Council of Nursing (ICN) announced the release of an equivalency table between the International Classification for Nursing Practice (ICNP) concepts and SNOMED CT concepts. What does this mean for nursing? In order to answer this I will describe the collaboration agreement between the ICN and IHTSDO, give an overview of ICNP, and discuss how this agreement impacts standardized nursing terminologies.

The IHTSDO has a formal Harmonization Agreement with ICN to “advance terminology harmonization and foster interoperability in health information systems.” ICN is a federation of more than 130 national nurse associations representing millions of nurses worldwide. Operated by nurses and leading nursing internationally, ICN works to ensure quality nursing care for all and sound health policies globally. Continue reading

How Progressive Hospitals Operationalize Their Quality Data

You’ve got your quality data. Now what?

Hospitals don’t lack for data on quality outcomes. The real question is what to do with it. Even after making sure the data is sound—by checking documentation, coding for accuracy, and verifying the integrity of data in the EHR, for example—people often wonder how to understand and use the information.

There aren’t easy answers. But, there are good answers and many, many good examples. A number of 3M customers are improving patient outcomes through deliberate and innovative uses of their quality data. Continue reading

Providers Dodge a Bullet: Reimbursement Might Have Been Tied to Hospital Medical Necessity Denials

Doctors, nurse practitioners, nursing homes, lab, ambulance, and home health providers dodged a major bullet.

While it’s still freezing cold on the East Coast, CMS released Transmittal 505, Change Request 8425 on a very hot topic – extending record requests for medical necessity audits of admissions. The subject of the CR “Removing Prohibition” means (according to CMS) “allow(ing) the contractors to make a decision or take action on claims that are not currently being under review.”

But on March 19, 2014 CMS rescinded the transmittal citing “the need to clarify CMS’s policy” regarding removing prohibition. They also said the policy will not be replaced at this time. Let this be a warning: CMS came very close to denying collateral provider claims for medically unnecessary admissions. This is something they are obviously serious about. Continue reading

Quality, Prices, and Health System Consolidation

The healthcare landscape is changing rapidly, but will we be happy with the outcome? The challenge of coordinated care, nascent accountable care organizations (ACO), and evolving integrated provider/payer entities that manage care on behalf of Medicaid programs, are supporting the rationale for increasing consolidation across providers. It is unclear whether this rationale holds water or is a cover for aggressive (or defensive depending on your viewpoint), market repositioning.

Federal regulation of the healthcare marketplace has a troubled history. While the Department of Justice and Federal Trade Commission hold to the core principle that consolidation that eliminates competition will result in higher prices and ultimately lower quality, plenty of opponents have lined up to describe the special situation of health care. In fact, until a successful post-merger challenge against Evanston Northwestern Corporation, the federal agencies had not won a single challenge against hospital system mergers in over a decade (Rice, 2010). In general, public sentiment, and by extension the legal system, tends not to side with powerful local monopolies.

Health care systems are different. They tend to be well financed, but not for profit. They raise prices for insurers, but not directly to consumers. Most importantly, they are run by the guys in white coats that we need to trust when we are ill. The confluence of these factors leads to scant public support for aggressive regulation. Continue reading

Top 5 Report Creation Annoyances in Radiology

It’s about productivity and accuracy – anything else is a distraction

Guest blog by Dr. Arnold Raizon, MD, a physician consultant with 3M ChartScriptMD for Radiology.

One of my biggest frustrations as a radiologist is dealing with the quirks of the software tools I must use to create my reports. Some applications look like they were not really created from the ground up for radiology use, but merely a collection of patches over generic software that frustrate busy radiologists like me. Let’s examine in more detail some of the common annoyances that hinder radiologists’ ability to stay productive and, more importantly, how to address them.

Continue reading

DIY ICD-10 conversion – Part 11

At the end of Part 9, we were translating a list of ICD-9 codes – a policy – into ICD-10. We used the 10-to-9 single GEMs with reverse lookup to find ICD-10 codes that should be in your ICD-10 version of the policy. We had some ICD-9 codes left over that no ICD-10 code translated to. You tried to look them up in the 9-to-10 single GEMs. You found some translated to ICD-10 codes already in your ICD-10 policy list, so you could feel assured that their meaning was taken care of. A few may have translated to single ICD-10 codes not already on your list. Those ICD-10 codes (“pink” in CTT) might be appropriate for your policy, but a clinical review of them was recommended.

Finding all the ICD-10 codes that might be on a patient’s record, and that might imply the patient satisfies the policy, is the objective of our process. Have we now found them all? Consider this case from Part 10: Continue reading

ONC Leaders on Ensuring Data Quality

On February 26 I was fortunate to attend a summit on “The Decade of Health IT” at the HIMSS 14 conference in Orlando, FL. The summit was sponsored by the Certification Commission for Health Information Technology (CCHIT) and featured a panel discussion made up of the current and three former National Coordinators for Health Information Technology. As part of the dialogue, audience members were invited to tweet questions for the panel concerning the future of HIT. I asked a question concerning data quality and want to share the response with you.

This was my initial question:Jill Devrick, Tweet 1

It generated a discussion among the panelists, which I recorded. Here’s how the panel conversation played out: Continue reading

Employees as the Teachers: What an Organization Can Learn

As a compliance officer I have the opportunity to publish training on various compliance topics to our workforce. We just completed a required training and I think I learned as much about how the organization works as the workforce may have learned from the training.

From an employee’s perspective, completing a required compliance training course may be the last thing they want to do, yet from the organization’s standpoint, it’s one of the most important things for them to do. Protecting the privacy and security of patient data is of utmost concern for any compliance officer in health care. The Ponemon Institute just published its Fourth Annual Benchmark Study on Patient Privacy and Data Security which emphasized the role employees have in detecting data breaches, while at the same time noted that employee negligence is considered a worry by many of the respondents to their survey. Organizations in the Ponemon study reported that they rely upon policies and procedures to achieve compliance and secure data. What this tells us is that training employees on proper security methods, policies and our code of conduct, as well as guidelines for how to report an issue is paramount. Continue reading