Category Archives: Quality Outcomes

Quality of care; pay for performance; quality-based reimbursement; case mix index; quality scores; quality report cards; data analytics; value-based purchasing; performance ratings; mortality rates; hospital report cards; POA; present-on-admission; HACs; hospital-acquired conditions; PPRs; potentially preventable readmissions; SOI; severity of illness; ROM; risk of mortality; healthcare reform; HealthGrades; P4P; potentially preventable complications; PPCs; state initiatives; federal funding

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

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

Whodunnit? Let’s be honest!

At the start of the New Year, I can’t help but reflect on how much patient care has changed in my 25+ years. Many things that were common practice back then were either not necessary or even sometimes harmful. An example would be Foley catheter placements. Foleys for “everyone” whether they needed them or not!

However, the advent of superbugs with increasing antibiotic resistance has also meant an increase in catheter-related UTIs. Organizations became focused on prevention, using different catheter materials thought to prevent colonization, and by evaluating the need for insertion and/or continued placement. It certainly didn’t hurt that catheter-associated UTIs (CAUTIs) were determined to be hospital-acquired preventable conditions that CMS would not reimburse, and were also factored into quality outcomes metrics by quality assessment programs or organizations. Continue reading

Those three little words…

As we wrap up another year of blogging at 3M Health Information Systems, we want to thank our readers and share an inspiring blog post from blogger Rebecca Caux-Harry.

Those three little words……that you NEVER want to hear: “You have cancer.” By the time I got that call my mind had already explored all of the possibilities from worst to best, and I was tired. You just can’t imagine how many “worst” things the mind can conceive of, especially if you’re in the healthcare industry and have a rich family history of cancer. But the call did come. I had been expecting it. I had been going through tests after finding a breast lump for about a month and a half. That’s a long time to fear the worst. At least for me it was a long time, having enjoyed exceptional health for my 50 years. Yep, turned 50 and was diagnosed with cancer in the same year. Lovely! Continue reading

Palliative Care: Payers and Providers Collaborate to Improve Quality of Life, Care and Experience

A study published by the Institute of Medicine (IOM) this fall, Dying in America: Improving Quality and Honoring Individual Preferences Near the End of Life, concluded that improving the quality and availability of medical and social services for patients and their families could not only enhance quality of life through the end of life, but may also contribute to a more sustainable care system. Among the calls to action from the IOM committee are strengthening palliative care and the reorientation of policies and payment systems to support high-quality, end-of-life care.

What is palliative care? Continue reading

Cut through to the “Gut” of Accidental Lacerations

One of the most controversial complications is an accidental laceration. It is a potentially preventable complication (PPC), a complication in all surgical cohorts for Healthgrades and is a patient safety indicator (PSI 15). Additionally, PSI 15 is included in the PSI 90 composite score and is the highest weighted component (29.83%). Hence, the importance of “getting it right” cannot be underestimated.

So when should an accidental laceration be documented, coded or clarified? Continue reading

Accuracy Matters

Thinking about all of the various quality initiatives currently out there or under development, I can’t help but think about what we DO with all of this information. Certainly accuracy is important for accurate quality scores, but isn’t accuracy important for a more basic and important reason?

Prior to joining 3M, I was employed as a nurse manager at a 600+ bed hospital. I was responsible for the CCU, CVICU and CV step-down units. Early on in my tenure, the quality and infection control departments presented statistics to the nurse managers on our infection rates by unit. To say it was concerning would be an understatement. We were tasked with developing a meaningful strategy to reduce the incidence of hospital-acquired infections and our strategy was two-fold: education and surveillance. We educated all stakeholders on the current statistics and the hospital protocols for reducing hospital acquired infections. Continue reading

Four Mistakes My Doctors Make with High Deductible Plans

A year ago my family changed to a high deductible health plan and started using a health savings account. Because we expect to pay higher upfront out-of-pocket expenses, we pay careful attention to the network requirements and out-of-pocket thresholds. Our local providers, though, seem to manage patients with high-deductible plans as if they were no different from traditional PPO plans.

There are several things I wish my providers would do differently, and not just to make it easier for me to manage my family’s health care. My providers inadvertently increased administrative time, delayed payment, and resulted in denials and write-offs. They would do better if they adapted their processes in light of the different plan requirements. Here are four suggestions for avoiding the mistakes my doctors made with my high-deductible plan: Continue reading

Who Will Win at Population Health Management?

Healthcare by transaction is dead. This economic model cannot be sustained. The new frontier involves aligning care providers across the continuum so they can think differently – and act differently. Successful population health management involves the strategic use of data to deliver the right care to the right population at the right time. Instead of managing the health of an individual episodically, providers will be challenged to manage the health of a group of individuals over time. The shift from volume to value requires providers to take on accountability for the total cost of care, the quality of care and the outcomes of care – rather than simply provide services when people are sick. Continue reading

Integrating Sociodemographic Factors into Risk Adjustment: Important Considerations for NQF’s “Robust Trial Period”

Why is it necessary that risk adjustment incorporate sociodemographic factors for my diabetic schizophrenic patients who have unstable housing?

Healthcare is fundamentally about people. That’s why, at the end of the day, it is the differences and disparities among individuals that are at the heart of the challenge facing the National Quality Forum (NQF) as it debates incorporating sociodemographic factors into risk adjustment.

Here’s a real-life example of the importance of SES factors to risk adjustment: Robert is a diabetic patient of mine who is schizophrenic with episodes of psychosis. He has difficulty with his meds in part because his housing situation is not stable. From time to time he is homeless. If there is any possibility of stabilizing his diabetes, he will need additional case management time over and above a diabetic schizophrenic who does not have the added SES burden. The case manager would not just deal with “medical” issues like making sure that Robert is taking his meds every day but also working with Robert to address conflict with neighbors that in turn are making him extremely anxious. In this case, the neighbors were extremely rowdy with loud music. The case manager was able to defuse the situation – when the neighbors were told by the housing authority to move. The same challenge applies to my asthmatic patients who live in substandard housing and are exposed to different allergens than those impacting middle-class asthmatics. In this situation, the case manager might help with making sure that insects exacerbating the asthma attacks are eliminated from the apartment. Continue reading