Maintenance of Situational Awareness, or SA, is crucial to all of our endeavors. It is the perspective and sense of what is going on around us. One would like to say it is an appreciation and evaluation of all that is relevant to the target pursuit plus extra detail to be stored away for access at a later date – often without a direct application in mind. To appreciate all aspects of an endeavor or project is an aspiration, and, depending on the context, unrealistic. In such cases, we depend on team members to help create a shared mental model. Maintaining SA is an active and incessant process. Common speech recognizes this concept in remarks such as “…missing the forest for the trees” or “…functioning with blinders on.” Continue reading
This summer, I attended a nursing informatics conference that inspired me to believe that interoperability of nursing data is achievable. The Nursing Knowledge: Big Data Science for Transforming Healthcare Conference, hosted by the University of Minnesota School of Nursing, brought together nursing thought leaders from nursing practice, education and informatics. The goal of the conference was to “Advance a national plan for capturing nursing information for big data research aimed at identifying effective care interventions and improving patient outcomes.” So the question I asked myself: “How far away are we and is nursing interoperability within reach?” This blog discusses the current state of nursing interoperability and an initiative in progress to support interoperable nursing data. Continue reading
An interesting FierceHealthIT article just announced that New York Presbyterian Hospital (NYP) is renting space at a New York City-based technology “accelerator” called Blueprint Health, LLC. Blueprint Health focuses on helping new companies or IT startups connect with healthcare organizations to aid them in developing products and bringing them to market. According to the article, NYP will run computer systems out of Blueprint’s offices and have an “innovation space.” NYP’s goal is to create closer collaboration between healthcare-IT focused startups and the hospital, ultimately resulting in new technologies being used at NYP. Continue reading
American health care continues to rank as the least cost-effective system in the developed world. Why? You might be tempted to say that, until recently, there was no incentive to change. A purely economic view is that the costs to healthcare providers have been greater than the payoff.
The economic landscape is changing. Quality reporting, value-based purchasing, Meaningful Use, risk-based contracts, and other reforms have created rewards and penalties intended to improve the value of health care. Will they work? Well. . . Ask instead, “How could they fail?” Continue reading
I have the opportunity to travel around the country, interacting with health plans and provider systems as they work out new payment models and new systems of care delivery, and I see an intense interest in these new models coupled with many theories on their pathway to success.
Weighed against the medical literature, three things are apparent:
- Most of the theories on improvement focus on processes that may have small relevance to outcomes.
- Most of the interventions at play are in very early stages and are very incremental.
- Interventions most likely to be linked to big outcomes are culturally challenging and being held at bay for the moment.
A major impact on outcomes requires bold action. Continue reading
As healthcare professionals, we have a lot of acronyms to keep straight, don’t we? Feels like alphabet soup in my head some days. I’m reminded of a scene in the movie, Good Morning Vietnam, where Robin Williams’ character has an entire conversation using acronyms, making fun of the military jargon. We could do the same in healthcare, especially in E&M coding.
Today, let’s think a bit about HPI, not to be confused with PHI. If you have a translator in your head the way I do, these two don’t even sound the same, but for those outside the realm of coding, these acronyms can get confusing. PHI is Protected Health Information. HPI, or History of Present Illness, is the portion of the E&M (Evaluation and Management) visit during which the patient describes why they are seeing the physician. Continue reading
July 4th has come and gone, but we can still look for fireworks in next year’s OPPS proposed rule, which is now available on the CMS website.
CMS plans to continue expanding the packaging they began in 2014 by implementing comprehensive APCs and packaging of ancillary services.
I was fortunate to serve on the NQF Task Force on Risk Adjustment for Socioeconomic Status or other Sociodemographic Factors (SDF)i. This report generated more comments than any other NQF Task Force Report – ever. Of the 700 comments received in reaction to the draft report, the vast majority (more than 98%) were in favor. CMS was one of a very small number of institutions opposed to the initial report. While the final report contains significant modifications to the initial report, much of the spirit and substance remains. Continue reading
A recent blog by François de Brantes, executive director of HCI3, titled “Letting the Facts Get in the Way of So-called Truths,” is highly critical of the DRG based Medicare inpatient prospective payment system (PPS). He urges readers to discover the facts about DRGs, a system he describes as endorsed by “agents of the status quo” that produces “meaningless comparisons” of patient data, with hospitals “being hurt more than helped by false truths.” As a member of the research team that developed Diagnosis Related Groups in the late 1970s, I want to respond to his assertions. Mr. de Brantes’ blog is rife with errors and distortions of fact; any valid points are lost in a barrage of misinformation. Continue reading
I previously discussed how selection of principal diagnosis may impact quality. This ripple effect (like a pebble on a pond) may occur when one works in a silo, ignoring other departments such as quality. If only the ripple effect was the lone “offender” in which CDI and coding may impact quality outcomes. Consider a spider web: intricately designed and seeming impervious. However, as strands get broken, the web collapses.
In review, CDI professionals and coders are tasked with obtaining and capturing a complete picture of the patient’s encounter for appropriate reimbursement, accurate reflection of severity of illness (SOI) and risk of mortality (ROM) and outcomes of care. Historical models of CDI programs and coding processes focused predominately on the first two tasks, without acknowledgement of how this may affect quality outcomes (potentially fracturing the spider web). Continue reading