What Can Go Wrong with PCP Attribution and How It Can Be Prevented

Attributing a person to a primary care physician (PCP) is an essential feature of population health management because it enables an accurate and fair assessment of the quality of care a provider delivers. Attribution is based on the concept that a PCP is responsible to a person across time and the entire continuum of care. It establishes this responsibility, creating a relationship between a person and his or her PCP. When members have a designated PCP, plans are able to consider the overall health of a PCP’s unique panel of patients, enabling them to measure and reward provider performance on an apples-to-apples basis. Continue reading

Flaunt Your (Quality) Assets

“That’s it baby. When you got it, flaunt it. Flaunt it!”

The famous line is shouted by theater producer Max Bialystock in the 1968 movie The Producers. It could just as easily be the advice of strategists to health systems and hospitals today. When you got good quality, flaunt it. Show it off in the marketplace.

The key is to demonstrate quality—which, like beauty, lies in the eye of the beholder. Some hospitals and health systems might feel they don’t have much to show off, but rankings aren’t the only measure of quality in health care. Continue reading

Meaningful Use and Laboratory Data Management: Getting to the Next Level

I am known for having a “glass is half full” optimistic view of life, so when I was recently presented with the opportunity to be a panelist at a Meaningful Use discussion, I accepted. The discussion was held at the American Association for Clinical Chemistry (AACC) 2014 annual meeting in Chicago. This year’s Healthcare Forum session was held jointly with American Society for Clinical Laboratory Scientists (ASCLS). I pondered the best way to adequately portray the complexity (a.k.a. frustration and confusion) occurring across the industry as hospitals attempt to keep up with MU (not to mention all of the other federal mandates). Continue reading

We Need a New Way to Finance Hospital Externalities

Paying hospitals for beneficial mission-related costs has been a hit and miss affair. These costs fall under the general headings of providing indirect medical education, ensuring standby capacity for trauma services, piloting new technologies, supporting medical research and treating those unable to pay for care. Providing funding for each of these categories is not without controversy – principally over how much support is warranted and how much contributes to wasteful inefficiency or just plain inequitable hospital funding. Whether we believe too much or too little is being given to support these community benefits, the existing structural problems for financing these mission-related costs are being exacerbated by changes in the insurance market. Continue reading

Follow-up: August Coding Challenge on Ebola

Since writing about coding of the Ebola virus disease in ICD-9 and ICD-10 for last month’s Coding Challenge, an interesting conundrum has come to light that I want to share with you.

It turns out there are two different codes that can be assigned to Ebola virus disease in ICD-9 depending on the way Ebola is located in the ICD-9 Alphabetic Index. Continue reading

Will you pass Meaningful Use Stage 1 for Natural Language Processing?

The MU of NLP. Haven’t heard of that yet? Well, it’s a new concept and I think it’s going to become as standard and important as Meaningful Use of EHRs. As important as MU is for EHR adoption and in fully evolving healthcare from the paper era, the true revolutionary advances are going to come from making sense of all of the digital data being collected in an electronic health record.

So, what are the Stage 1 requirements for meeting Meaningful Use of Natural Language Processing? The criteria are twofold. The first part is the criteria for establishing a fully integrated NLP platform with your clinical workflows. The second part is meeting two key use cases. Continue reading

The Oops Factor: Not All Documentation Errors are Created Equal

When reviewing and evaluating healthcare documentation from a quality and integrity perspective, a QA reviewer is looking to capture and address any error, regardless of source and severity. However, some errors are more critical in nature because of their potential impact upon patient safety, care, or treatment. Other errors may have an impact upon documentation quality, but their presence does not change the meaning of a document or affect patient care. In this post I would like to discuss critical errors discovered through documentation QA, but stay tuned for future posts addressing noncritical errors and educational feedback opportunities. Continue reading

ICD-10: A Common Language for Monitoring Ebola and Other Global Health Threats

As the fourth American Ebola patient, a physician serving in West Africa, was flown to the U.S. for emergency care this week, I was reminded that public health also wins from the implementation of ICD-10.

According to World Health Organization (WHO), the latest Ebola outbreak has killed almost 2,300 people in five West African countries. Medical workers have been hit hard by the Ebola epidemic. As of late August, more than 240 healthcare workers had developed Ebola and more than 120 had died. Continue reading

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


A 65-year old female was seen as an outpatient by her internist for monitoring of her hypertension and type 2 diabetes mellitus. During the course of the visit, the patient told her physician that she had been feeling sad and depressed as of late. After discussion, the patient agreed to a trial of antidepressant medication therapy. Prescription renewals for enalapril and metformin along with a new prescription for the antidepressant were sent to the patient’s pharmacy electronically. The diagnoses for the visit were hypertension, type 2 diabetes mellitus and depression. Assign diagnoses codes for this outpatient encounter. Continue reading

Four Things Providers Need Before They Can Embrace Value-Based Payment

The concept that payment for health care should be based on quality and clinically meaningful outcomes is not new, but the current breadth, variety and rapid adoption of value-based models is unprecedented. Value-based payment models now include accountable care organizations (ACOs), patient-centered medical homes (PCMHs), bundled and episode-based payments, and pay for performance structures.

There are now more than 600 Medicare and non-Medicare ACOs. This is more than a 300% increase from the end of 2011 when the first 32 Medicare ACOs were announced, at which time there were approximately 160 private sector ACOs. The increase in PCMHs is no less remarkable with a 5-year increase from 28 in 2008 to nearly 6,000 in late 2013 – and that only includes those with NCQA accreditation.

Continue reading