Hiking the Path to Interoperability

Interoperability is one of the leading goals in the healthcare industry, but how can we get there? In spite of decades of experience with electronic health records, the lack of semantic interoperability in healthcare has prevented sharing of healthcare data. Often, health data is not comparable, cannot be aggregated, and  cannot be used to accurately automate or augment clinical decision making. The Health Information Technology Standards Committee has recommended Logical Observations, Identifiers, Names and Codes (LOINC) as the standard for structured coded assessment instruments and Systemized Nomenclature of Medicine Clinical Terms (SNOMED CT) for appropriate responses (“answers”). This implies that point-of-care measures should be codified using LOINC and SNOMED CT.

Reviewing “Reviewing Top 10 DRGs…”

For the Record magazine recently posted an article, “Reviewing Top 10 DRGs, Codes, Insufficient for ICD-10 Prep,” by Valerie Rinkle. AHIMA linked to it from one of their recent emails, so many of you may have already seen it.

The article accurately reflects the current ICD-10 zeitgeist—everyone is concerned about the financial impact of the coming transition to ICD-10—and since 3M also sells the kind of comprehensive analysis it recommends, I ought to be like, “Right on! Go for it!” But I have some reservations that get in the way, so I figure I can share them with you and you can draw your own conclusions.

CMS Follows the Money with New Audits

When I read recently about the new pre-payment audit plan to assess accuracy of the Medicare Electronic Health Record (EHR) Incentive Program payments, I was not surprised at all. In fact, I expected these audits would have been conducted sooner. CMS has indicated for years that they are stopping pay and chase (paying claims and then chasing to recoup errors) and will attempt to eliminate inappropriate payments from being made in the first place. That method of stopping the pay and chase has been introduced into the Medicare EHR Incentive Program starting with the attestations made in January 2013. Providers are now subject to pre-payment audits, yet not all providers receiving a letter from the contractor, Figliozzi and Company, for a pre-payment audit will be under suspicion. Some providers will be randomly selected in addition to those that have been targeted.

Medicare ICD-10 National Provider Call on April 18—Be There or Be the Only One Not There

I just got an email from Medicare telling me the ICD-10 outreach calls have become extremely popular. In fact, the number of registrants is currently at a ginormous 10,977—10,978 once I register. If you haven’t listened to one of these, you should. If you haven’t listened in on one of these lately, you should again. I am in the “not lately” camp, so I’m going to be there.

This link will give you a summary of the presentation and the link to register for the call. It’s free, but you have to register ahead of time, before noon on Thursday, April 18. If you are an AHIMA member or AAPC member, you can get CE credits for attending.

If you can’t make the call, the presentation is already posted at the site. If you are registered, the slide presentation will be emailed to you on the day of the call.

Rhonda Butler is a Senior Clinical Research Analyst with 3M Health Information Systems.

For or Against – Which Side Will Providers Choose in the Big Data Revolution?

The healthcare industry, and specifically the healthcare provider segment, is moving towards a rather interesting and potentially dangerous intersection in the near future.  As electronic health records expand and allow for more digitized patient data to be analyzed by an ever-increasing array of analytical processing power, we’re going to see a huge growth in the amount of “information” that can be returned to healthcare providers.  At the same time, we’re seeing the well-known-but-often-ignored issue of “alert fatigue” and EHR workflow frustration becoming a major problem for healthcare providers.

Just browsing through any healthcare industry websites or taking a quick look at the PR coming from healthcare software companies, you can easily see what the McKinsey Company outlines in a recent article, “The big data revolution in healthcare: Accelerating value and innovation”: big data is on its way. 

Troubleshooting: WHEN and WHY?

When troubleshooting technical problems, I recommend answering six questions regarding the who, what, when, where, why, and how of the situation.  In this post, I will discuss WHEN and WHY.

When does the problem occur?

WHEN an issue occurs, it’s helpful to know the date and time of the onset, and if it is a recurring issue, how often it reappears.  At what point did it go from working acceptably to not?  Does it happen every time you perform a certain function?  Does it occur at the same time every day?  Is it constant?  Does it get better or worse at certain times of the day? 

Misusing the Reimbursement Map

The so-called Reimbursement Mapping is an ICD-10-code-to-ICD-9-code/cluster crosswalk available on the CMS website. It was created by taking each ICD-10-CM/PCS code and looking it up in the ICD-10–to–ICD-9 GEM. When only one ICD-9 translation was found there, it was left just as it is in the GEM entry, paired with the source ICD-10 code in the Reimbursement Map. When multiple alternatives were found, the ICD-9 alternative most frequently coded was used (based on ICD-9 Medicare data for everything but obstetrics and newborns and several years of commercial data for obstetrics and newborns).

The Reimbursement Mapping was developed by 3M under contract to CMS, in response to industry requests for a 10-to-9 crosswalk that could be used for payment. CMS did not create it for itself and has announced at every opportunity that CMS will not be using the mapping for any purpose whatsoever.

I can think of only two legitimate uses for the so-called Reimbursement Mapping:

Differences that Impact MS-DRGs: Obstetrics and Complete Coding for ICD-10

Since MS-DRGs get used for all kinds of things beyond their intended use, which is prospective payment for Medicare recipients, one of the most commonly discussed differences between ICD-9 and ICD-10 is in the obstetrics DRGs. If you ever have seen, heard, or read even one presentation about ICD-10 codes, you have probably been told that one major difference is, “ICD-9 obstetrics codes are classified by whether the patient delivered during the encounter, and ICD-10 codes are classified by trimester of the pregnancy.”

Excellent bit of ICD-10 intel, but it is about three rungs up the ladder of abstraction for our purposes. To understand how this impacts MS-DRGs, I intend to plant both feet on the rhetorical ground. Let’s take the simplest of examples—a pregnant woman is admitted to the hospital in active labor.

Five Simple Principles for Tackling Hospital-Acquired Complications

My first epiphany at the 3M Client Experience Summit this week came ten minutes into the first client presentation I attended. Here it is: There is a simple approach to the complex issue of reducing hospital-acquired complications (HACs).

By simple I don’t mean easy, because there is plenty of hard work involved. Nor is it simplistic, because it requires smart problem-solving. Yet I can count the guiding principles on the fingers of one hand:

Are Docs On Board with Clinical Documentation Improvement?

This February, I participated in the first of four 3M Data Integrity webinars, where a polling question was asked of the audience: Are your physicians actively engaged in documentation improvement?” Here’s how the participants answered:

• 59 percent said that their physicians were actively engaged in documentation improvement
• 36 percent responded that their physicians were NOT actively engaged in documentation improvement
• 5 percent were not sure or did not know