The Patient’s Side of Telemedicine

Last week, I had the opportunity to visit Good Samaritan Clinic in central Honduras. The clinic supports the primary care needs of 90,000 people within the municipality. Access to specialists is few and far between so Good Samaritan recently implemented telemedicine technology (computer, camera, imaging, and internet) to connect with specialists in the US. Access to these specialists is made available at no cost through the “Global Partnership for TeleHealth (GPT).”

Telemedicine is often defined as “the use of information and communications technology to deliver healthcare, particularly in settings where access to medical services is insufficient.” Better overall patient care and improved outcomes are cornerstones of telemedicine. As a result, many hospitals and health systems are deploying telemedicine as a way for rural patients to have access to healthcare services that they would not be able to obtain otherwise. Continue reading

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

Blog by Julia Palmer

A patient presented to outpatient surgery for laser treatment of scars from third-degree burns. The patient had a large scar on her neck, one on her chest, and a third one on her abdomen. Laser treatment of the skin of each area was performed successfully.

The codes for last month’s scenario are as follows:
L90.5 Scar conditions and fibrosis of skin
T21.32XS Sequela of third degree burn of abdomen
T21.31XS Sequela of third degree burn of chest
T20.37XS Sequela of third degree burn of neck Continue reading

Medical Homes: It’s not “Do they work?” but “How do they work?”

Earlier this year, The Journal of the American Medical Association (JAMA) published a widely publicized but limited article on medical homes in Pennsylvania that found little improvements in quality and no improvements in costs or utilization associated with medical homes. The authors concluded medical homes may generally “need further refinement” — a phrase that was taken by many in the press to mean that medical homes “don’t work.”

Subsequently, there has been much debate and little clarity around the promise of medical homes. Continue reading

Report from AMDIS: Top CMIO Issues

Last week we attended the 2014 Physician-Computer Connection Symposium sponsored by AMDIS, the Association of Medical Directors of Information Systems. It was our first time attending the event, held this year in Ojai, California. The conference is geared toward the needs and concerns of Chief Medical Information/Informatics Officers (CMIOs), and we learned a great deal about the issues that are top of mind for today’s CMIOs. This is a relatively new role within hospitals, health systems, and corporations. In the past, the CMIO was primarily seen as a liaison or bridge between providers and IT; more recently, however, the role has transformed into a leadership position that plays a key role in IT decision making, managing people, and even managing its own budget. Continue reading

CQI and Performance Evaluation: The Debrief

Continuous quality improvement is well known to us and integral to the culture of 3M. We often think of this as process improvement, employing Six Sigma and Lean methodologies. There is a distinctly human aspect to evaluation of individual and critical team performance because of opportunities for personal growth and refinements to team dynamics, respectively. Tremendous value is achieved when individuals bring absolute honesty and integrity to the process. Continue reading

What Will Patients Do When They See Your Prices?

Two trends are forcing greater consumerism and price sensitivity in health care. One is that Medicare, Medicaid, and some commercial insurance carriers, are starting to show patients and employers the prices facilities charge for common procedures. Another factor is that patients with high-deductible health and account-based plans have an incentive to consider cost when choosing services and providers.

How consumer-savvy are patients? They can search for providers by quality measures on a number of websites including and But it’s not as easy to find out what providers charge for, say, an MRI or sinus surgery and compare prices to quality measures. Continue reading

A Gift from the OIG That Could Be Worth Millions

Not convinced of the importance of administrative and financial data integrity in health care? Consider – both OIG and OCR (Office of Civil Rights) are monitoring healthcare provider’s (facility and professional) compliance patterns. Whether it is a HIPAA violation or claim error, they are able to determine if the problem is due to a simple mistake or emblematic of larger systems issues. Repeated non compliance patterns are revealed in monitored data.

On June 5, 2014 the OIG released results of an audit performed on a large medical center for calendar years 2010 and 2011. Unfortunately, the medical center was found to be in non compliance with about 50 percent of the claims reviewed. The OIG’s data monitoring efforts identify areas of concern – even when an organization believes it is compliant. Just like banking and other regulated industries, data integrity is crucial to both providers and monitors. Every aspect of compliance – especially those that are most complicated – becomes critical. Continue reading

Price Shopping and Narrow Networks

Making available hospital prices – amounts paid to hospitals – has historically been handled with a great deal of caution by policy makers. Fear that hospitals will use posted prices to coordinate negotiated rates with insurers has evolved into numerous legal arrangements shielding payments from scrutiny. Moreover, the hospitals that would be seen to gain, if we accept this viewpoint, are concerned that the public will misinterpret price information. The result has been a payment system that is to a large extent shielded from daylight. There are signs that this is changing. While there seems to be increasing support for, and attempts to deliver, hospital price transparency, there remains little consistency among proponents on how to define transparency and what it should achieve. Continue reading

Live from HFMA: Will data fix our broken health care system?

At the 2014 HFMA conference here in Las Vegas, Dr. Atul Gawande delivered the keynote address and outlined four emerging lessons about U.S. health care:

  1. The debate about whether to provide health care coverage to Americans is over.
  2. The delivery system is still broken.
  3. Understanding the sickest is how we fix our health care system.
  4. Success requires making data the most important resource to clinicians and patients for improving care.

So, what does this really mean and what is missing from this picture? Continue reading

Toss Those Pebbles Carefully…The Ripple Effect of CDI and Coding on Quality Outcomes

I have never been able to skip a stone, but I do enjoy watching the ripples expand until they disappear. Or do they?

Clinical documentation improvement (CDI) has been around for quite a while and the function has changed throughout the years. Initially, the focus was on appropriate financial reimbursement for resources provided to patients. As quality of care became more transparent, the scope expanded into accurate reflection of severity of illness and risk of mortality. Today, the role of clinical documentation has grown far beyond these two functions. Continue reading