Donna: Hey Sue, I am getting questions regarding Clinical Documentation Improvement (CDI) staff involvement in ICD-10 implementation.
Sue: Hopefully the CDI staff will be involved in the enterprise wide ICD-10 education, allowing them to fully understand the documentation changes needed to support ICD-10 as well as what stays the same. They’ll be on the front lines educating the physicians on I-10.
Donna: That’s true, along with generating queries for additional documentation. I see them starting to query as soon as possible for some of the specificity needed to minimize the query overload that is anticipated after October 2014.
Sue: They can pick a few diagnoses to start with and then gradually add more – you know, kind of easing themselves as well as the physicians into I-10. Take for example the diagnosis of respiratory failure. In ICD-9, the diagnosis of “respiratory failure” defaulted to the code for acute respiratory failure. In ICD-10 that won’t be the case – it will default to an unspecified respiratory failure code. So, today, when the CDI staff sees a diagnosis of unspecified respiratory failure, they can work on clarifying whether it is acute, chronic, or acute-on-chronic. Oh, and now in ICD-10, respiratory failure is further specified as being “with hypoxia” or “with hypercapnia.” Continue reading
Wow, the last couple weeks have been busy, considering the 2014 Outpatient Prospective Payment System (OPPS) proposed rules . Every year CMS publishes an OPPS proposed rule with a 60 day comment period, giving affected parties a chance to review it. CMS includes descriptions of changes to grouping logic, updated packaging policies, modifications to payment rules, and other pertinent topics affecting OPPS. The final rule is usually published on or about November 1st. The 2014 proposed rule was published July 8th with a comment period set for September 6th. This rule represents the largest change in hospital payment since OPPS was introduced in August 2000. Continue reading
Strides seem to have been made towards a moderate approach to the oversight of Health IT. When I read recently that the Health Information Technology Policy Committee (HITPC) of the Office of the National Coordinator (ONC) approved the recommendations of its workgroup related to oversight of Health IT, I was intrigued. It seems that the Food and Drug Administration (FDA) has been increasingly interested in regulating Health IT. It is understandable that when software is directly linked to patient safety, regulation may be necessary to prevent unintended consequences. But where did that leave the rest of the software that managed administrative and other functions that providers rely upon? Does the non-patient care software require the same level of overhead and oversight as software that functions with a medical device? Continue reading
Towards midnight, a cop comes upon a guy crawling around on his hands and knees under a streetlight. The cop asks, “What are you doing?” “Looking for my car keys.” The cop thinks maybe he can help, so he asks, “Exactly where were you when you dropped them?” The guy looks up, considers and points into the dark, halfway down the block. “Somewhere there.” The cop asks, “Then why are you looking here?” Answer: “The light is better here.”
We’ve developed a tool that lets a payer or provider input the number of claims they submitted or processed under MS-DRGs or APR-DRGs in one year. The tool then computes estimates of the changes in reimbursement that might occur if those claims were coded in ICD-10. It also provides a table by DRG of all estimated shifts to other DRGs under ICD-10, their probability of occurrence, and projected reimbursement change. For some of those shifts, we provide a clinical explanation of the coding reason behind the shift and, when possible, improved ICD-10 coding practices that would avoid the shift. Continue reading
What do we want?
When do we want it?
If only it were that simple. It’s easy for an organization to say, “We have a quality program for healthcare documentation,” but what exactly does that mean? When designing or evaluating a documentation quality assessment (QA) program, there are many factors to consider. If a QA plan is comprehensive, it has the following characteristics: Continue reading
Texas is implementing a new approach to the payment and delivery of Medicaid services, referred to as the Texas Healthcare Transformation and Quality Improvement Program. Through a Medicaid 1115 Waiver, the state has been granted the ability to expand their managed care program and still draw down FFP funds for Supplemental Payments. Further, they will do so while simultaneously providing incentives for quality improvements and shifting focus from providing minimum standards of care to achieving positive outcomes from care. This managed care expansion includes approximately 940,000 Medicaid enrollees in 164 rural counties . The prior method of Supplemental Payments to these counties was discontinued and replaced by a new method funded through savings from the managed care expansion. Supplemental Payments will instead be distributed through two vehicles, the Uncompensated Care (UC) Pool and the Delivery System Incentive Reform Payment (DSRIP) Pool.
The UC Pool operates similarly to the current Medicaid Disproportionate Share (DSH) method, with hospitals receiving payments relative to their uncompensated care costs and Medicaid margins. By contrast the DSRIP Pool is an innovative attempt to tie Supplemental Payments with providers achieving measured performance targets (milestones) that improve outcomes quality . Since performance change and resulting value has to be objectively measured, discrete events such as potentially preventable readmissions, admissions, complications and emergency room visits are significant utilized in this quality improvement initiative. This is a particular interest to us at 3M HIS as Texas uses 3M’s Potentially Preventable Event (PPE) suite of classification methodologies to determine these preventable rates. Continue reading
Last month, 3M Health Information Systems hosted our bi-annual Summit for healthcare executives in Park City, UT. This Summit brings together executives from many of the largest health systems throughout the United States to discuss issues they face and how 3M can help them achieve their organizational goals. It is a wonderful opportunity for peer-to-peer networking and information sharing.
Throughout the three day Summit, a few common themes emerged. When boiling the themes down, it became clear that each theme involved the need for large health systems to acquire, accurately document, organize and finally, fully utilize clinical data. Continue reading
I recently read a blog post about commercializing big data in healthcare that listed some very interesting figures:
- 90 percent of the world’s data is less than two years old
- Total data collected will grow by 40% next year
- Per IBM’s estimates, 2.5 quintillion bytes of new data is generated each day (a quintillion is 1018, or 10 followed by 18 zeros)
Now that is a lot of data. Digital pieces (bits and bytes) of information, stored on servers, just waiting for someone to make sense of it and do something useful with it. When you get this much data, we get creative and call it “Big Data.” Some industries are already starting to use the Big Data that they are gathering to benefit themselves and their customers. Think of financial services, insurance and retail. Continue reading
Disclaimer: Everyone is just getting back from the holiday or still in “holiday mode” and I am feeling a bit holiday myself. So dear reader if you are not in the mood for “lite” reading, don’t bother with this blog. Get off your computer and go do something fun for three minutes instead—it’s on me!
When we talk about the benefits of ICD-10, we usually talk about additional detail that has been added to the system. I have discussed it in many previous blogs, including my most recent one . But there is another benefit to moving into a new classification system and out of the old. Just as when you move to a new house, you get the chance to get rid of old stuff you don’t use anymore.
Think of the last time you moved to a new place. What happened? After ten years in your house all the closets were so full your kids were complaining there was no place to hide. When you put things in the basement storeroom you didn’t even turn on the light anymore, just opened the door, tossed it in and shut the door again—quick. And needless to say, your cars lived outdoors on the driveway, where they stared longingly at the garage.
So now that you are moving, you will take the time to sort through your closets, your storeroom, your garage, your drawers and cabinets. (For a fabulous treatment of cubbyholes and classification, see Ron Mills’ recent blog series on the subject.) If you don’t, you have to find somewhere to put it in the new house. Throwing the old stuff out is work, but you know you’ll be glad you did it when you get to the new place. Continue reading
Posted in ICD-10
Tagged ICD-10, ICD-9
With all of the challenges around healthcare documentation lately, it’s fun to dream of “documentation utopia.” In other words, what are the guiding principles of documentation quality that ensure every patient encounter is documented efficiently and accurately, with the appropriate detail and timeliness? The following ideas inspired the development of the existing AHDI/AHIMA best practice recommendations.
Every document is an accurate, detailed, and complete description of the patient encounter. A high-quality document will not leave blanks or inconsistencies that require queries or addenda. Physicians and other caregivers need good tools to capture the information efficiently without bogging down their workflow, cutting corners, or making errors. As the ICD-10 date looms closer, healthcare organizations should ensure that each department has the optimal content capture technology for their situation, whether with dictation/transcription, speech recognition, direct template entry, or other methods. Continue reading