Why are we hoarding quality measures?

It’s hard to get rid of something you use but don’t like, even if it’s no longer practical. Things that are familiar have a lot of staying power. That may be why we can’t seem to shed ourselves of the suffocating layers of quality measures that have accumulated over the years.

There are over 4,600 healthcare quality measures and measure sets in the public repository set up by the National Quality Measures Clearinghouse. Granted, these measures represent all settings and aspects of care delivery and management. The numbers are still staggering: Continue reading

ICD-10 financial impact update

Back in March, I reported at the CMS ICD-10 Coordination and Maintenance meeting that the expected financial impact of the conversion to ICD-10 for a typical Medicare inpatient case mix was -0.04% — that is, about $4 less on each $10,000 of reimbursement. I reminded the audience several times that such a tiny amount is statistically zero, since the study’s sampling error is at least 0.10%.

The report was based on several things particular to the Medicare setting in which I gave the talk: Continue reading

E&M coding: Element-based or time-based?

I went to see one of my physicians today. She at her computer, me in a chair, discussing the multiple medications I’m taking, and the resulting side effects. If you’re a regular reader of my blog, you’re aware of my recent health challenges. I try not to think about what it was like before having a drawer full of medicine bottles but, I’m just whining. I know I’m lucky and I know I’m basically healthy. I’m probably a bit spoiled, too. But, back to the office visit today. My doctor and I talked for a long time. We reviewed my extensive (for me) list of medications and I complained about those side effects. She proposed a different medication regimen, then we discussed the risks associated with this change. I had a lot of questions, she consulted some studies online and we talked some more. At the end of this visit, I was examined and the impression and plan were discussed. Continue reading

Using Scrum to tackle technical debt

I guess I may be part of a revolution and that revolution is called “Scrum.” Like many health IT leaders who are challenged with an ever growing backlog of work, there is no good, quantifiable way to prioritize that backlog, and it just keeps growing.

Enter what Scrum can do for healthcare IT. Continue reading

Transparency of healthcare prices and quality of care: The caboose is at the station waiting…

…for the engine to pick up steam. In the past ten years, the train carrying healthcare pricing and quality information has been rolling but the caboose is still waiting at the station. Significant improvement is necessary before we can say with confidence that pricing and quality information is sufficiently transparent, accessible and provided in a timely manner. As importantly, ongoing concerns need to be addressed so that those using information provided will be able to interpret it in a meaningful way. It is clear that while most people have difficulty understanding and, more importantly, acting on the healthcare information that is currently available, the situation is getting better¹. Continue reading

HIMagine That! Collaborating on ICD-10 Documentation

Donna and Sue are joined this month by fellow 3M HIS blogger Jill Devrick.

Donna: Hi Sue. How was the AHIMA-AHDI summit? Didn’t you give a presentation?

Sue: The summit was really good, and yes, Jill Devrick and I gave a presentation on how CDI professionals and Healthcare Documentation Specialists can work together to improve the content of the medical record in light of the transition to ICD-10.

Donna: So tell me more…

Sue: You know what, let’s get Jill on the line and we can both tell you about it… Continue reading

Social Determinants of Health- Are They Still Relevant?

What is the impact of the social determinants of health, such as income, education and occupation, as U.S. health care moves from volume to value-based care with a focus on population health management? Providers of health care have been well-trained to focus on the clinical manifestation and treatment of disease, but often struggle with the environmental and social context within which they occur. Continue reading

Attention Physicians and Coders: CMS’ Advanced Analytics Paying Off – Big Time

My mother taught me that it’s impolite to say “I told you so.” My daughter tells me I’m bossy and health care compliance is pretty dry (she’s trying not to be impolite and say “boring”) but when millions of dollars are connected, it’s much more interesting and news worthy.

So, sorry Mom, but I told you so and I’ve been telling you since I began blogging. And yes, big brother and his whole family are watching. Continue reading

Half of Primary Care Physicians Think Quality Metrics Have a Negative Impact on Quality

In a Commonwealth Fund/Kaiser Family Foundation survey, 50 percent of PCPs report that quality metrics have a negative impact on their ability to provide quality care to their patients.i

Quality Metrics Chart

Click to Enlarge

If you spend any time in a primary care office practice this should come as no surprise. PCPs tend to be deeply dedicated to their patients and want very much to do the right thing. Continue reading

Twenty Years of Transcription

Twenty years ago, I began my journey in healthcare documentation technology. I’ve been traveling up and down memory lane for the past few days, thinking about how the healthcare industry has changed, and healthcare documentation tools and processes along with it.

Back in the mid-90s, healthcare documentation was almost entirely created for paper, whether it be handwritten notes and forms or transcribed documentation. Many of the hospital medical transcription departments I visited at that time were transitioning from typewriters and fancier word processing units to networked workstations running our DOS-based ChartScript application. I remember transcriptionists being concerned because a computer-based transcription system could measure productivity more consistently and precisely than the manual methods employed with typewriters and word processors. Continue reading