Analyze this! Administrative claims data or EHR data in health services research?

One of the ongoing debates in health services research concerns the relative merits of using administrative claims data versus electronic health record (EHR) data for research. Should one be preferred over the other? Some question the degree to which administrative claims data continue to be valuable for health services research given the growth of EHR systems. Continue reading

Quality versus quantity…a real dilemma

Happy New Year to all! As we make (and break) many New Year’s resolutions this month, I’d like to talk about resolutions for quality.

I appreciate the challenges and pressures to get claims coded and out the door and meet productivity standards. I am sure many organizations think I live in an ivory tower and not in the real world. Let me just tell you that we all have some sort of productivity standards in our jobs for which we are held accountable (myself included). Finding the right balance means hitting the mark on productivity while still doing a quality job. Continue reading

Documenting medical necessity

CMS recently released a new National Coverage Determination (NCD), which was implemented on January 4. NCD 210.14 titled “Lung Cancer Screening with Low Dose Computed Tomography” is good news and expands the preventive services CMS offers its beneficiaries. Continue reading

Transitional care interventions: Evidence supports more intense interventions

Responding to value-based-purchasing, provider groups across the US are implementing or tweaking programs to reduce unnecessary hospital readmission or emergency department visits. Much of this is stimulated by Medicare’s plans to move the bulk of their payment into new models and the current incentives around readmission reduction for beneficiaries with certain conditions. Continue reading

Technology and natural disasters: Surviving the floods in Chennai

Exactly one month ago, I came face to face with the fury of El Niño in Chennai, a sprawling city in India of more than 7 million people. The storms and the floods of December 1 left 1.8 million people displaced from their homes and about 400 dead. I narrowly escaped the floods, thanks to my mobile device and the thoughtfulness of strangers. Now, I have a chance to reflect on how technology has made crowdsourced disaster relief possible, and what lessons healthcare can learn from this. Continue reading

Bringing health care and nutrition closer together

Losing weight consistently makes the Top 3 for New Year’s resolutions. Closely related to this are pledges by Americans to exercise and eat healthier. According to a review of the most popular Google “how-to” searches made during the first week before and after New Year’s 2015, learning to cook healthier fare made the top 10, including kale chips (#2), lentils (#5), cabbage (#6), collard greens (#8) and broccoli (#9). Luckily for resolution makers, there are 3 developments in healthcare that will help them follow Hippocrates counsel to “Let medicine be thy food and let food be thy medicine.” Continue reading

Counting down the top 5 blogs of 2015

Happy New Year to all our readers! Before the ball drops in Times Square, catch up on five of our most read blogs of the year: Continue reading

New year, new CPT modifications

Another year has come and gone and we are now entering into the most exciting time of year. Yes, that’s right, it’s CPT additions, deletions and modifications time!   Each year, coders across the United States eagerly await our new CPT books. Mine is still leaving paper dust all over my desk as I turn each newly printed page to see the updates.

Because the CPT manual puts the E&M codes in the front, I’ll list those changes first. Continue reading

Does anyone really believe quality scores change referral patterns or the doctors patients choose?

This question was posed by an audience member to speakers at the 3M Value-Based Care Conference. The answers were all “yes,” but not without qualification about how data transparency changes behavior.

Precisely, the question was, “Does anybody really believe that putting up a quality score changes referral patterns or makes a patient go someplace different?” The asker explained, “In New York, we’ve had the Cardiac Report Card forever and forever . . . I have never seen a badly reported cardiac surgeon come off that list or not do cases.” Continue reading

Measuring the quality of life component in patient-centric care

Health status can be defined succinctly as, “the range of manifestation of disease in a given patient including symptoms, functional limitation, and quality of life, in which quality of life is the discrepancy between actual and desired function.” 1 Physicians spend their lives focused on the diagnosis of patient symptoms and, since clinical classification models are primarily structured for and by physicians, most models measuring variation in population health rely on reported diagnoses. Functional limitations, limitations in activities of daily living (ADLs) or instrumental activities of daily living (IADLs), are measured (either by the patient or the health professional) by a variety of tools utilizing a variety of scales.   Continue reading