They just don’t get it: Who is to blame for increased complication rates?

Let me start by saying Happy Holidays to everyone. However, I am feeling a bit like Mr. Scrooge. I have heard from many clients lately regarding their struggles with obtaining accurate complications rates. In almost every instance, there is finger-pointing (with coding and CDI taking the hit) and even software gets blamed for the increased capture of complications rates.

So let me explain a few things: Continue reading

Will the first technology choices in design of population health be the most important?

As the healthcare industry strives to converge all the data sources required to manage population health, the mass of data needed to do it well, and to both clinically and analytically inform, will require something of a science project. Let’s call it gravity. Continue reading

Coast to coast with ICD-10

We’re now almost two months into ICD-10. I’ve been, literally, coast to coast during that time and have asked everyone how their transition is going. To my surprise, regardless of where physician practices were in their preparation when ICD-10 was delayed last year, everyone that I’ve visited with was well prepared for this year’s Oct. 1 implementation.

Many practices used the extra time to work on dual coding, testing of clearinghouses, reviewing new LCD policies, etc. Some groups were glad the implementation date was pushed back, but equally as many were not, having to retrain coders and providers on the new code set. As mentioned last month, there have been a few bumps, but the only consistent comment I hear is about coder productivity and documentation. Continue reading

The seven habits of highly successful care programs—and six examples

Last month, David Blumenthal, MD, director of The Commonwealth Fund, addressed a 3M conference in New York City on value-based care. He mentioned soon-to-be-released recommendations from his organization on effective models for healthcare improvement.

What he didn’t say was that the recommendations would be accompanied by a media crusade. In the past several weeks, The Commonwealth Fund has released a range of multi-media content advocating new models of care. Continue reading

ICD-10 coding challenge: Legionnaire’s disease


An outbreak of Legionnaire’s disease has plagued residents of the South Bronx area of New York City this summer. At least 12 people have died from the disease and greater than 100 have been sickened by it. The source of the infection has been linked to water cooling towers in the area.

Assign the ICD-10-CM code for Legionella pneumonia. Continue reading

MedPAC financing recommendations for rural hospitals should be extended to all

In the MedPAC October meeting, the commission returned to the seemingly intractable problem of equalizing access to health care for rural communities. Medicare payment offers three sources of support within the inpatient prospective payment system (IPPS) for rural hospitals—through designation as a Medicare-dependent hospital, a sole-community hospital or qualification for a low-volume adjustment. A fourth avenue of support is exempting a hospital from IPPS and allowing it operate as a Critical Access Hospital (CAH). Continue reading

ICD-10: No news is good news

It seems that wishes are not just for fairy tales, they can come true after all. So far, it looks like the wish for an uneventful ICD-10 transition is a reality. Even the month-end report from CMS was fabulously dull.

The bottom line is, coding issues are historically a tiny percentage of the total claim denials, and that is just as true for ICD-10 as for ICD-9. Historically, total claim denials run around 10% of total, and of those, 2% are due to incomplete or invalid information of any kind, including things like provider ID. Both the 10% and the 2% statistic remained stable across the transition to ICD-10. Continue reading

Good news and bad news: The cost of (partial) Patient-Centered Medical Home implementation

Magill and colleagues published a nice analysis of the staffing costs of a Patient-Centered Medical Home (PCMH). Compared to a regular practice that already has an electronic medical record, they looked at the incremental costs associated with meeting NCQA standards for Patient-Centered Medical Home recognition.

The investigators reported incremental costs in three ways: Continue reading

“What did you have for dinner last night?” Nutrition and the healthcare system

While we often hear about the role of good nutrition in promoting health, it is not typically discussed in the context of the Triple Aim – better outcomes, lower cost and improved patient satisfaction. What are the opportunities in health care to promote good nutrition and improve healthcare outcomes? Continue reading

Focus on patient preferences

I am a Registered Nurse. I won’t admit to how many years’ experience I have, but suffice to say, this is not my first rodeo. I had to chuckle when I read the October 29, 2015 news release from CMS titled, “Discharge Planning Proposed Rule Focuses on Patient Preferences.”

For those who are not case managers, and I know there are a ton of you out there, “discharge planning” is the term we apply to the act of planning a patient’s discharge as soon as they are admitted to the hospital or other facility. Continue reading