WIFM? Engaging physicians in quality outcomes improvement

WIFM (what’s in it for me) is a common question in health care. With too many patients and not enough hours in the day, compounded by requests for additional documentation regarding medical necessity/continued need for inpatient admission, quality outcomes data can quickly fall down to the bottom of the provider’s to-do list.

Let me be clear on one thing. Providers do care about quality data and how their care is perceived, some more than others. Asking any surgeon to comment on a potential complication is fairly easy. But providers need better, more detailed information about how quality beyond operative complications impacts them and their practice of medicine. What follows is a partial list of WIFMs for providers from a quality perspective: Continue reading

ICD-10-PCS: Making It Real

A system for classifying knowledge is a framework for organizing information. It is usually a vastly simplified model of some aspect of reality as we understand it, like the periodic table, is a simple model for representing our understanding of chemistry. In that sense, ICD-10-PCS is one among several systems that attempt to construct a systematic way of describing the things done to the human body that we collectively call “procedures.”

When I remind coders who are grappling with some aspect of ICD-10-PCS, that PCS is a model of reality and not reality itself, it gets a wry laugh and a sort of “no kidding it’s not reality” look. Continue reading

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