Swiss Cheese and the Balkanization of Big Data in Healthcare

Reading the title, you are probably wondering how the two go together. In relation to big data, both terms produce some of the largest challenges we experience with the efficacy of data within the realm of healthcare big data analytics. These pains, explained later, can be addressed early in building useful, large datasets. Understanding them may be the key difference in managing a successful “big” dataset versus another collection of useless binary. Continue reading

Where Would We Be Without Clinical Coders?

I’m sitting on a plane today, traveling through the air as a result of some very bright people that enabled this mode of transportation. I’m doing so safely, thanks to strict airport security practices. Many years ago, when more stringent airport security screening was established, I would listen to fellow travelers complain about the invasion of privacy, the maybe not-so-random searches and the added expense tacked on to everything. And the lines in security, oh the lines! However, as a frequent traveler I’m forever thankful for the process we flyers have to go through to ensure the safest passage possible. Continue reading

Improving Outcomes by Focusing on Results: Readmissions, Complications and CMS

It’s been nearly a century since Dr. Ernest Codman championed an “end results system” to track and measure hospital outcomes to determine the effectiveness of treatment and improve patients’ lives. Within the last decade, outcome measurement has gained momentum as the health care industry seeks to improve quality of care/patient outcomes and reduce health spending through initiatives such as pay-for-performance or value-based purchasing. Continue reading

Taking a Closer Look at the March ICD-10 Coding Challenge

CHALLENGE QUESTION:

A 62-year old male who was diagnosed with pancreatic cancer two weeks ago, was admitted to the hospital with malaise, fever, and an elevated WBC of 15.21 k/uL. The patient was diagnosed with sepsis. Blood cultures were positive for carbapenem-resistant Enterobacteriaceae (CRE). Infectious Diseases was consulted. A review of the patient’s history revealed that the patient had undergone an ERCP with biopsy of the pancreas approximately two weeks ago at which time a diagnosis of cancer of the head of the pancreas was made. It was eventually determined that the patient had been contaminated with the CRE organism from the duodenoscope used during the ERCP. The patient was discharged to an extended care facility with a PICC line for ongoing IV antibiotic therapy. Assign diagnosis codes for this inpatient encounter and sequence appropriately. Continue reading

Predicting Medical Resource Utilization with Patient Surveys

Success in population health management rests in part on being able to identify high cost/high utilization population segments and provide interventions that help achieve better outcomes.

With enough of a claims history (typically at least seven months), we can go from a simple “Who has diabetes?” to a much more nuanced understanding of total illness burden with a much better prediction of future medical resource utilization. Continue reading

Better Living—and Documentation—Through Computer Assistance

Have you ever driven a car without power-steering? It’s quite a workout. We used to all drive without power-steering and for “entertainment” you had to spend ten minutes twisting a small dial back-and-forth trying to get a radio station to come in clearly, only to drive under a bridge and completely lose it. Now we’re on the verge of self-driving cars and I can stream an entire album saved in the cloud into my car just about anywhere and anytime I want. No more fine-tuning that pesky radio dial. Continue reading

My Wish List for HIMSS15: Bring Documentation into the Health IT Conversation

For the past two years, I have been fortunate to attend the HIMSS Annual Conference & Exhibition in both New Orleans and Orlando. HIMSS puts on a massive event for about 38,000 people, so it’s definitely a great place to learn and network around the newest technologies, trends, and solutions in healthcare information technology. HIMSS15 kicks off in Chicago on April 12, and although I am unable to attend this year, I’ve been thinking about the conversations and ideas I hope will be generated by the organizers, presenters and attendees. Continue reading

Three Strategies to Fund Sustainable State IT Data Projects

Escalating healthcare costs have persuaded many states to redesign their Medicaid payment systems. Most of them are also developing innovative uses of their client data to help reduce Medicaid costs and improve health. The projects range from alternative payment models to all-payer claims databases, often funded by grants. Continue reading

Observation Services: Documenting Medical Necessity (Part Two)

In last week’s blog, I discussed observation services and private payer requirements. Now let’s take a look at CMS requirements which are a bit different. Observation is expected to be used when the physician presumes the patient will need less than 48 hours of care and the time in the hospital does not cross two midnights. Specifically, CMS says “The physician’s ‘expectation …should be based on such complex medical factors as patient history and comorbidities, the severity of signs and symptoms, current medical needs, and the risk of an adverse event.’” The CMS clinical and time expectations are similar to BCBS of NC. Continue reading

Observation Services: Documenting Medical Necessity (Part One)

I shudder to think about the compliance quicksand surrounding observation services. Regardless, I’m going to attempt to explain how to document medical necessity for observation services (OBS). Fortunately – or unfortunately – depending on how you look at it, documentation requirements for medical necessity for OBS is not the same for all payers. Continue reading