Author Archives: Cheryl Manchenton

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

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

Getting it “right”: Risk-adjusted rates for potentially preventable readmissions

Ever wonder how states (or CMS) set thresholds for readmission rates? Much has been said about and written on the subject, but there a few things I think are highly overlooked.

1. Organizations actually set readmission rates themselves

Now before you fire off an email to me, let me clarify. Documentation (or lack thereof) on a patient’s health status is gathered by government agencies via claims data and analyzed.   In determining readmission rates, what else is at their disposal on a detailed claim besides diagnoses and health status? As a whole, lack of complete documentation for many years gave data to CMS and state agencies that may not have told the whole story on the health of a populations. And remember, CMS and states are typically utilizing a three-year rolling period of data. So not only did our documentation probably not accurately reflect the health of our populations three or even five years ago, we probably aren’t doing it correctly now either. Continue reading

What you don’t know might hurt you…the potential negative impact of CDI programs on quality outcomes data

We’ve all heard the phrase…”what you don’t know won’t hurt you.” That might be true in some settings, but in the world of documentation improvement this is definitely not the case.

Let’s look at a few commonly queried diagnoses and their impact on quality profiles. The first one is acute blood loss anemia (ABLA). Certainly this can be a diagnosis present on admission (POA), but many times it is a diagnosis clarified in the postoperative setting. And heaven forbid the provider document dilutional anemia even though it might actually be the case! On the plus side, this may increase reimbursement or impact severity of illness. On the negative side, ABLA not present on admission is a potentially preventable complication (PPC). Continue reading

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

HCCs: Don’t Underestimate Their Importance

So there are PPCs and HACs, PPRs and PPAs, PSIs and VBP just to name a few. But please don’t forget or underestimate the importance of HCCs. Why should you care about HCCs? HCCs are Hierarchical Condition Categories (there’s a mouthful). In simpler terms, HCCs are diagnoses/conditions that are present in the patient that complicate their care and management and require more resources to treat. Sounds easy enough right? Continue reading

“My Patients Are Sicker”…Prove it!

When thinking of quality outcomes improvement, much focus is on the particular quality concern (such as a readmission, accidental laceration, etc.) and reducing the incidence through better practice, improved documentation or coding. But not enough attention is focused on risk-adjustment for the various quality indicators. And sadly, this is the easiest part to fix! Continue reading

A Tale of Two Hospitals…Ethics in Reporting Quality Outcomes

Pardon the bad play on words, but “it was the best of hospitals, it was the worst of hospitals.” Within the past week I interacted with two healthcare organizations and had the chance to discuss not only how they report, but improve their quality outcomes. In order to protect both the guilty and the innocent, I will only state that both are large academic medical centers with similar services, physician leadership and quality organizational structures. In comparing the two organizations, the gargantuan differences in reporting frustrate me, and the ethics of the leaders involved in quality at one institution frankly disgust me. How can we accurately measure, and ultimately improve, quality outcomes if all are not “playing” honestly? And yes, I acknowledge that “gaming” in quality scores has been occurring for decades. But does that make it right?
Continue reading

Present and Accounted For…Potentially Preventable Complications

We all know the phrase “First do no harm,” a philosophy that is a driving force in health care. In other words, if we do not do anything to improve the health of our patients during their stay, at least let’s not allow anything bad to happen to them on our watch. Continue reading

To Readmit or Not Readmit…Is That the Question?

As many of us in health care realize, sometimes it is just not possible to keep patients out of the hospital! All of our best strategies are in some cases not used, or in others, did not work. So how do we keep patients out of the hospital? Per chance we are putting the cart before the horse. Let me explain. Continue reading