Category Archives: Quality Outcomes

Quality of care; pay for performance; quality-based reimbursement; case mix index; quality scores; quality report cards; data analytics; value-based purchasing; performance ratings; mortality rates; hospital report cards; POA; present-on-admission; HACs; hospital-acquired conditions; PPRs; potentially preventable readmissions; SOI; severity of illness; ROM; risk of mortality; healthcare reform; HealthGrades; P4P; potentially preventable complications; PPCs; state initiatives; federal funding

The Need for Case Mix Adjusted Payments: Lessons from Louisiana’s PCMH Program

The title says a lot: “Patient-Centered Medical Homes In Louisiana Had Minimal Impact On Medicaid Population’s Use Of Acute Care And Costs.”¹

Health plans and other payers want to improve total cost of care and quality by aligning payment and measurement models with better health care delivery. They ask “How will we know better care delivery when we see it?” The National Committee for Quality Assurance’s PCMH (patient-centered medical home) recognition program is one way. Continue reading

Airbags and Analytics

I am not a fan of cold weather. Not a snow lover, don’t like sleet, detest freezing rain and ice and the resulting traffic accidents. Most folks don’t think about their airbags until they begin to skid on an ice-covered road and suddenly it becomes one of the most critical components of the vehicle.

Bad weather makes me think about the news reports of the frightening problems with faulty airbags. I was surprised to hear reports that the problem impacts the entire price range of vehicles – from economy to luxury brands. The news got me thinking – is an airbag a component auto manufacturers would compromise? Continue reading

“The Times They Are a-Changin’”

Sing along with me! We are entering a time of unprecedented change in healthcare. I had the pleasure of attending and speaking at the Healthcare Finance Management Association (HFMA) Region 11 Symposium in San Diego recently. This was one of the most dynamic conferences I have ever attended and I came away, by far, with more knowledge than I was imparting. There were certainly some clear surprises which I would like to share with you. The biggest reward for me was listening to finance leaders express their compassion and determination to care for their populations. Not only were they committed to ensuring all had access to healthcare and the means to pay for it, they were extremely focused on making it affordable and were open to an overhaul to pricing and pricing structures. It is moments like this that make me proud to be a member of the healthcare community.

What other lessons did I learn? Continue reading

Singapore Ranks #1 in Healthcare Efficiency, but Not Primary Care – What Are the Lessons for the U.S.?

In 2014, Singapore achieved the top rank among 54 industrialized countries for healthcare efficiency. The United States ranked 44th. Singapore’s average life expectancy of 82.1 years and a per capita healthcare cost of only $2,426 (4.5% of GDP) earned it top billing. The average life expectancy in the United States is 78.7 and the U.S. reluctantly boasts the highest per capita healthcare expense of $8,895, accounting for 17.2% of GDP.

Should the U.S. adopt Singapore’s approach to the financing and delivery of health care, and if it did, would it achieve the same outcomes and similar quality? First, we need to understand what makes Singapore so different. Continue reading

Why Would Anyone Care about Solo and Small Primary Care Practices?

 

Maybe solo primary care practices are dying, but so what?

This question led some folks at Mathematica Policy Research to look into solo primary care practice and the results are interesting

They looked at a handful of states and found that the ratio of solo and very small practices varies quite a bit but represents a significant proportion of practices.  While on average 13 percent of primary care physicians practice solo, this represents 46 percent of practices.  65 percent of practices have one or two physicians. Continue reading

Three Resolutions Any Hospital Can Follow for Better Performance in 2015

There is plenty of speculation about the fate of hospitals and healthcare IT. The uncertainty could make it difficult for hospital executives to set strategies for the coming year. Yet, there are a few near-certainties as we go into 2015. Here are three resolutions hospital executives should make to keep pace with 2015 trends. Continue reading

Whodunnit? Let’s be honest!

At the start of the New Year, I can’t help but reflect on how much patient care has changed in my 25+ years. Many things that were common practice back then were either not necessary or even sometimes harmful. An example would be Foley catheter placements. Foleys for “everyone” whether they needed them or not!

However, the advent of superbugs with increasing antibiotic resistance has also meant an increase in catheter-related UTIs. Organizations became focused on prevention, using different catheter materials thought to prevent colonization, and by evaluating the need for insertion and/or continued placement. It certainly didn’t hurt that catheter-associated UTIs (CAUTIs) were determined to be hospital-acquired preventable conditions that CMS would not reimburse, and were also factored into quality outcomes metrics by quality assessment programs or organizations. Continue reading

Those three little words…

As we wrap up another year of blogging at 3M Health Information Systems, we want to thank our readers and share an inspiring blog post from blogger Rebecca Caux-Harry.

Those three little words……that you NEVER want to hear: “You have cancer.” By the time I got that call my mind had already explored all of the possibilities from worst to best, and I was tired. You just can’t imagine how many “worst” things the mind can conceive of, especially if you’re in the healthcare industry and have a rich family history of cancer. But the call did come. I had been expecting it. I had been going through tests after finding a breast lump for about a month and a half. That’s a long time to fear the worst. At least for me it was a long time, having enjoyed exceptional health for my 50 years. Yep, turned 50 and was diagnosed with cancer in the same year. Lovely! Continue reading

Palliative Care: Payers and Providers Collaborate to Improve Quality of Life, Care and Experience

A study published by the Institute of Medicine (IOM) this fall, Dying in America: Improving Quality and Honoring Individual Preferences Near the End of Life, concluded that improving the quality and availability of medical and social services for patients and their families could not only enhance quality of life through the end of life, but may also contribute to a more sustainable care system. Among the calls to action from the IOM committee are strengthening palliative care and the reorientation of policies and payment systems to support high-quality, end-of-life care.

What is palliative care? Continue reading

Cut through to the “Gut” of Accidental Lacerations

One of the most controversial complications is an accidental laceration. It is a potentially preventable complication (PPC), a complication in all surgical cohorts for Healthgrades and is a patient safety indicator (PSI 15). Additionally, PSI 15 is included in the PSI 90 composite score and is the highest weighted component (29.83%). Hence, the importance of “getting it right” cannot be underestimated.

So when should an accidental laceration be documented, coded or clarified? Continue reading