A few months ago I wrote a personal blog detailing the lack of interoperability for my data after a knee replacement. The most important observations that are measured after knee replacement are pain intensity and knee flexion angle. I would have loved to see my pain levels graphed out over time as it decreased while my knee flexion graph showed an increase. This meant that my measurements from hospital, home, physical therapy and the physician’s office all needed to be in the same system. So…what needs to be done to have my data where it needs to be to track my progress? Continue reading
The team I work with has done an enormous amount of work translating medical necessity policies from ICD-9 to ICD-10. And we have had many discussions regarding the codes that represent “unspecified” care in ICD-10. Should they stay in the translations – or go? Is ICD-10 specific enough to cover all care and coding contingencies now?
An internet search (don’t you love being able to search so easily?) revealed:
Un-spec-i-fied: (adjective) meaning “not stated clearly or exactly”. Synonyms: unnamed, unstated, unidentified, undesignated, undefined, unfixed, undecided, undetermined, uncertain… Continue reading
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
In past blogs, I’ve written about a variety of E&M services and how to code those visits. In case that seemed straightforward, many years ago mid-level providers were added into the mix. You will see these types of providers abbreviated as MLP (mid-level providers), NPP (Non-physician practitioners), NP (Nurse Practitioners), PA (Physician’s Assistants), and some others. For the purpose of this blog, I’ll use MLP. The introduction of these types of providers created a new education opportunity for all of us. CMS created “Incident-to” guidelines and published them in the Medicare Benefit Policy Manual (S60.1-S60.4). This means that an MLP can provide services to a patient and report those services under the physician’s name when those services are provided incident to an established plan of care for that patient. Continue reading
Reducing healthcare costs through better care delivery begs the question: “Where do we start?” When the goal includes something to the effect of “the greatest possible improvement for a population,” it is good to reflect on the body of evidence pointing to high performing population health outcomes.
The work of Starfield and others is instructive: High performing health systems have high performing primary care as their foundation. High performing primary care has four cardinal features:¹ Continue reading
For the last decade, we have been fortunate enough to work with many state Medicaid programs and commercial payers on reform efforts incorporating outcomes targets for health care providers. The outcomes targets we establish are collectively termed potentially preventable events (PPEs) and provide a direct link between the cost of adverse outcomes and provider payments. The big difference in using an outcome-based approach to incentivize healthcare improvements is that provider engagement requires a demonstrated improvement in the actual health of patients. Continue reading
Data as a career may be a bit ambiguous. How about looking for a career in data modeling, preserving, securing, delivering and making data readily available?
Beyond the obvious solutions available within healthcare data to inform products and influence reform, there is a residual need for how to carefully steward and retain the data. Some refer to this as data governance. I call it simply, “a retention and capacity strategy in need of professionals.” Over the last five years, the healthcare industry has lost a tremendous amount of talent to the promise of “big data” and data driven analytics. The industry need is greater than ever to field a new set of talent. Continue reading
Anyone who has renovated a home while living in it should relate to the challenges of shifting to value-based payment. It is takes time, money and grit to redesign a house and maintain any sort of normalcy for the occupants. The transition from fee-for-service reimbursement to value-based payment isn’t a tidy process either. As with home renovation, having a blue-print and a project plan makes it manageable. Continue reading
Donna: Sue, what results are you hearing about ICD-10 coder agreement as sites get ready to implement October 1, 2015?
Sue: What do you mean by “ICD-10 coder agreement?”
Donna: Well, as hospitals are in the homestretch of their ICD-10 preparation activities, one of the things they’re doing is having all of their coding staff code the same cases in ICD-10 so they can compare results. Continue reading
The design and implementation of accountable care structures like ACOs has been a popular mode of transforming healthcare from volume- to value-based healthcare delivery systems. As was oft-quoted in the early stages of ACO development, they are akin to a unicorn—that is, everyone knows what they look like but no one has ever seen one. Now, as ACOs have evolved and have some experience under their belt, the common quote seems to be “when you’ve seen one ACO, you’ve seen one ACO.” Continue reading