ICD-10: One month in

October 1, 2015 has come and gone. I didn’t really expect everything to come to a screeching halt, as warned during the anticipation of Y2K. I did, however, expect that by the middle of this month, we would have some horror stories about claims issues with regard to the transition from ICD-9 to ICD-10. I’m still waiting. I’m sure there have been individual issues, but scanning list serves, web sites, CMS, etc., I haven’t seen any systemic issues with regard to claims payment in the professional, Part B world. Insert sigh of relief here. Continue reading

Healthcare execs weigh in on population health and value-based care

There is no common definition for population health. But if you ask enough healthcare executives, you’ll get a clear sense of what it means in terms of how it challenges them. That’s what I discovered at the Value-Based Care Conference hosted by 3M in New York City.

In a conference survey, I asked 42 leaders from health plans, government agencies, health systems, quality review organizations and consulting firms what they thought about population health. Their responses are a good gauge for where these organizations will be investing their efforts in the coming months. Continue reading

HIMagine That! ICD-10 fallout?

Donna: Hey, Sue! We haven’t talked since AHIMA. Did you get back in time for ICD-10 go-live?

Sue: Yes, I was in my office, bright and early on October 1. I couldn’t wait to see how it was going to go!

Donna: Well, I talked to a lot of people at AHIMA and it was clear the general mood was one of excitement. Finally, we’re able to move forward with ICD-10 after all these years of preparing and practicing.

Sue: I heard pretty much the same thing. One HIM director captured it perfectly when she said, “Bring it on!” I think everyone was confident, anxious to get going and ready to deal with the fallout, if any. Continue reading

Should providers embrace and adopt the “Cloud?”

Information technology planning in the 1990s and early 2000s involved forecasting capacity based upon detailed planning. Technologists would meet with business teams and supporting staff, and then whiteboard and spreadsheet the planned IT activity.

This effort resulted in vendor relationships, proposals and capital expenses, then waiting on equipment to arrive with the inevitable communication around delays due to backordered equipment and telephony circuits. No offense to my contemporaries of that time period, but as an industry we either under-provisioned, over-provisioned, or in rare cases, forecasted the right amount of capacity. The simple math is that 66 percent of the time, we technologists were not accurate in our ability to provide the services of infrastructure, capacity and performance. Continue reading

ICD-10: Keep up the calm

Keep calm and carry on…that was the title of the first thing I ever wrote, in early 2010, about the hype surrounding ICD-10. Less than six months after the CMS final rule for implementation of ICD-10 on October 1, 2013, the engines of hysteria were already churning out alarmist rhetoric.

In a moment of nostalgia, I went looking for that article. Here are a couple of examples of ICD-10 sound bites that were popular in 2010, and my reaction to them. Continue reading

Strong patient-provider relationships drive healthier outcomes

Maybe there is a way to measure quality so that metrics better represent outcomes that matter.

Harvard Medical School’s Center for Primary Care has been studying exemplars in primary care through a series of case studies in the past two years. Their article in Harvard Business Review describes the finding that good outcomes are related to the strength of relationship between the primary care provider and patient. This finding is strong and consistent across all primary care exemplars in their study.i Continue reading

Controlling the cost of pharmaceuticals through the EAPG payment system

In a recent blog we made the case for quantifying the net effect of drugs upon health expenditures so as to make more rational decisions. Providing information about costs and outcomes and then realigning incentives are important big picture approaches for handling new drugs covered by patent protection – an issue that is getting swept up in the brushfire of national political debate. Older drugs no longer covered by patent or exclusivity rights also provide plenty of challenges – ones that need better approaches than CMS’ Average Sales Price (ASP) plus fixed mark-up approach, which directly passes through the cost of utilization and provides more revenue for using higher cost drugs. Continue reading

Healthcare compliance more important than ever

On September 10, 2015, while most of us in health care were deeply involved in ICD-10 preparation, the Department of Justice (DOJ) released a ruling that will significantly impact every healthcare provider – facility and professional alike. The DOJ announced that no civil or criminal settlements will be made absent the names of the individuals involved. The DOJ will not allow culpable individuals to avoid punishment when it settles cases. 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

Value-based care is more than the new ICD-10

I’ve heard value-based care called “the new ICD-10.” I understand the comparison, at least in reference to regulatory disruption. But aside from the CMS willpower behind value-based care, I don’t see a lot of similarities.

I think of ICD-10 as a new language that requires translation within every system using ICD codes. All system users need some level of literacy training. Value-based care is this and more. It is like moving to another state—even another country—where the customs, geography and idioms of speech are entirely different. Continue reading