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

The Oops Factor: Are Documentation Edits Nitpicky or Necessary?

In my last two “Oops Factor” posts, I discussed the necessity of addressing critical errors in healthcare documentation that could affect patient safety, as well as non-critical errors which may not harm the patient, but could impede the reader’s understanding of the content. But what about the nitpicky stuff? How far should editing go in the electronic world in which we now work?

I remember when I started consulting with hospital transcription departments almost 20 years ago that it mattered very much how the document appeared on paper and that every detail of spelling, grammar, punctuation, and other stylistic rules were maintained. Nowadays, adoption of speech recognition and direct EHR entry have fostered a new mindset of getting the documentation created as quickly as possible without worrying about minor issues. The advent of this mindset is in direct correlation to the expectation that the new technologies are efficient enough that physicians and other clinicians should create their own documentation without assistance. 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

E&M Coding: Promoting the Value of Coders

Because this is a new year, my mind turns to the things I’d like to change. Rather than making the tried and true, or tried and failed “New Year’s resolutions,” I like to set goals for myself. Since 2014 was difficult in terms of my health, one of my goals is to return to my previous fitness. But, I also like to think about my professional life and the goals I’d like to set within that realm. What sort of fitness can I improve on in my professional life?

The world of professional coding is changing fast. I don’t mean ICD-10. The new code set has been imminent since I started coding many, many years ago. I’m talking more about ACOs, HCCs, PBCs, and the ever present EMRs. Continue reading

Dumb Ways to Die: The 8 Not Dumbest ICD-10 Codes

Yes, there are ICD-10 codes for exceedingly rare ways to die, and yes, they are easy to parody. This does not matter at all, since not many people are admitted to the hospital for a prolonged stay in a weightless environment.

What does matter is that preventable errors in hospital care are the third leading cause of death, after cancer and heart disease. Updated estimates in a 2013 study in the Journal of Patient Safety say that between 210,000 and 440,000 people die in US hospitals every year because some preventable harm was done to them. Continue reading

Complexity Adjustment: CMS Updates I/OCE Specifications and Software

Last week, CMS published updated I/OCE specifications and software. The changes revolved around calculations of the complexity adjustment for the comprehensive APCs (C-APCs).

Bypassing the code pair ranking

The specific language change in the specifications is in Appendix L where there is a note added: “In some instances, code pair combinations specified for complexity-adjustment may have a secondary procedure with a higher rank than the primary procedure. In these cases, the rank is ignored and the complexity-adjusted APC remains assigned to the primary procedure of the code pair.” Continue reading

HIMagine That! Dual Coding

Sue: Happy New Year, Donna! Did you enjoy the holidays?

Donna: The holidays were wonderful, and you know I always feel reenergized in the new year!

Sue: Me, too! Instead of making New Year’s resolutions though, I focus on cleaning, straightening and getting organized.

Donna: Speaking of getting organized, I started making a list of what needs to be accomplished before ICD-10 goes live in October. Continue reading

Gaining Value from Post-Acute Care: Incentives, Structure or Management?

It is well known that a viable source of health dollar savings is the efficient use of post-acute care (PAC) services. MedPAC has identified widespread variation in post-acute care utilization, with limited control over the reasonableness and quality of service provided. This situation has resulted from three factors: confusion as to what constitutes PAC (defined by program benefit), fragmentation of PAC payment (which tends to be site rather than service specific) and the absence of comprehensive risk-adjustment to determine the relative intensity and need for PAC services. Substantial opportunities to improve risk-adjustment will be available after the implementation of ICD-10 (which contains significant numbers of continuation of care codes), particularly if the Continuity Assessment Record and Evaluation (CARE) is also implemented across PAC settings. 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