The Results Are In: Pioneer ACO Model

Last week, The Journal of the American Medical Association (JAMA) published the results of a study that showed that the Pioneer Accountable Care Organization (ACO) Model achieved almost $400 million less spending for patient care than fee-for-service (FFS) Medicare patients over two years. These cost savings were attained without deterioration in the quality of care. 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?
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The Hippocratic Oath in the Age of Accountable Care – First Do No (Financial) Harm

Patients are becoming increasingly responsible for a greater proportion of their medical costs. The upfront share of premium payments, cost sharing at the point of care in the form of copays and deductibles, as well as the proportion of Americans with high deductible plans, have all been increasing. Since patients are the ultimate consumers of healthcare services, the issue of cost and the efforts to minimize the “financial harm” that can result from overprescribing, overtreating, or simply overlooking price differences among similar treatments should be a top concern of healthcare providers. Does the Hippocratic Oath that physicians take upon entering the practice of medicine extend to avoiding financial, as well as physical harm? Continue reading

Four SIM Projects Likely to Prove Truly Innovative and Worth Modeling

Thirty-eight states are developing State Innovation Models (SIM), or new models for multi-payer healthcare payment and service delivery, funded by grants from CMS. The SIM program tests ways to lower costs of caring for Medicare and Medicaid clients while maintaining or improving quality of care. It is an experiment in payment transformation, and, as with most experiments, some trials will perform better than others. Which SIM projects are most innovative? Which are most likely to succeed? Continue reading

New Outpatient Evaluation & Management Codes?

On April 17 the American Academy of Family Practitioners (AAFP) reported that a coalition of providers sent a letter to CMS proposing to “redefine and reevaluate” outpatient E&M service codes. These providers include:

  • American Academy of Allergy, Asthma and Immunology
  • American Academy of Neurology
  • American College of Allergy, Asthma and Immunology
  • American College of Rheumatology
  • American Society of Hematology
  • American Psychiatric Association
  • Endocrine Society
  • Joint Council of Allergy, Asthma and Immunology on behalf of the Advocacy Council of the ACAAI
  • Society of General Internal Medicine

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Population Health Management and the Annual Physical Exam

Population Health Management (PHM) is the application of specific interventions and approaches within a healthcare delivery system designed to improve and maintain the health of a population. PHM strategies should be effective (lead to better outcomes), as well as efficient (achieve the best outcome at the lowest cost). As the U.S. healthcare system continues to promote value-based care and PHM, it’s critical that health systems address the most important issues that lead to the best outcomes. Continue reading

Our Response to the ONC 2015 Standards Advisory

Earlier this year, the Office of the National Coordinator (ONC) released the 2015 Interoperability Standards Advisory which was “meant to provide the industry with a single, public list of the standards and implementation specifications that can best be used to achieve a specific clinical health information interoperability purpose.”¹ The ONC solicited comments on the advisory “to prompt dialogue, debate, and consensus among industry stakeholders.”¹ As is evident by the recent discussion in our blogs around the importance of interoperability, the 3M Healthcare Data Dictionary Team at 3M HIS drafted a response to the 2015 Advisory that we provided to the ONC this week. Our response has a few underlying themes: Continue reading

HIMagine That! In Spain: ICD-10, por favor

Donna: Hola! How was your trip to Spain?

Sue: My trip was great! I really enjoyed sharing ICD-10 experiences with our customers there.

Donna: When are they transitioning to ICD-10? 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

Swiss Cheese and the Balkanization of Big Data in Healthcare

Reading the title, you are probably wondering how the two go together. In relation to big data, both terms produce some of the largest challenges we experience with the efficacy of data within the realm of healthcare big data analytics. These pains, explained later, can be addressed early in building useful, large datasets. Understanding them may be the key difference in managing a successful “big” dataset versus another collection of useless binary. Continue reading