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

Taking a Closer Look at the January ICD-10 Coding Challenge

CHALLENGE QUESTION:

A subway train car filled with thick black smoke due to an electrical malfunction. One woman on board had difficulty breathing and collapsed to the floor of the train, unconscious. Fellow passengers began performing CPR in an effort to help the woman. Emergency workers arrived and transported the woman to the Emergency Room of a nearby hospital. Resuscitative efforts were continued to no avail and the woman expired. The Emergency Department physician recorded the following diagnoses: acute respiratory failure due to smoke inhalation.

Assign diagnosis codes for this outpatient encounter. Continue reading

Designing Smarter Pay-for-Performance – Let’s Not Go down This Path

Aaron Mckethan, PhD, and Ashish K. Jha, MD, MPH, recently wrote an article for The Journal of the American Medical Association (JAMA) with an irresistible title: “Designing Smarter Pay-for-Performance Programs¹.” The key sentences of the perspective article are:

To the extent that higher-risk patients can be reliably identified prospectively, this information can inform the design of smarter, more targeted pay-for-performance programs. Specifically, a targeted pay-for-performance program would have, at its core, a prediction model that would identify patients who are at elevated risk of failing to meet a meaningful clinical goal or of having a bad outcome. Continue reading

Interoperability Matters: The ONC Interoperability Roadmap and Standards Advisory

Healthcare reform has been a hot topic over the past few days and health information technology (HIT) is at the hub. Last week, the Office of the National Coordinator (ONC) released a Shared Nationwide Interoperability Roadmap¹, setting the goal to exchange and use “a common set of electronic clinical information at the nationwide level by the end of 2017.” Also, President Obama highlighted the Precision Medicine initiative² which included funding for ONC to support the development of interoperability standards, and CMS announced that Medicare payments are moving towards a model based on value and care coordination rather than volume and care duplication (and it is well known that lack of interoperability underlies the latter)³. Continue reading

Must-View Websites for Information on Population Health

I’m not an expert on population health, though I’d like to be. So I read a lot—books, blogs, magazines, newsletters, white papers, you name it. Time and time again, there are a handful of organizations I go back to for reliable information and credible opinions.

If you want to keep pace with payment policies, economic shifts, market disruptions, and technology, I recommend the following: 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

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