More changes contemplated for short stays

As we all focus on the looming deadline for the ICD-10 go-live, CMS is quietly floating more changes to short stay requirements.

CMS reiterated its goals of “respecting the judgment of physicians, supporting high quality care for beneficiaries, providing clear guidelines for hospitals and doctors and incentivizing efficient care to protect the Medicare trust funds.” So, what’s new? Continue reading

Is the accountable care community the next evolution of the ACO?

The move to accountable care is ultimately about achieving better health outcomes at lower cost while creating a better experience for the patient. This is the Triple Aim. A narrow view of health focuses on health care, which is understandable in the United States, since a wide range of health-related expenditures are funneled through the medical system. The United States has long been the leader among industrialized countries in healthcare spending, while other nations have led in health outcomes, such as lower infant mortality rates, lower mortality amenable to health care and longer life expectancy. Continue reading

20 days, 12 hours, 8 minutes, and 21 seconds….

That’s the current countdown to ICD-10, ticking away as I sit and write this blog post. By the time it’s posted, we’ll be even closer. And for every day, in every minute of each of those remaining hours, all of us at 3M Health Information Systems are working to help you, our customers, succeed as you make the transition.

Like you, we have worked for years to prepare for what will finally happen on October 1. Our mission has always been to develop ICD-10 products and services that would be ready when our customers needed them. Virtually every department within HIS has contributed to what has been a massive undertaking, and the work reflects thousands of hours invested by 3M HIS employees. Continue reading

Happy LOINCing with HDD Access!

The July release of HDD Access, the open public version of the 3M Healthcare Data Dictionary, included LOINC® (version 2.50), the standard terminology for lab and clinical observations. We thank Regenstrief Institute for their active support in making this possible. LOINC was perhaps the most-requested terminology on the HDD Access discussion forums, and we hope that this release helps our users to take another big step towards clinical data interoperability. We noticed an increase in downloads after we released LOINC, many of them by new users. So, for those who are just starting out, here’s a brief overview of how to use the LOINC content within HDD Access. Continue reading

Health care’s “one percenters:” Hot spotting to identify areas of need and opportunity

Since Atul Gawande popularized the term in describing the work of Dr. Jeffrey Brenner in a New Yorker article,1 “hot spotting” has been used in health care to describe the process of identifying “super-utilizers” of health care services, then defining intervention programs to coordinate their care. According to Brenner’s data from Camden, New Jersey, 1% of patients generate 30% of payments to hospitals, while 5% of patients generate 50% of payments.2 More recent reports on larger datasets have corroborated these metrics.3 I recently analyzed a sample dataset of (primarily commercial) health insurance claims representing about 2 million covered lives and found that the top 1% of the population representing the highest risk patients accounted for 17% of the Total Medical Allowed (TMA)–the sum of insurer allowed charges for inpatient, outpatient (including hospital emergency department), and professional claims. Casting a wider net, I found that the top 12% of high-risk patients accounted for 55% of charges.    Continue reading

WIFM? Engaging physicians in quality outcomes improvement

WIFM (what’s in it for me) is a common question in health care. With too many patients and not enough hours in the day, compounded by requests for additional documentation regarding medical necessity/continued need for inpatient admission, quality outcomes data can quickly fall down to the bottom of the provider’s to-do list.

Let me be clear on one thing. Providers do care about quality data and how their care is perceived, some more than others. Asking any surgeon to comment on a potential complication is fairly easy. But providers need better, more detailed information about how quality beyond operative complications impacts them and their practice of medicine. What follows is a partial list of WIFMs for providers from a quality perspective: Continue reading

ICD-10-PCS: Making It Real

A system for classifying knowledge is a framework for organizing information. It is usually a vastly simplified model of some aspect of reality as we understand it, like the periodic table, is a simple model for representing our understanding of chemistry. In that sense, ICD-10-PCS is one among several systems that attempt to construct a systematic way of describing the things done to the human body that we collectively call “procedures.”

When I remind coders who are grappling with some aspect of ICD-10-PCS, that PCS is a model of reality and not reality itself, it gets a wry laugh and a sort of “no kidding it’s not reality” look. Continue reading

Why are we hoarding quality measures?

It’s hard to get rid of something you use but don’t like, even if it’s no longer practical. Things that are familiar have a lot of staying power. That may be why we can’t seem to shed ourselves of the suffocating layers of quality measures that have accumulated over the years.

There are over 4,600 healthcare quality measures and measure sets in the public repository set up by the National Quality Measures Clearinghouse. Granted, these measures represent all settings and aspects of care delivery and management. The numbers are still staggering: Continue reading

ICD-10 financial impact update

Back in March, I reported at the CMS ICD-10 Coordination and Maintenance meeting that the expected financial impact of the conversion to ICD-10 for a typical Medicare inpatient case mix was -0.04% — that is, about $4 less on each $10,000 of reimbursement. I reminded the audience several times that such a tiny amount is statistically zero, since the study’s sampling error is at least 0.10%.

The report was based on several things particular to the Medicare setting in which I gave the talk: Continue reading

E&M coding: Element-based or time-based?

I went to see one of my physicians today. She at her computer, me in a chair, discussing the multiple medications I’m taking, and the resulting side effects. If you’re a regular reader of my blog, you’re aware of my recent health challenges. I try not to think about what it was like before having a drawer full of medicine bottles but, I’m just whining. I know I’m lucky and I know I’m basically healthy. I’m probably a bit spoiled, too. But, back to the office visit today. My doctor and I talked for a long time. We reviewed my extensive (for me) list of medications and I complained about those side effects. She proposed a different medication regimen, then we discussed the risks associated with this change. I had a lot of questions, she consulted some studies online and we talked some more. At the end of this visit, I was examined and the impression and plan were discussed. Continue reading