Do You Want a Healthcare House of Straw or Bricks?

Anyone who has renovated a home while living in it should relate to the challenges of shifting to value-based payment. It is takes time, money and grit to redesign a house and maintain any sort of normalcy for the occupants. The transition from fee-for-service reimbursement to value-based payment isn’t a tidy process either. As with home renovation, having a blue-print and a project plan makes it manageable. Continue reading

HIMagine That! Coder Agreement

Donna: Sue, what results are you hearing about ICD-10 coder agreement as sites get ready to implement October 1, 2015?

Sue: What do you mean by “ICD-10 coder agreement?”

Donna: Well, as hospitals are in the homestretch of their ICD-10 preparation activities, one of the things they’re doing is having all of their coding staff code the same cases in ICD-10 so they can compare results. Continue reading

Transforming Health Care Through Accountable Care Organizations

The design and implementation of accountable care structures like ACOs has been a popular mode of transforming healthcare from volume- to value-based healthcare delivery systems. As was oft-quoted in the early stages of ACO development, they are akin to a unicorn—that is, everyone knows what they look like but no one has ever seen one. Now, as ACOs have evolved and have some experience under their belt, the common quote seems to be “when you’ve seen one ACO, you’ve seen one ACO.” Continue reading

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

CHALLENGE QUESTION

A 37-year old male was found unresponsive in a bedroom at his home by a family member. Paramedics arrived and found the patient pulseless and not breathing. The patient’s skin was cool and cyanotic. The family member said the patient had been using Oxycodone for long-standing back pain for the past two to three years. A prescription bottle for the drug was found at the scene. The patient was transported to a nearby Emergency Room where he was pronounced dead. The Emergency Room physician recorded the diagnoses of: Continue reading

Medical Care: When Do Harms Outweigh the Benefits?

Medical care produces both benefits and harms. There are risks associated with care delivered in the hospital, including infections, medical errors and delirium. There are side effects associated with medication and, ultimately, there are risks associated with all medical procedures. When a patient is suffering from a painful or debilitating illness, it is understandable how they might overestimate the benefits of medical care and underestimate its risks in an effort to obtain a cure or symptom relief. More worrisome is that some physicians may be poor estimators of risk. The medical community often ascribes to the adage that it is better to act than do nothing, whereas “nothing” may be in the best interest of the patient. Continue reading

Millions Claimed by Lost Physicians and Coders

There was only one time in my life that I literally did not know where I was. I had just moved to Alexandria, Virginia and took a wrong turn off the Beltway. I didn’t know which state I was in until I asked at a gas station. The station attendant thought I was crazy of course, but when I explained my predicament he laughed and told me that I was actually in Maryland. Since this happened pre-GPS, he also gave me directions to get back to Virginia – but, as I said, that only happened once. Continue reading

ICD-10: One Small Step for Health Care—Politics Can Take a Hike

If no further weird politics intervene, we will be able to use ICD-10 codes for real, finally, beginning October 1, 2015.

This experience has been emotionally draining for everyone. For years now we have worked in good faith toward what should have been a modest, straightforward and totally un-newsworthy goal—upgrading an old transaction infrastructure. Imagine this headline: “Old Wiring in the Basement Replaced.” That’s about how exciting ICD-10 implementation should have been. Continue reading

Revenue Neutrality in ICD-10: How Will You Know?

No one likes surprises, especially when it comes to financial performance. In order to reduce unexpected results, many hospitals and payers have decided to address the issue up front. You can call it risk reduction, revenue neutrality, or negotiated reimbursement, but in all cases the goal is to reduce the financial impact ICD-10 has on your organization. Continue reading

Will Health Care Transparency Work? Four Unique Perspectives

Health care is not a commodity. Shopping for health care services is not like shopping for a refrigerator, a tennis racquet or a DVD. Identical commodities can be offered by numerous vendors and consumers can reasonably access their prices for comparison as an important element of their purchasing decision. Consumers, however, can’t (and shouldn’t) compare health services on price alone. Health care is a service, but one unlike most other services we use on a regular basis. Continue reading

Is Our Approach to Quality Measurement Getting in the Way of Quality?

The path to better population health outcomes is difficult–and our approach to quality measurement may be making it harder. Process measure improvement does not consistently lead to outcomes that matter, and narrow-focus outcome measures sometimes apply to a very small part of the overall population. Continue reading