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

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


 A 72 –year old male was admitted to the hospital with a chief complaint of a  fever with a temperature of 101° F and feeling ill with worsening chills, cough, nasal congestion and body aches that began two days prior to admission. A chest x-ray revealed bilateral infiltrates in both lower lobes of the lungs. A viral culture was positive for AH3N2 influenza.  The patient received antiviral medication and supportive care.  The patient recovered enough to be discharged three days later with a diagnosis of pneumonia due to AH3N2 influenza.

Assign ICD-10 diagnosis codes for the inpatient hospitalization. Continue reading

Three Resolutions Any Hospital Can Follow for Better Performance in 2015

There is plenty of speculation about the fate of hospitals and healthcare IT. The uncertainty could make it difficult for hospital executives to set strategies for the coming year. Yet, there are a few near-certainties as we go into 2015. Here are three resolutions hospital executives should make to keep pace with 2015 trends. Continue reading

ICD-10: Defining Clearer Boundaries

What makes a species distinct enough that it gets its own unique name? In my last blog, I discussed the taxonomy of living things developed by Carl Linnaeus in the 18th century. Like any classification system, Linnaeus’ conceptual framework for organizing and naming living things is an exercise in drawing boundaries. Similar things are grouped together, initially by laying out general boundaries—is it animal, vegetable, or mineral?—and making progressively finer distinctions.

All classification systems work in basically the same way, because all classification systems are products of the human mind. Classification is a profoundly human endeavor. We invent systems that allow us to organize and codify our understanding of the world and ourselves. Continue reading

Whodunnit? Let’s be honest!

At the start of the New Year, I can’t help but reflect on how much patient care has changed in my 25+ years. Many things that were common practice back then were either not necessary or even sometimes harmful. An example would be Foley catheter placements. Foleys for “everyone” whether they needed them or not!

However, the advent of superbugs with increasing antibiotic resistance has also meant an increase in catheter-related UTIs. Organizations became focused on prevention, using different catheter materials thought to prevent colonization, and by evaluating the need for insertion and/or continued placement. It certainly didn’t hurt that catheter-associated UTIs (CAUTIs) were determined to be hospital-acquired preventable conditions that CMS would not reimburse, and were also factored into quality outcomes metrics by quality assessment programs or organizations. Continue reading

Resolution 2015: Time to Audit

Like many, the end of the year is a time of reflection and planning for me. Where did I succeed in 2014 and where do I need to focus in 2015?

One of my plans for 2015 is cleaning the basement. I know, I hate doing it too – that’s why I had to make it a resolution – give it more emotional power.

My daughter graduated from college in 2006 and wanted to “leave some of my stuff here temporarily.” It’s now 2015 and that stuff is still in my basement. Does she need it? Likely not, since it hasn’t seen the light of day in nine years. But before it’s moved, we’re going to go through it and throw out what’s no longer needed. I’ve learned that it makes more sense both from a time and cost perspective, to clean up before a move than to pack, move, unpack and then throw out the same stuff. Continue reading

Those three little words…

As we wrap up another year of blogging at 3M Health Information Systems, we want to thank our readers and share an inspiring blog post from blogger Rebecca Caux-Harry.

Those three little words……that you NEVER want to hear: “You have cancer.” By the time I got that call my mind had already explored all of the possibilities from worst to best, and I was tired. You just can’t imagine how many “worst” things the mind can conceive of, especially if you’re in the healthcare industry and have a rich family history of cancer. But the call did come. I had been expecting it. I had been going through tests after finding a breast lump for about a month and a half. That’s a long time to fear the worst. At least for me it was a long time, having enjoyed exceptional health for my 50 years. Yep, turned 50 and was diagnosed with cancer in the same year. Lovely! Continue reading

AMIA 2014: RxNorm

Guest blog by Michael Totzke, 3M data analyst.

At the AMIA 2014 convention in Washington D.C., we showcased some of our processes for mapping and maintaining RxNorm drugs into the Healthcare Data Dictionary (HDD). Our poster and podium presentations emphasized the fact that with clinical data, accurate and consistent mapping of terminology standards over successive versions is critical. With the selection of RxNorm as the drug terminology standard required to meet Meaningful Use criteria, it has become necessary for the HDD to maintain RxNorm’s drug data from a longitudinal perspective. Our former process for maintaining RxNorm dealt solely with the mapping of the current version, with limited regard to managing changes in RxNorm’s data over time. However, it’s not just the initial mapping that is important; having a long term strategy for maintaining that terminology within a larger terminology server is crucial for ensuring data quality. Medical terminologies change over time, and there is no algorithm yet that can alone guarantee the level of accuracy required for exchange of clinical data. Continue reading