While we often hear about the role of good nutrition in promoting health, it is not typically discussed in the context of the Triple Aim – better outcomes, lower cost and improved patient satisfaction. What are the opportunities in health care to promote good nutrition and improve healthcare outcomes? Continue reading
After decades of development, endless regulatory hurdles and multiple delays, the implementation date for ICD-10 has arrived. If ICD-10 had a theme song, it certainly would be “The Long and Winding Road” by the Beatles. “Don’t leave me standing here” is the lyric that sums up the frustrations of enduring repeated last minute delays. Finally, the healthcare industry will no longer be left standing in the past, chained to the out-of-date and inadequate ICD-9 coding system. Continue reading
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
…for the engine to pick up steam. In the past ten years, the train carrying healthcare pricing and quality information has been rolling but the caboose is still waiting at the station. Significant improvement is necessary before we can say with confidence that pricing and quality information is sufficiently transparent, accessible and provided in a timely manner. As importantly, ongoing concerns need to be addressed so that those using information provided will be able to interpret it in a meaningful way. It is clear that while most people have difficulty understanding and, more importantly, acting on the healthcare information that is currently available, the situation is getting better¹. Continue reading
As a compliance officer I have the opportunity to publish training on various compliance topics to our workforce. We just completed a required training and I think I learned as much about how the organization works as the workforce may have learned from the training.
From an employee’s perspective, completing a required compliance training course may be the last thing they want to do, yet from the organization’s standpoint, it’s one of the most important things for them to do. Protecting the privacy and security of patient data is of utmost concern for any compliance officer in health care. The Ponemon Institute just published its Fourth Annual Benchmark Study on Patient Privacy and Data Security which emphasized the role employees have in detecting data breaches, while at the same time noted that employee negligence is considered a worry by many of the respondents to their survey. Organizations in the Ponemon study reported that they rely upon policies and procedures to achieve compliance and secure data. What this tells us is that training employees on proper security methods, policies and our code of conduct, as well as guidelines for how to report an issue is paramount. Continue reading