Tag Archives: HealthIT

AHIMACon vs. Comic-Con: We All Have a Role to Play

Last week I checked in on Facebook from the AHIMA convention in San Diego. My brother, who attends San Diego Comic-Con religiously every year, decided to weigh in:

Brother: My San Diego convention is superior to your San Diego convention.

Me: My convention is more conventional than your convention.

Brother: I expect you’ll have better Cosplay, though.

Me: Lots of Clark Kent and Lois Lane types.

It turns out this exchange fit perfectly with the vibe at #AHIMACon14 over the following three days. I arrived at the Monday general session in time to see and hear several inspirational messages about how innovation and, as AHIMA CEO Lynne Thomas Gordon put it, “embracing reinvention,” are the keys to success in health information management. Continue reading

Three Reasons Not to Model Health Care after Trader Joe’s

The AHIP conference in Seattle this month includes three consumer retail executives on the agenda. In leading up to the event, the media cited one of the speakers, the former president of Trader Joe’s, and suggested that health care should take some cues from the retail grocer.

Stop right there. Health care should not imitate the business model of Trader Joe’s, known for its folksy story-telling and unique selection of private label foodstuffs. The healthcare market is significantly different from grocery stores in ways that make it difficult to be consumer friendly: Continue reading

Health Equity: Data and Analytics Are The Great Equalizer

Those in public health believe that everyone is entitled to breathe the same clean air, drink the same safe water, and eat the same uncontaminated food. Public health protects and promotes health for everyone — regardless of race, sex, age, socioeconomic status, whether among rural or urban dwellers, whether the employed or unemployed. The basis for charting progress has been measuring and monitoring health indicators using epidemiologic tools and methodologies that account for variations in the population, such as identifying risk factors for certain conditions and geographic considerations.

But what about equity in access to health care, health information and health security? Continue reading

CMS, 2-Midnights, and linking payment with what you want to achieve

A recurring theme in our blog posts is the need for payment policy to reflect a clearly defined purpose. Start with what you want to achieve and work backwards to a policy that delivers it. The ongoing saga of the CMS 2-Midnight rule is an excellent case study for this principle.

First, some history: CMS was/is faced with two related but distinct challenges. The first is the inexorable rise in observation stays, particularly those stays which exceed 48 hours. CMS observed an increase in the average duration of observation cases exceeding 48 hours from three percent in 2006 to eight percent in 2011. A subsequent OIG study put the rate at 11 percent in 2012. Extended observation creates a knock-on effect for beneficiaries, both for personal liability and qualification for post-acute care benefits. Hospitals blamed the increase upon aggressive Recovery Audit Contractors and rules that only paid for ancillary tests for inpatient admissions deemed unnecessary after review. This is not a determination that the service was not medically necessary, but rather that it need not have required an inpatient stay. Continue reading

Accepting the Status Quo: Cost of Non-Compliance vs. ICD-10

Like many in the healthcare industry, I’ve spent the last few weeks reading about the ICD-10 delay. Depending on which camp you are in, the opinions are lining up predictably. I’ve read a lot of comments about the ”cost of ICD-10.” Though many agree the adoption of a more sophisticated code set brings important benefits, the conversation always circles around to the expense of implementation.

If high costs are really the issue with ICD-10, why do we continue to ignore known cost-saving measures that would easily offset the expense of implementation for the average physician practice? For instance, I find the willingness to accept the enormous cost of years of non-compliance with medical necessity perplexing. Or consider the continued practice of submitting poorly coded claims based on subpar clinical documentation. What about the cost of claim denials, write-offs, and fraud in ICD-9 – or any other coding language for that matter? In my opinion, complaints about the cost of doing business have less to do with the expense of implementing ICD-10 and more to do with human nature. Continue reading

Listen up: How the healthcare documentation team can optimize quality

In my February post, “Can You Hear Me Now?” I shared a list of suggestions for physicians and other dictators to help improve documentation quality. This time around, I am going to focus on the healthcare documentation staff in HIM and transcription. There are many best practices that the healthcare documentation team can implement to assist with dictation and documentation quality, and they all fit into three major categories:

Set expectations

The best way to get the results you want is to spell out what you expect through standards, procedures, and best practices. The healthcare documentation team needs to set the tone for how the organization captures patient information by: Continue reading

How Progressive Hospitals Operationalize Their Quality Data

You’ve got your quality data. Now what?

Hospitals don’t lack for data on quality outcomes. The real question is what to do with it. Even after making sure the data is sound—by checking documentation, coding for accuracy, and verifying the integrity of data in the EHR, for example—people often wonder how to understand and use the information.

There aren’t easy answers. But, there are good answers and many, many good examples. A number of 3M customers are improving patient outcomes through deliberate and innovative uses of their quality data. Continue reading

Providers Dodge a Bullet: Reimbursement Might Have Been Tied to Hospital Medical Necessity Denials

Doctors, nurse practitioners, nursing homes, lab, ambulance, and home health providers dodged a major bullet.

While it’s still freezing cold on the East Coast, CMS released Transmittal 505, Change Request 8425 on a very hot topic – extending record requests for medical necessity audits of admissions. The subject of the CR “Removing Prohibition” means (according to CMS) “allow(ing) the contractors to make a decision or take action on claims that are not currently being under review.”

But on March 19, 2014 CMS rescinded the transmittal citing “the need to clarify CMS’s policy” regarding removing prohibition. They also said the policy will not be replaced at this time. Let this be a warning: CMS came very close to denying collateral provider claims for medically unnecessary admissions. This is something they are obviously serious about. Continue reading

The Healthcare Provider Relay: Why We Need a Patient-focused Episode Payment System

An alien watching a 500 meter relay would think the race is all about the baton. Why else would these beings dedicate themselves to getting this object to its destination as quickly and flawlessly as possible? A relay race would not exist without the baton to bind the individuals together and create a team event. Although each team member’s leg of the race is important, the requirement that the baton be handed from one team member to the next turns four separate runs into a single, unified performance that can be evaluated and rewarded for its overall excellence.

In the relay that is the U.S. healthcare system, the patient is the baton—and the patient baton is not as fortunate as the white plastic one. In the current healthcare set-up, the hospital discharges its responsibility for the patient’s care once it discharges the patient. Then the patient is passed like a baton from one set of provider hands to the next, wobbles and all. Continue reading

Healthcare’s Efficiency Challenge

I’ve started reading a book by William Baumol called The Cost Disease, which raises an interesting question. Why in 2014 can I buy a laptop computer that is smaller, more powerful, and most of all, much cheaper than one I could have bought just ten years ago, but healthcare costs have risen from ten years ago? Why are some industries able to become more efficient, and produce more of their goods or services, faster and cheaper, while other industries are stuck in a spiral or are continually raising costs with stagnant efficiency?

I won’t give a full, in-depth review of the book, but in short, the analysis lays out the premise that in some industries, such as with computers or automobiles, manufacturers are able to continually improve on both their manufacturing processes and the quality of the goods they are manufacturing. This enables these manufacturers to produce better goods at lower costs. These lower costs then enable them to pass some of these savings on to their customers, as well as to pay their employees more money. Continue reading