Tag Archives: Quality

Quality versus quantity…a real dilemma

Happy New Year to all! As we make (and break) many New Year’s resolutions this month, I’d like to talk about resolutions for quality.

I appreciate the challenges and pressures to get claims coded and out the door and meet productivity standards. I am sure many organizations think I live in an ivory tower and not in the real world. Let me just tell you that we all have some sort of productivity standards in our jobs for which we are held accountable (myself included). Finding the right balance means hitting the mark on productivity while still doing a quality job. Continue reading

Does anyone really believe quality scores change referral patterns or the doctors patients choose?

This question was posed by an audience member to speakers at the 3M Value-Based Care Conference. The answers were all “yes,” but not without qualification about how data transparency changes behavior.

Precisely, the question was, “Does anybody really believe that putting up a quality score changes referral patterns or makes a patient go someplace different?” The asker explained, “In New York, we’ve had the Cardiac Report Card forever and forever . . . I have never seen a badly reported cardiac surgeon come off that list or not do cases.” Continue reading

Good news and bad news: The cost of (partial) Patient-Centered Medical Home implementation

Magill and colleagues published a nice analysis of the staffing costs of a Patient-Centered Medical Home (PCMH). Compared to a regular practice that already has an electronic medical record, they looked at the incremental costs associated with meeting NCQA standards for Patient-Centered Medical Home recognition.

The investigators reported incremental costs in three ways: Continue reading

ICD-10: The road ahead

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 Finally, the healthcare industry will no longer be left standing in the past, chained to the out-of-date and inadequate ICD-9 coding system.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

Half of Primary Care Physicians Think Quality Metrics Have a Negative Impact on Quality

In a Commonwealth Fund/Kaiser Family Foundation survey, 50 percent of PCPs report that quality metrics have a negative impact on their ability to provide quality care to their patients.i

Quality Metrics Chart

Click to Enlarge

If you spend any time in a primary care office practice this should come as no surprise. PCPs tend to be deeply dedicated to their patients and want very much to do the right thing. 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

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

It’s Complicated! Just Because You “Can” Doesn’t Mean That You “Should”

Remember as a child using the argument, “Everyone else’s parents are letting them” and your mother asking, “If everyone else jumped off a bridge, would you jump too?” When it comes to capture of diagnoses, the same type of argument can occur between HIM and Quality. Coding professionals will refer to the alphabetical/tabular indexes, official Coding Guidelines and AHA Coding Clinics for ICD-9-CM to support the capture of a diagnosis or for specific code assignment.  Quality staff will refer to the clinical picture, the probable intended meaning of the author and in applicable cases, the CDC diagnostic criteria as support for not assigning a code. I can remember a very passionate “discussion” between myself and a coding professional about a complication and whether or not it had to be assigned as a complication.  I stated, “Just because you can code it that way does not mean you have to code it that way!” Continue reading

Airbags and Analytics

I am not a fan of cold weather. Not a snow lover, don’t like sleet, detest freezing rain and ice and the resulting traffic accidents. Most folks don’t think about their airbags until they begin to skid on an ice-covered road and suddenly it becomes one of the most critical components of the vehicle.

Bad weather makes me think about the news reports of the frightening problems with faulty airbags. I was surprised to hear reports that the problem impacts the entire price range of vehicles – from economy to luxury brands. The news got me thinking – is an airbag a component auto manufacturers would compromise? Continue reading