Posts by Danielle Scheurer

Frequency & Clinical Relevance of Inconsistent Code Status Documentation

I had the pleasure of interviewing Dana Edelson, a Hospitalist at the University of Chicago, about her team’s recent publication in the Journal of Hospital Medicine (JHM), Comparison of mental status scales for predicting mortality on the general wards. We know from previous literature that altered mental status is a strong predictor for inpatient mortality. But it is not clear which mental status assessment tool is best in detecting the risk of mortality. This study retrospectively compared the accuracy of 3 mental status scales [Glasgow coma scale (GCS), the Richmond Agitation and Sedation Scale (RASS) and Alert, responsive to Verbal stimuli, responsive to Painful stimuli, and Unresponsive (AVPU)] in predicting inpatient mortality. The authors found RASS to be the most predictive, followed by GCS, followed by AVPU. The combination of RASS + GCS was the most predictive, compared to any of the scales alone. What is your background and how…

It’s That Time again…

It’s that time of year again, when hospitals around the country are being notified of their 30-day readmission penalties from CMS. Now in the fourth year of the program, many hospitals have come to dread the announcement of how much they are being penalized each year.1 This year the readmission reduction program will decrease Medicare payments within a total of 2,592 U.S. hospitals, for a combined total of $420 million.2 Unfortunately, safety-net hospitals were about 60% more likely than other hospitals to have been penalized in all 3 years of the program. In addition, hospitals with the lowest profit margins were 36% more likely to be penalized than those with higher margins. Despite criticisms of the program, there is no doubt that it has forced hospitals to pay keen attention to transitions of care and avoidable readmissions. And it does appear to be an effective strategy for CMS to achieve…

Improving Patient Satisfaction through Education, Feedback & Incentives

[caption id="attachment_12537" align="alignright" width="221"] Chart couresty of Kaiser Health News.[/caption] Patient satisfaction survey performance is becoming increasingly important for hospitals, as the ratings are being used by payers in pay-for-performance programs more and more (including the CMS Value Based Purchasing program). CMS also recently released their “Five-Star Quality Rating System” for hospitals, which publicly grades hospitals on 1-5 stars based on their patient satisfaction scores. Unfortunately, there is little literature to guide physicians on exactly HOW to improve patient satisfaction scores for themselves or their groups. A recent publication in the Journal of Hospital Medicine (JHM) found a feasible and effective intervention to improve patient satisfaction scores among trainees, the methodology of which could easily be applied to hospitalists. Dr. Gaurav Banka, a former internal medicine resident (and current cardiology fellow) at UCLA Hospital, was interviewed about his team’s recent publication in the Journal of Hospital Medicine, “Improving patient satisfaction…

Frequency and Clinical Relevance of Inconsistent Code Status Documentation

I had the pleasure of interviewing Adina Weinerman, a Hospitalist in the Division of General Internal Medicine at Sunnybrook Health Sciences Centre in Toronto, Canada, about her team’s recent publication in the Journal of Hospital Medicine (JHM) Frequency and Clinical Relevance of Inconsistent Code Status Documentation. This “point prevalence” study from 3 academic medical centers found that 65% of inpatients had at least 1 code status documentation inconsistency, and 20% were clinically relevant. What is your background and how did you become interested in evaluating inconsistencies in code status in the medical record? I did my IM residency at University of Toronto, and during my last year I had the opportunity to do an administrative position as a chief resident, which helped me get a good understanding of the administrative side of medical centers. Also during my residency, I was surrounded by mentors in quality improvement at the University and…

Value-based Payments: On the top of CMS’s List and Yours, Hospitalists

The Department of Health and Human Services (HHS) announced a bold new goal to rapidly enhance the adoption of value-based reimbursement for all payors in the medical industry. The Medicare goal is to tie 30% of payments to ACOs or bundled payments by the end of 2016 and 50% by the end of 2018. HHS also set a goal to tie 85% of traditional payments to quality/value by the end of 2016, and 90% by the end of 2018. In order to stretch these goals beyond Medicare, they will set up a Health Care Payment Learning and Action Network, in order to get other payors to live up to the same value-based payment goals (the Network will hold its first meeting in March 2015). It is obviously easy to support such a notion that the health care system needs to move from fee-for-service payment models to those that drive value…
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