Quality Improvement (QI)

What the Heck Is an HAC Anyway?

Many are well aware that Medicare has been publicly reporting the “Hospital Acquired Condition” or “HAC” list since 2008. These are conditions that should (ideally) never happen, or at least happen at a very low frequency. The HAC list has been controversial for a number of reasons: There is no risk adjustment Some HACs occur even if the best of care is provided (e.g. VTE after hip or knee surgery) They are defined by coded data (which does not always correlate with abstracted data) Despite these limitations, Medicare has penalized hospitals for HACs (by not reimbursing for a higher DRG payment, if the HAC would have resulted in a higher payment) and has publicly reported HAC rates by hospital. However, Medicare had stopped publicly reporting HACs for a period of months, but says it will resume public reporting soon, at least for eight of the HACs. Now, these HACs should…

Disillusioned

I don't know if anyone had a chance to hear the interview on Fresh Air on NPR with Dr. Sandeep Jauhar about his recent book,  Doctored: The Disillusionment of an American Physician. I found that I could easily relate to his perspectives on modern medicine. He discussed how patients increasingly are living with multiple chronic illnesses that require multiple sub-specialists; but that there is little time for coordination of that care, much less preventative care in an environment that wants primary care physicians to see patients every 10 minutes. [caption id="attachment_11046" align="alignleft" width="200"] source: www.amazon.com[/caption] Dr. Jauhar talked about how, though physicians know there is a great need for primary care physicians, the payer model doesn't support a system that forces physicians to see patients on the basis of volume, with less pay.  That specialists who just "see patients" are not nearly as profitable as  those who perform diagnostic tests,…

Medicine and surgery in 1900. Should you watch TV’s latest medical drama?

Someone recently stopped you and said, “I can’t believe you are not watching [Breaking Bad, Mad Men, OITNB, Downton Abbey, House of Cards].” You made some reference about the lead character, but know you don’t have the time to watch one episode, let alone 4 seasons on Netflix to catch up.  I did indulge in HBO’s True Detective. Completely worth it. Largely to simply understand these hilarious memes. When the latest buzz surrounded a medical drama during the turn of the 20th century, New York City, and cable television’s ability to hold nothing back, I had to tune in. In the first episode of Cinemax’s new adventure in highbrow cable television, The Knick, the lead surgeon announces, “Let’s give them a show.” Does the show deliver? Before the opening credits, the superstar surgeon of the Knickerbocker Hospital visited a brothel and found the remaining vessel to help propel the cocaine. Added…

Who is the most productive hospitalist in the country? Guess what. It’s not you.

  Some of you might know CMS released our Part B productivity data earlier in 2014.  We have discussed on the policy side of SHM how we might use the data to learn about our field.  Unlike other specialties, we do not have a unique billing identifier.  Without the information, we cannot easily interrogate the database and view the patterns of the more than 40,000 hospital-based practitioners within our healthcare system.  The absence of such a feature creates gaps in our learning.  And as they say, you can't manage what you can't measure. We will acquire a unique code at some point, my conjecture, but until we do, we use inpatient-billing figures to assist in tagging physicians who practice hospital medicine. Most guess ambulatory docs do not bill greater than 25% of their codes on the hospital side, and as the hospitalist majority have their boards in IM or FP…

“How do you know the two-midnight rule doesn’t deliver?” We just learned why.

93% of Hospitalist respondents rated observation policy as critical, but close to two-thirds were not confident in determining a patient's status. For several years, hospital-based practitioners have struggled with observation status, the two-midnight rule, and recovery audit mechanisms.  Doubly so because of the evolving regulations CMS continues to proffer.  Expect additional guidance as the workings (and vagaries) of the rule still plague patient admissions. We all toil with “medical necessity” and what the term means.  The linchpin of successfully implementing the rule hinges on deciphering that very term.  We look towards colleagues, administrators, and consultants for aid. However, after countless internal meetings, conference calls, and failed attempts in obtaining an instruction manual, we realized no one had answers.  Moreover, we at SHM did not know if members were coping and applying the rule in a consistent manner. (more…)
...10...1819202122...30...