Introduction to US Health Care

Unit 9: The Future of Health Care Administration

Unit 9 Overview

The Future of Health Care Administration This week we will look towards the future – when you are a health care administrator. We will look at what we have learned in the previous units and see how we need to change our focus to successfully run a practice or hospital.

(Kaplan Student Website Unit 9)

Reading and Preparation

This week we will read three articles on some topics that are generating buzz in the administration field. We will examine the electronic medical record (EMR), which is a huge undertaking for clinics and hospitals in the near future, as deemed necessary by the Obama administration. We will also look at the biopsychosocial model of care, treating the patient as a whole versus just symptoms. Last, we will examine the ICD-10 code set that will be launched in 2013 to replace the current system.

(Articles in doc sharing)

(Kaplan Student Website Unit 8)

Discussion Board

Discussion responses should be on topic, original, and contribute to the quality of the discussion by making frequent informed references to lesson materials and seminars. Initial discussion responses should be around 150 words. Responses to your classmates or instructor should be around 75 words. Make two or more responses to classmates that are thoughtful and advance the discussion. REMEMBER APA is necessary! Use your resources and in-text citations to give credit where credit is due for the opportunity to get the highest grade. Based upon your readings this week, answer one of the two questions below for this week’s discussion topics. Remember to post your initial post by Saturday and to respond to at least two classmates on two separate days by Tuesday midnight.

Answer one (1) of the two questions below:•Question 1: Do you think the biopsychosocial model is a good model to structure the care of patients? Why or why not? •Question 2: What steps would you take as an administrator to transition your staff to a new electronic medical record?

(Kaplan Student Website Unit 9)

What you should learn in Unit 9

Unit Outcomes

• You should read about electronic medical records and their anticipated future use.

• You should read about the biopsychosocial model of care and the challenges it presents.

• You should look at the new ICD-10 codes that will be implemented in 2013.

(Kaplan Student Website Unit 9)

Synchronous Seminar

This week we will read three articles on some topics that are generating buzz in the administration field.

We will examine the electronic medical record (EMR), which is a huge undertaking for clinics and hospitals in the near future, as deemed necessary by the Obama administration.

We will also look at the biopsychosocial model of care, treating the patient as a whole versus just symptoms.

Last, we will examine the ICD-10 code set that will be launched in 2013 to replace the current system.

Electronic Medical Record (EMR)

• Whether you say EMR or EHR is more than a matter of semantics. Electronic medical records (EMRs) and electronic health records (EHRs) are not the same thing.

• The acronyms represent entirely different concepts, so insisting that they're used correctly is more than quibbling over words.

• Most care delivery organization (CDO) decision makers, clinicians, legislators, bureaucrats and members of the press are not experts in healthcare IT. If they're observant, however, and read the unending press releases that attempt to pass for news, they know that the latest rage is regional healthcare information organizations (RHIOs) purporting to share summary information (EHRs) from patient records (EMRs).

Electronic Medical Record (EMR)

• EMRs are computerized legal clinical records created in CDOs, such as hospitals and physician offices.

• EHRs represent the ability to easily share medical information among stakeholders and to allow it to follow the patient through various modalities of care from different CDOs.

Electronic Medical Record (EMR)

Because of these many "after entry" benefits, federal and state governments, insurance companies and other large medical institutions are heavily promoting the adoption of electronic medical records.

Congress included a formula of both incentives (up to $44K per physician under Medicare or up to $65K over 6 years, under Medicaid) and penalties (i.e. decreased Medicare/Medicaid reimbursements for covered patients to doctors who fail to use EMR's by 2015) for EMR/EHR adoption versus continued use of paper records as part of the American Recovery and Reinvestment Act of 2009.

U.S. Department of Health and Human Services Centers for Medicare & Medicaid Services 42 CFR Parts 412, 413, 422 et al. Medicare and Medicaid Programs; Electronic Health Record Incentive Program; Final Rule

Biopsychosocial Model of Care

The biopsychosocial model (abbreviated "BPS") is a general model or approach that posits that biological, psychological (which entails thoughts, emotions, and behaviors), and social factors, all play a significant role in human functioning in the context of disease or illness. Indeed, health is best understood in terms of a combination of biological, psychological, and social factors rather than purely in biological terms.

Many consider it Holistic Medicine, too!

(Santrock, J. W. (2007). A Topical Approach to Human Life-span Development (3rd ed.).

St. Louis, MO: McGraw-Hill.)

Biopsychosocial Model of Care

The biopsychosocial model is both a philosophy of clinical care

and a practical clinical guide. Philosophically, it is a way of understanding how suffering, disease, and illness are affected by multiple levels of organization, from the societal to the molecular.

At the practical level, it is a way of understanding the patient’s subjective experience as an essential contributor to accurate diagnosis, health outcomes, and humane care.

(The Biopsychosocial Model 25 Years Later: Principles, Practice, and Scientific Inquiry . Retrieved from http://www.annfammed.org/cgi/content/short/2/6/576)

ICD-10 code set

The International Statistical Classification of Diseases and Related Health

Problems 10th Revision (ICD-10) is a coding of diseases, signs and symptoms,

abnormal findings, complaints, social circumstances and external causes of

injury or diseases, as classified by the World Health Organization (WHO).

(http://www.who.int/classifications/icd/en/)

ICD-10 code set

International Classification of Diseases (ICD)

• ICD-10 was endorsed by the Forty-third World Health Assembly in May 1990 and came into use in WHO Member States as from 1994. The classification is the latest in a series which has its origins in the 1850s.

• The first edition, known as the International List of Causes of Death, was adopted by the International Statistical Institute in 1893. WHO took over the responsibility for the ICD at its creation in 1948 when the Sixth Revision, which included causes of morbidity for the first time, was published.

• The World Health Assembly adopted in 1967 the WHO Nomenclature Regulations that stipulate use of ICD in its most current revision for mortality and morbidity statistics by all Member States.

(http://www.who.int/classifications/icd/en/)

ICD-10 code set

How can I obtain an electronic copy of the ICD-10?

• An electronic version of ICD-10 is currently available here:

ICD-10 online (http://www.who.int/classifications/apps/icd/icd10online/)

How can I translate between ICD-10 and ICD-9?

It is not possible to convert ICD-9 data sets into ICD-10 data sets or vice versa.

ICD-9 has 6,969 codes while there are 12,420 codes in ICD-10 (14,199 with the fourth-character place of occurrence codes in Chapter XX (External Causes of Morbidity and Mortality).

ICD-10 code set

How can I obtain an electronic copy of the ICD-10?

• An electronic version of ICD-10 is currently available here:

ICD-10 online (http://www.who.int/classifications/apps/icd/icd10online/)

How can I translate between ICD-10 and ICD-9?

It is not possible to convert ICD-9 data sets into ICD-10 data sets or vice versa.

ICD-9 has 6,969 codes while there are 12,420 codes in ICD-10 (14,199 with the fourth-character place of occurrence codes in Chapter XX (External Causes of Morbidity and Mortality).

LOOKING AHEAD! ICD-11

The International Classification of Diseases 11th Revision is due by 2015

ICD is the international standard to measure:

Health & health services Mortality statistics Morbidity statistics Health care costs Progress towards the Millenium Development Goals Research

(http://www.who.int/classifications/icd/revision/en/index.html)

Questions?