Click here to load reader

The Impact of ICD-10-CM and ICD-10-PCS on Medical ... · PDF file ICD-9-CM and ICD-10-CM/PCS Mapping • To facilitate the transition from ICD-9-CM to ICD-10-CM/PCS, mapping between

  • View
    1

  • Download
    0

Embed Size (px)

Text of The Impact of ICD-10-CM and ICD-10-PCS on Medical ... · PDF file ICD-9-CM and ICD-10-CM/PCS...

  • Taiwan Medical and Health Information Management Association

    Saturday, July 28, 2012

    Nelly Leon-Chisen, RHIA, Director Coding and Classification

    American Hospital Association

    Lee H. Hilborne, MD, MPH,

    The Impact of ICD-10-CM and

    ICD-10-PCS on Medical

    Documentation, Patient Safety

    And Quality Initiatives

    Medical Director, Care

    Coordination

    UCLA Health System

    Health Services Researcher

    RAND Corporation

    Medical Director

    Quest Diagnostics

    http://www.uclahealth.org/

  • 2

    Public Reporting Of Data Is A Driving

    Force

    • Transparency is a property of a high reliability organization

    • Many initiatives are emerging to evaluate and report quality

    of care and patient safety

    • Reported data serve four common interconnected purposes

    – Quality Improvement

    – Public Reporting

    – Pay-For-Performance

    – Research

    Copyright (c) 2012 by American Hospital Association. All rights reserved.

    http://www.uclahealth.org/

  • 3

    Where Does The Pressure Originate?

    • Employers

    – Reducing costs

    – Improving clinical quality

    – Comparative performance data available in the public domain (e.g. Leapfrog Group, National Business Coalition on Health)

    • Health plans

    – Data to describe providers’ and enrollee’s actions, costs, and health outcomes

    – Analysis of comparative performance data and pricing

    • Consumer concerns

    – Medical errors

    – Increased cost

    – Lack of coverage

    – Access to comparative performance

    Copyright (c) 2012 by American Hospital Association. All rights reserved.

    http://www.uclahealth.org/

  • 4 Copyright (c) 2012 by American Hospital Association. All rights reserved.

    Pay For Performance Is On Everybody’s Mind

    • Also called value based purchasing

    • Differential payment to hospitals

    and physicians based on

    performance on a set of specified

    measures

    – Quality

    – Efficiency

    – Patient experiences

    – Structural reforms (e.g.,

    information technology)

    • Aligns financial incentives with

    delivery of high quality care

    • Rapidly expanding programs

    0

    50

    100

    150

    200

    P4P Programs

    2003 2004 2005

    2006 2008

  • 5

    Private Sector Initiates Most Pay for

    Performance Programs

    • Most link relatively small bonus payments to better performance on specific process measures with outcome correlation

    • Focus on costly and relatively common conditions

    • Hospital “pay for performance” (P4P) experiments are run either by commercial plans or by employer-payer coalitions

    • Most include process and structure measures

    – Some include condition specific clinical outcome measures

    – But process measures are easiest to identify because what was actually done gets coded

    • Wide range of incremental revenue from successful performance—from less than 1% to 15%

    Copyright (c) 2012 by American Hospital Association. All rights reserved.

    http://www.uclahealth.org/

  • 6

    Pay For Performance Is A Centers for

    Medicare & Medicaid Priority

    • Shift in payment considerations

    – Payment traditionally based on the process of care (what was

    done)

    – P4P: Outcome influences payment (treatment impact); better

    outcomes paid more

    – Value-based purchasing

    • Goal

    – Right care for every patient every time

    – Conforms to Institute of Medicine (IOM) quality domains

    • Safe

    • Effective

    • Centered on the patient’s needs

    • Timely

    • Efficient

    • Equitable

    Copyright (c) 2012 by American Hospital Association. All rights reserved.

    http://www.uclahealth.org/

  • 7

    Medicare Programs Target Multiple Settings

    • Various initiatives to encourage improved quality

    of care in all health care settings:

    – Hospitals

    – Physicians’ offices

    – Ambulatory care facilities

    – Nursing homes

    – Home health care agencies

    – Dialysis facilities

    Copyright (c) 2012 by American Hospital Association. All rights reserved.

    http://www.uclahealth.org/

  • 8

    Quality Reporting Programs Working With CMS Are

    Dramatically Impacting Hospital Care

    • The Hospital Quality Alliance (HQA)

    – Created in 2002 as the USA’s first multi-stakeholder

    private/public organization dedicated to developing, reporting

    and updating information about hospital quality performance,

    and encouraging efforts to improve hospital quality.

    – Transferred the quality measure review processes to the

    Measures Application Partnership (MAP) in 2012.

    – Catalyzed adoption of the Hospital Consumer Assessment of

    Healthcare Providers and Systems (HCAHPS), the nation’s first

    standardized survey for measuring patients’ perceptions of their

    hospital care.

    – Introduced the nation’s first measures of surgical site infections.

    – Virtually all of the 10 core measures that the HQA first put

    forward now are above 95 percent compliance.

    – Advised CMS on the creation of Hospital Compare

    Copyright (c) 2012 by American Hospital Association. All rights reserved.

    http://www.uclahealth.org/

  • 9

    Quality Reporting Programs Working With CMS Are

    Dramatically Impacting Hospital Care (cont.)

    • Hospital Compare www.hospitalcompare.hhs.gov

    – The nation’s broadest compendium of publicly available,

    internet accessible and comparable national hospital

    quality measures.

    – Currently reports on more than 50 performance

    measures for inpatient and outpatient care and allows

    the public and health care providers to compare the

    performance of more than 4,500 hospitals across the

    nation.

    Copyright (c) 2012 by American Hospital Association. All rights reserved.

    http://www.uclahealth.org/ http://www.hospitalcompare.hhs.gov/

  • 10

    Addressing Quality Creates Data Challenges

    • Retrospective chart abstraction

    – Burdensome

    – Time-consuming

    – Mostly manual process

    – Able to collect more specific clinical measures

    • Administrative claims data

    – More efficient

    – Quality reporting as a by-product of the administrative

    process

    – Codes do not provide level of detail necessary

    – Concerns over accuracy of coded data

    Copyright (c) 2012 by American Hospital Association. All rights reserved.

    http://www.uclahealth.org/

  • 11

    We Focused On Patient Safety In Taiwan - 2003

    http://www.uclahealth.org/

  • 12

    We Agreed Safety Is Not New And Surely Not

    Unique to the USA

    “Grant me the courage to realize my daily mistakes so

    that tomorrow I shall be able to see and understand in a

    better light what I could not comprehend in the dim light

    of yesterday” Maimonides (1135-1204)

    “I would give great praise to the physician whose

    mistakes are small for perfect accuracy is seldom to be

    seen” Hippocrates

    “…even admitting to the full extent the great value of the

    hospital improvements in recent years, a vast deal of

    the suffering, and some at least of the mortality, in these

    establishments is avoidable.” Florence Nightingale, 1863

    http://www.uclahealth.org/

  • 13

    Safety Has Reached Our Patients’ Journals

    http://www.uclahealth.org/

  • 14

    Errors Made News In Taiwan Too

    United Daily News

    2 December 2002

    http://www.uclahealth.org/

  • 15

    We Discussed Changing The Culture In Which

    We Practice

    • Vague/slippery concept

    – “How we get things done around here”

    – Unofficial organizing principles; the way problems are solved; organizational glue

    – We know it when we see it

    – It eats strategy for lunch

    • But there are some themes

    – Corporate self-esteem

    – Organizational structures that are important

    – How the organization views itself/outside world

    – Degrees of autonomy/collaboration, expectations,

    hierarchies of decision making

    http://www.uclahealth.org/

  • 16

    The Heart Of Culture Change In Medical Care

    • The idea that medical errors are caused by bad systems is a transforming concept

    • Complex systems have latent errors

    – Design of work

    – Conditions of work

    – Training

    – Design and maintenance of equipment

    • Must have clear responsibility to make the changes needed

    • Safety must trump personal preferences

    • Safety is everyone

Search related