Modern Practice Podcast

Challenges in documenting spinal surgery, Part 3

On this episode, Dr. Tomas Villanueva and a leading clinical documentation expert finish their discussion on the need to correctly document everything involving spial surgery. Spinal surgery represents a complex challenge for documentation specialists and clinicians alike, and this episode will clear up what is needed to be successful in coding and documenting these procedures.
 
Moderator:Tomas Villanueva, DO, MBA, FACPE, SFHMSenior Principal, Clinical Operations and QualityVizient
 
Guest:Rachel Mack, MSN, RN, CCDS, CDIP, CCS, CRCConsulting Director, Clinical Documentation ImprovementVizient
 
Show Notes:
[00:31] Query opportunities and low-hanging fruit
[01:53] Blood loss and the whole clinical picture in querying
[02:50] Using that “magic word” can make a difference – coding to an MCC
[03:43] Other query opportunities
[10:36] When the documentation is wrong
[12:44] Reconciliation and feedback needed
 
Links | Resources:
To contact Modern Practice: modernpracticepodcast@vizientinc.com
Rachel Mack’s email: rachel.mack@vizientinc.com
 
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Challenges in Documenting Spinal Surgery, Part 2

On this episode, Dr. Tomas Villanueva continues his discussion with a leading clinical documentation expert on the need to correctly document everything involving spial surgery. Spinal surgery represents a complex challenge for documentation specialists and clinicians alike.
 
Moderator:
Tomas Villanueva, DO, MBA, FACPE, SFHM
Senior Principal, Clinical Operations and Quality
Vizient
 
Guest:
Rachel Mack, MSN, RN, CCDS, CDIP, CCS, CRC
Consulting Director, Clinical Documentation Improvement
Vizient
 
Show Notes:
[00:41] Rise in spinal surgeries
[01:23] Coding challenges and parameters
[01:53] Predicaments for coding and CDI specialists
[07:22] Common DRGs for spinal surgeries – the need to use the “magic words”
 
Links | Resources:
To contact Modern Practice: modernpracticepodcast@vizientinc.com
Rachel Mack’s email: rachel.mack@vizientinc.com
 
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Challenges in documenting spinal surgery, Part 1

Spinal surgery represents a complex challenge for clinical documentation. Difficult to code and representing query situations that can be demanding, this is the area of focus for this episode of Modern Practice. Joining Dr. Tomas Villanueva is a leading expert returning to the podcast to talk about the challenges of spinal surgery documentation.
 
Moderator:Tomas Villanueva, DO, MBA, FACPE, SFHMSenior Principal, Clinical Operations and QualityVizient
 
Guest:Rachel Mack, MSN, RN, CCDS, CDIP, CCS, CRCConsulting Director, Clinical Documentation ImprovementVizient
 
Show Notes:
[01:26] Around 1.62 million procedures per year
[02:22] Procedures on the increase (2.4 times the level of 15 years ago)
[03:54] The most common spinal diagnoses
[05:15] Often not caught by primary care
[06:20 Less common reasons for spinal surgery
[07:09] Reasons for planned surgeries—often a last resort
[08:45] Risks for avoiding surgery
 
Links | Resources:
To contact Modern Practice: modernpracticepodcast@vizientinc.com
Rachel Mack’s email: rachel.mack@vizientinc.com
 
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Mental fitness for physicians, Part 3

Years of medical school, residency and fellowships have proven to do little in teaching physicians how to care for themselves. Physician burnout is at an all-time high. On this episode, a physician who is a leading expert on physician stress discusses how to improve mental fitness in those who’ve given their lives to the care of others.
 
Moderator:Tomas Villanueva, DO, MBA, FACPE, SFHMSenior PrincipalClinical Operations and QualityVizient
Guest:Cecilia Cruz, MD, MPH, CPCC, ACCFounder and Chief Executive OfficerMarpe, LLCBoard-certified emergency medicine physicianFormer co-chair of QualityDivision of Emergency MedicineNorthShore University HealthSystem
 
Show Notes:
[00:34] Physician suicide
[02:44] Need connection
[04:03] What organizations need to do
[06:20] A learned skill and resource
[06:37] Mental fitness
[08:20] The Marpe approach
 
Links | Resources:
To contact Modern Practice: modernpracticepodcast@vizientinc.com
Dr. Cruz’s email: ceciliacruz@marpejourney.com
Dr Cruz’s Linkedin page: Cecilia Cruz - Founder and CEO - MARPE, LLC | LinkedIn
MARPE, LLC website: https://www.marpejourney.com/
 
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Mental fitness for physicians, Part 2

This episode of our award-winning podcast continues the discussion on why mental fitness is so crucial for physicians and other clinicians today and yet is a concept that physicians still tend to avoid or downplay. Physician training and medical school have not helped. Join us for this gritty discussion.
 
Moderator:Tomas Villanueva, DO, MBA, FACPE, SFHMSenior PrincipalClinical Operations and QualityVizient
Guest:Cecilia Cruz, MD, MPH, CPCC, ACCFounder and Chief Executive OfficerMarpe, LLCBoard-certified emergency medicine physicianFormer co-chair of QualityDivision of Emergency MedicineNorthShore University HealthSystem
 
Show Notes:
[01:00] The in-box, EMR documentation and authorizations have only gotten worse
[01:40] If we don’t change, it’s all going to fall apart
[03:23] Examples from medical school and training—a lack of respect
[06:45] The EMR and the need for a 27-hour day
[08:05] Deficit of 40,000 primary care physicians by 2030 (AAMC)
[08:30] Emerging mental health issues and workplace violence
 
Links | Resources:
To contact Modern Practice: modernpracticepodcast@vizientinc.com
Dr. Cruz’s email: ceciliacruz@marpejourney.com
Dr Cruz’s Linkedin page: Cecilia Cruz - Founder and CEO - MARPE, LLC | LinkedIn
MARPE, LLC website: https://www.marpejourney.com/
 
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Mental fitness for physicians, Part 1

Though physicians spend years in medical school, residency and fellowships to learn how to care for patients, they spend little time learning how to care for themselves. Physician burnout, leading to physician turnover, is skyrocketing. On this episode, a physician who is a  leading expert on physician stress, having gone through that stress herself, discusses how to improve mental fitness in those who’ve given their lives to the care of others.
 
Moderator:Tomas Villanueva, DO, MBA, FACPE, SFHMSenior Principal, Clinical Operations and QualityVizient
 
Guest:Cecilia Cruz, MD, MPH, CPCC, ACCFounder and Chief Executive OfficerMarpe, LLCBoard-certified emergency medicine physicianFormer co-chair of QualityDivision of Emergency MedicineNorthShore University HealthSystem
 
Show Notes:
[01:10] Physician heal thyself? Not happening!
[02:35] Weakness means not being the best
[03:31] An ingrained culture of perfectionism
[04:20] The burnout crisis
[06:40] Physician types affected the most
[07:30] Bigger burden on specialists
[09:13] Overcoming – awareness is only 20% of progress
 
Links | Resources:
To contact Modern Practice: modernpracticepodcast@vizientinc.com
Dr. Cruz’s email: ceciliacruz@marpejourney.com
Dr Cruz’s Linkedin page: Cecilia Cruz - Founder and CEO - MARPE, LLC | LinkedIn
MARPE, LLC website: https://www.marpejourney.com/
 
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The difficulty of quality metrics, Pt 3

On this episode of our award-winning podcast, Dr. Tomas Villanueva concludes his discussion on how organizations can approach quality metrics today – what metrics to choose and how to apply them.
 
Moderator:Tomas Villanueva, DO, MBA, FACPE, SFHMSenior Principal, Performance Improvement ConsultingVizient
 
Guest:Rick May, MDSenior Principal, Consulting SolutionsVizient
 
Show Notes:
[00:38] The burden of reporting
[02:09] Surgical quality and outcomes – technical vs. medical
[03:41] A focus on the systems
[05:00] Systems changes and results
[05:42] Engaging the physicians
 
Links | Resources:
To contact Modern Practice: modernpracticepodcast@vizientinc.com
Dr. May’s email: rick.may@vizientinc.com
 
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The difficulty of quality metrics, Pt 2

On this episode of our award-winning podcast, Dr. Tomas Villanueva continues his discussion on how organizations can approach quality metrics today – what metrics to choose and how to apply them.
 
Moderator:Tomas Villanueva, DO, MBA, FACPE, SFHMSenior Principal, Performance Improvement ConsultingVizient
 
Guest:Rick May, MDSenior Principal, Consulting SolutionsVizient
 
Show Notes:
[00:54] Importance clinical documentation
[02:40] Is it possible to eliminate all CLABSIs (or other infections)?
[04:40] Length of stay as quality metric
[05:10] Surgical complications and length of stay
[05:55] Length of stay and complication rates
[06:40] The most heavily weighted metric
 
Links | Resources:
To contact Modern Practice: modernpracticepodcast@vizientinc.com
Dr. May’s email: rick.may@vizientinc.com
 
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The difficulty of quality metrics, Pt 1

Concerning quality measures in healthcare organizations, a common complaint is, “I've got so many people looking over my shoulder, pulling our data in, ranking me, rating me, everything else, and there is no way I can keep track of literally the hundreds of metrics for which we’re accountable.”
 
On this episode of our award-winning podcast, Dr. Tomas Villanueva welcomes back a leading quality expert to discuss how organizations can approach quality metrics today – what metrics to choose and how to apply them.
 
Moderator:Tomas Villanueva, DO, MBA, FACPE, SFHMSenior Principal, Performance Improvement ConsultingVizient
 
Guest:Rick May, MDSenior Principal, Consulting SolutionsVizient
 
Show Notes:
[01:49] Why measuring quality is crucial
[02:17] If you do quality well, financial success follows
[02:57] Quality attracts staff
[03:46] Has quality improved overall in healthcare?
[04:42] Choosing the right metrics – 500 metrics exist overall
[05:58] Mishmash in timing of measures – complex and “all over the map”
[08:03] Realistic rate of improvement (hint: it’s not 10%!)
[08:53] Impact of under-capturing documentation
 
Links | Resources:
To contact Modern Practice: modernpracticepodcast@vizientinc.com
Dr. May’s email: rick.may@vizientinc.com
 
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Why Risk Adjustment Is So Important

This episode of the award-winning podcast examines the importance of risk adjustment. Dr. Tomas Villanueva leads the discussion on the impact of this crucial aspect of documentation that can affect hospital outcomes.
 
Moderator:
Tomas Villanueva, DO, MBA, FACPE, SFHM
Senior Principal, Clinical Operations and Quality
Vizient
 
Guest:
Erica Braun, MS, RN, CCDS
Senior Consulting Director, Clinical Documentation Improvement
Vizient
 
Show Notes:
[01:29] Defining risk adjustment – maintaining an apples to apples comparison
[02:41] Capturing comorbid conditions to the highest level of specificity
[04:08] Capturing the low-hanging fruit
[05:47] Case mix index issues
[07:44] Severity of illness and risk of mortality
[08:52] Addressing query fatigue
 
Resources:
To contact Modern Practice: modernpracticepodcast@vizientinc.com
Erica Braun’s email: erica.braun@vizientinc.com
 
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