On this episode, we continue our discussion with a physician executive on addressing mortality as a key quality indicator. We focus on using the correct coding and documentation scores for a more accurate representation. We examine the under-use of palliative care, and we discuss how to better work with transfer centers, patients and their families to improve patient experience and hospital mortality scores.

Guest speaker:

Aman Sabharwal, MD, MHA, CPHM

Executive Principal

Operations and Quality

Vizient

Moderator:

Tomas Villanueva, DO, MBA, FACPE, SFHM

Principal

Clinical Operations and Quality

Vizient

Show Notes:

[00:46] Role of documentation and coding

[01:52] Example from neurosurgery notes

[03:20] Gaming the system accusation

[04:12] Ignorance about coders and coding process

[05:10] Surgeons and the medical record

[06:27] Risk stratification and the transfer center in the academic medical center

[08:10] Patient-family involvement in the transfer

[09:16] Use of observation and of virtual care

Links | Resources:

To contact Modern Practice: modernpracticepodcast@vizientinc.com

Aman Sabharwal’s contact email: aman.sabharwal@vizientinc.com

Mortality Measures Hospital-Specific Reports (CMS) Click here

Selected Best Practices and Suggestions for Improvement – Mortality (AHRQ) Click here

Variation in US Hospital Mortality Rates for Patients Admitted With COVID-19 During the First 6 Months of the Pandemic (JAMA Internal Medicine) Click here

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Mortality scores are increasingly an issue for many health care organizations across the country. Obviously, the pandemic had a major role in affecting these scores, but the truth is this was an issue before the pandemic and only rose to attention of the public and regulators from it. Despite the obvious reasons organizations need to address their mortality scores as a key quality indicator, these scores also are a major influence in national quality scores and reputation. Organizations can also use good scores as leverage in negotiations with payers. In earlier episodes, we addressed this issue with a data scientist and a documentation specialist. In this series, a physician executive gives his perspective.

Guest speaker:

Aman Sabharwal, MD, MHA, CPHM

Executive Principal

Operations and Quality

Vizient

Moderator:

Tomas Villanueva, DO, MBA, FACPE, SFHM

Principal

Clinical Operations and Quality

Vizient

Show Notes:

[01:32] Importance of mortality scores

[02:50] Putting the pandemic aside

[03:09] Mortality weighs heavily in rankings

[04:08] Mortality scores and payers

[04:30] The O/E Ratio

[06:11] Four workstreams to address mortality

[08:33] One single thing an organization can do to improve ranking

Links | Resources:

To contact Modern Practice: modernpracticepodcast@vizientinc.com

Aman Sabharwal’s contact email: aman.sabharwal@vizientinc.com

Selected Best Practices and Suggestions for Improvement – Mortality (AHRQ) Click here

Variation in US Hospital Mortality Rates for Patients Admitted With COVID-19 During the First 6 Months of the Pandemic (JAMA Internal Medicine) Click here

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This episode continues the discussion on Hierarchical Condition Categories, or HCCs, examining the impact of HCCs on reimbursement, approaches to risk-adjustment and changes in payment policies.

Guest speaker:

Angela Hunt, RN, MBA, CCDS

Principal

Operations and Quality

Vizient

Moderator:

Tomas Villanueva, DO, MBA, FACPE, SFHM

Principal

Clinical Operations and Quality

Vizient

Show Notes:

[00:43] RAF scores defined

[01:22] Importance of RAF scores for reimbursement

[03:40] Importance of understanding HCCs and their documentation

[04:07] Risk adjusting patients

[06:07] Payment structures in commercial policies

[06:49] Approach and input from the Vizient team – focus on documentation

[07:59] The future of HCCs and documentation

Links | Resources:

To contact Modern Practice: modernpracticepodcast@vizientinc.com

Angela Hunt’s contact email: angela.hunt@vizientinc.com

Hierarchical Condition Categories Coding (AAFP) Click here

HCC Fact Sheet (Vizient) Click here

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Hierarchical Condition Categories (HCCs) aren’t a new concept, but as more and more organizations shift to value-based care, there has been renewed issue in the subject. This is based on the recognition that without solid foundational knowledge of HCCs, health systems risk lower rates of reimbursement, or sometimes not getting paid at all.

On this program, we will explore the use of HCCs and their importance to medical practice.

Guest speaker:

Angela Hunt, RN, MBA, CCDS

Principal

Operations and Quality

Vizient

Moderator:

Tomas Villanueva, DO, MBA, FACPE, SFHM

Principal

Clinical Operations and Quality

Vizient

Show Notes:

[01:36] Background and definition for HCCs

[02:24] Using HCCs

[02:54] Physicians and clinicians who use HCCs

[04:08] Importance

[05:34] Documentation approaches

[08:47] Deriving value through the HCC designation

Links | Resources:

To contact Modern Practice: modernpracticepodcast@vizientinc.com

Angela Hunt’s contact email: angela.hunt@vizientinc.com

Hierarchical Condition Categories Coding (AAFP) Click here

HCC Fact Sheet (Vizient) Click here

Subscribe Today!

Apple Podcasts

Spotify

Android

Google Podcasts

Stitcher

RSS Feed

Read Full Post »