Modern Practice Podcast

Patient Safety Indicators

Patient Safety Indicators, or PSIs, provide insight into safety events that occur during care delivery. Health care organizations can use PSIs to assess potential complications and events to improve their care. Today, we define PSIs and their importance. We also discuss how health care organizations can use Present on Admission data to alleviate being unfairly compared to other organizations regarding care outcomes.
 
Guest speaker:
Terry Golde, MBA, RN, CCDS
Consulting Director
Vizient
 
Moderator:
Tomas Villanueva, DO, MBA, FACPE, SFHM
Principal
Clinical Operations and Quality
Vizient
 
Show Notes:
[00:53] Definition
[01:14] Importance of PSIs
[01:44] What PSIs measure
[03:07] Development of PSIs
[03:36] What lower PSI rates mean for hospital performance
[04:14] How PSI data is collected
[07:10] Hospital Rate in PSIs
[08:07] Calculating PSI rates
[09:13] Adjust for patient characteristics – so hospitals will compare fairly
[10:01] Using Present on Admission (POA) data
[11:08] Effect of PSIs on reimbursement and performance ranking
[11:49] PSIs as a useful measure
 
Links | Resources:
To contact Modern Practice: modernpracticepodcast@vizientinc.com
Terry Golde’s contact email: teresa.golde@vizientinc.com
Patient Safety Indicators (AHRQ) Click here
 
Subscribe Today!
Apple Podcasts
Amazon Podcasts
Android
Google Podcasts
Spotify
Stitcher
RSS Feed

Clinical validation and denials

When a clinical diagnosis or procedure is not validated in the medical record, resulting in a claim denial, the health care organization loses reimbursement, the physician or clinician involved may come under scrutiny and the reputations of both clinician and hospital may suffer. Errors in documentation needlessly contribute to this problem. On this episode, we discuss what clinicians and organizations can do to avoid claim denials.
 
Guest speaker:
Erica Braun, MS, RN, CCDS
Consulting Director
Vizient
 
Moderator:
Tomas Villanueva, DO, MBA, FACPE, SFHM
Principal
Clinical Operations and Quality
Vizient
 
Show Notes:
[01:11] Clinical validation denial
[01:31] Implications for denials: downgraded DRGs and lower reimbursement
[02:31] Avoiding denials
[03:25] When diagnoses are at high risk for denial
[03:59] Examples of disputed diagnoses
[04:30] Establishing criteria for diagnoses
[05:15] What physicians can do to help improve documentation
[06:17] What to do when a denial occurs
[07:29] Negotiating and coordinating with payers
 
Links | Resources:
To contact Modern Practice: modernpracticepodcast@vizientinc.com
Erica Braun’s contact email: erica.braun@vizientinc.com
Fact sheet on Vizient’s clinical documentation improvement services: Click here
Clinical Validation: The Next Big Challenge in Inpatient Coding (American Academy of Professional Coders, AAPC): Click here
 
Subscribe Today!
Apple Podcasts
Amazon Podcasts
Android
Google Podcasts
Spotify
Stitcher
RSS Feed

Accreditation services – Part 2

A strategy to achieve regulatory and accreditation compliance is important more than ever, especially in the wake of COVID-19 when regulatory agencies ramp up their efforts again. On this episode, we’ll discuss how health care organizations can face the challenges they face in achieving compliance.
 
Guest speaker:
Diana Scott, MHA, RN, CPHQ
Associate Vice President
Accreditation and Regulatory Services
Vizient
 
Moderator:
Tomas Villanueva, DO, MBA, FACPE, SFHM
Principal
Clinical Operations and Quality
Vizient
 
Show Notes:
[00:37] Challenges are not new, with infection prevention at the forefront
[02:48]  Cleanliness of ice machines
[03:25] Dialysis: orders, water management, disinfecting equipment
[04:23] Behavioral health: suicide risk
[05:31] Medication management
[06:26] Perinatal standards
[07:27] New requirements/developments
[09:24] Vizient resources
 
Links | Resources:
To contact Modern Practice: modernpracticepodcast@vizientinc.com
Diana Scott’s contact email: diana.scott@vizientinc.com
Vizient Accreditation Services: Click here
The Joint Commission: www.jointcommission.org
 
Subscribe Today!
Apple Podcasts
Amazon Podcasts
Android
Google Podcasts
Spotify
Stitcher
RSS Feed

Accreditation services – Part 1

Health care organizations need a comprehensive strategy to achieve regulatory and accreditation compliance. At stake are crucial certification and approval ratings and, more crucial, patient and workplace safety. On this two-part series, we’ll examine the current status of regulatory and accreditation organizations and the latest challenges organizations face in their efforts to reach compliance.
 
Guest speaker:
Diana Scott, MHA, RN, CPHQ
Associate Vice President
Accreditation and Regulatory Services
Vizient
 
Moderator:
Tomas Villanueva, DO, MBA, FACPE, SFHM
Principal
Clinical Operations and Quality
Vizient
 
Show Notes:
[01:17] Status on accreditation and surveys
[02:38] Update on survey methods: the hybrid model
[05:38] Impact of decreasing COVID infection rates
[06:39] Surveyor expectations
[07:32] Clinical workforce issues and expectations
[09:40] Water management, fire safety/sprinkler systems and workplace safety
 
Links | Resources:
To contact Modern Practice: modernpracticepodcast@vizientinc.com
Diana Scott’s contact email: diana.scott@vizientinc.com
Vizient Accreditation Services: Click here
The Joint Commission: www.jointcommission.org
 
Subscribe Today!
Apple Podcasts
Amazon Podcasts
Android
Google Podcasts
Spotify
Stitcher
RSS Feed

Readmission reduction – Part 2

The last episode of this two-part series covered why readmissions occur. This episode explores those causes in more depth – the clinical and social issues underneath readmissions—and what health care organizations can do to prevent these from happening.
 
Guest speaker:
Tod Baker, BS
Principal
Operations and Quality
Vizient
 
Moderator:
Tomas Villanueva, DO, MBA, FACPE, SFHM
Principal
Clinical Operations and Quality
Vizient
 
Show Notes:
[00:40] Addressing clinical issues
[02:59] Addressing social issues
[04:38] Best practices/new approaches in risk stratification
[09:00] Engaging the family or community to manage the patient
[10:11] Where to start
[12:17] Post-acute care
 
Links | Resources:
To contact Modern Practice: modernpracticepodcast@vizientinc.com
Tod Baker’s contact email: tod.baker@vizientinc.com
Designing and Delivering Whole-Person Transitional Care (AHRQ) Click here
Vizient’s Clinical Data Base (CDB) and readmissions Click here
CMS Hospital Readmissions Reduction Program Click here
Amy Boutwell, MD, MPP, presents six videos on Multi-visit Patients (MVPs) and readmissions Click here
Contact Dr. Amy Boutwell at: amy@collaborativehealthcarestrategies.com
 
Subscribe Today!
Apple Podcasts
Amazon Podcasts
Android
Google Podcasts
Spotify
Stitcher
RSS Feed

Readmission reduction – Part 1

The value of reducing readmissions to the hospital has been well-established: lowering health care costs, eliminating wasted resources, improving quality and increasing patient satisfaction. However, organizations still wrestle with the causes for readmissions, whether it is poor care coordination or poor patient follow-up after discharge. This next two-part series will examine why readmissions occur and what organizations can do to improve on them.
 
Guest speaker:
Tod Baker, BS
Principal
Operations and Quality
Vizient
 
Moderator:
Tomas Villanueva, DO, MBA, FACPE, SFHM
Principal
Clinical Operations and Quality
Vizient
 
Show Notes:
[01:11] Defining readmissions
[01:48] Issues resulting from readmissions
[02:17] Misaligned incentives and compartmentalization
[03:27] New energy for reducing readmissions
[04:46] Getting started
[05:49] Effective risk-stratification
[07:13] Impact of social issues
 
Links | Resources:
To contact Modern Practice: modernpracticepodcast@vizientinc.com
Tod Baker’s contact email: tod.baker@vizientinc.com
Designing and Delivering Whole-Person Transitional Care (AHRQ) Click here
Vizient’s Clinical Data Base (CDB) and readmissions Click here
CMS Hospital Readmissions Reduction Program Click here
Amy Boutwell, MD, MPP, presents six videos on Multi-visit Patients (MVPs) and readmissions Click here
 
Subscribe Today!
Apple Podcasts
Amazon Podcasts
Android
Google Podcasts
Spotify
Stitcher
RSS Feed

Mortality Reduction – Part 3

On this episode, we continue our discussion on mortality by addressing hospice and palliative approaches as a way to provide improved care for patients and improve 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:
[00:35] Hesitancy in leveraging palliative and hospice care
[01:08] A success story with palliative care
[01:51] Vizient Clinical Data Base analytic can pinpoint use of palliative and hospice care in an organization
[02:22] The advanced directive process: everyone’s responsibility
[03:04] Surgeons and the medical record
[04:05] Triggering palliative care consults
[05:28] Patients discharged to hospice do not factor into hospital mortality index
[06:02] Mortality review – best practice
 
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
 
Subscribe Today!
Apple Podcasts
Amazon Podcasts
Android
Google Podcasts
Spotify
Stitcher
RSS Feed

Mortality Reduction – Part 2

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
 
Subscribe Today!
Apple Podcasts
Amazon Podcasts
Android
Google Podcasts
Spotify
Stitcher
RSS Feed

Mortality Reduction – Part 1

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
 
Subscribe Today!
Apple Podcasts
Spotify
Android
Google Podcasts
Stitcher
RSS Feed

Hierarchical Condition Categories – Part 2

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
 
Subscribe Today!
Apple Podcasts
Spotify
Android
Google Podcasts
Stitcher
RSS Feed