Posts tagged Quality of Care
And the Survey Says: Active EMR Use May Significantly Reduce Malpractice Liability
Nov 24th
A peer-reviewed article published today indicates that physicians who adopt and actively utilize electronic medical records (also known as “electronic heath records”, “EMR” or “EHR”) are almost 50% less likely to have a history of a paid medical malpractice claim.
| The survey, which was published in today’s issue of Archives of Internal Medicine concluded the following: | |
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The survey concerning EMR adoption and usage involved a random sample of 1,884 healthcare providers (with a response rate of 71.4%) in Massachusetts. The settlement data were gleaned from the mandatory public disclosures of settlements that are contained on the Massachusetts Board of Registration in Medicine (BRM) Web site.
While the results of this survey are consistent with the anecdotal evidence and widely-held beliefs of public policy makers and the healthcare community, the authors acknowledged that confirmatory studies are required.
Disclaimer: The information contained within the MTBC® Learning Center is provided for general educational and informational purposes only and should not be construed as legal advice. The author of the Learning Center does not represent the Web site user or the individual submitting a particular question. Please seek the advice of legal counsel to address any specific questions you may have regarding your particular facts or circumstances
Anthem BCBS of Indiana Climbs On Board the Pay-For-Performance Bandwagon
Oct 13th
As regular readers of this blog may recall, last year, Medicare implemented its Physician Quality Reporting Initiative,which is also known as PQRI. Doctors who satisfied the quality of care and reporting requirements under PQRI received bonuses equal to 1.5% of their 2007 reimbursements.
A very limited number of small to medium size practices have opted to participate in PQRI due to the onerous reporting requirements (which, realistically speaking, can only be satisfied by EMR users) and the modest financial incentive. While providers have not embraced Medicare’s PQRI, many have been more receptive of the quality of care initiatives launched by such commercial payers such as Blue Cross Blue Shield.
Anthem Blue Cross and Blue Shield of Indiana (Indiana BCBS) has just announced that it will be following the emerging industry trend of offering bonuses to providers who follow its quality of care recommendations. Indiana BCBS’s bonus program, which is focused on primary care providers, will allow providers to earn a bonus equal to as much as 10% of their annual reimbursements.
As to the mechanics of the program, the Indianapolis Star explains that it is “based on information gleaned from the Indiana Health Information Exchange’s Quality Health First program… an Indianapolis-based nonprofit company that operates a widely used messaging service that allows thousands of area health-care providers to access lab results and other medical information securely over the Internet. Such data allows IHIE to generate reports for its Quality Health First program that tells doctors which of their patients have received recommended screenings and care.”
Disclaimer: The information contained within the MTBC® Learning Center is provided for general educational and informational purposes only and should not be construed as legal advice. The author of the Learning Center does not represent the Web site user or the individual submitting a particular question. Please seek the advice of legal counsel to address any specific questions you may have regarding your particular facts or circumstances
Medicare to Stop Paying for Certain “Never Events”
Sep 30th
Beginning tomorrow, Medicare will no longer provide reimbursement for certain newly added “never event.” In particular, Medicare will refuse to provide reimbursement for the following conditions:
- Surgical site infections following certain elective procedures
- Legionnaires’ disease
- Extreme blood sugar derangement
- Lung collapse (Iatrogenic pneumothorax)
- Delirium
- Ventilator-associated pneumonia
- Formation/movement of a blood clot (Deep vein thrombosis/Pulmonary Embolism)
- Bloodstream infection (Staphylococcus aureus septicemia )
- Bacterial infection that causes severe diarrhea and serious intestinal conditions such as colitis (Clostridium difficile associated disease)
CMS has explained that the underlying rationale for denying reimbursement is “to strengthen the tie between the quality of care provided to Medicare beneficiaries and payment for the services provided when they are in the hospital.” This goal is consistent with the Deficit Reduction Act of 2005 (Pub. L. 109-171), which requires the Secretary of HHS to identify certain high cost and/or high volume preventable conditions that result from inadequate hospital care and are identifiable by unique ICD-9-CM codes.
Finally, if you manage hospital A/R, you should remember that you are prohibited from billing patients for these claims, even though they will be denied by Medicare.
Disclaimer: The information contained within the MTBC® Learning Center is provided for general educational and informational purposes only and should not be construed as legal advice. The author of the Learning Center does not represent the Web site user or the individual submitting a particular question. Please seek the advice of legal counsel to address any specific questions you may have regarding your particular facts or circumstances