Archive: 18 September 2016

Morning musings from a CEO

Front End Speech Recognition: A case of dime wise and dollar foolish?

Sep 18, 2016 by Raghu Vir 0 Comments


medical-error-picA new study sponsored by Agency for Healthcare Research and Quality (AHRQ) identified the frequency with which errors occur when physicians use front end speech recognition.

” Critical errors were found in 15 percent of data entered into patients’ electronic health records by physicians using computerized speech recognition technology, according to a pilot study funded by AHRQ. The study evaluated front-end speech recognition technology that allows dictation and editing in an electronic record’s text field. The study examined speech recognition errors based on 100 patient notes by attending emergency department physicians in Boston from January to June 2012. Findings showed that there were 128 errors, or 1.3 errors per note, and that of the 71 percent of notes that contained errors, 15 percent contained one or more critical errors that could potentially lead to miscommunication affecting patient care. Annunciation errors were most common, followed by deletions and added words. Study findings represent the first estimates of speech recognition errors in dictated emergency department notes, researchers said. The study, “Incidence of Speech Recognition Errors in the Emergency Department,” and abstract were published in the International Journal of Medical Informatics.”

As you know for years EHR vendors and speech recognition technology vendors have been pushing front end speech recognition as an alternative to dictation. With fancy demos and presentations, they have been able to convince CFOs how hospitals can save millions by avoiding transcription. But by avoiding transcription and pushing the burden of documentation onto physicians, hospitals definitely saved money but in that process had to accept incomplete and inadequate documentation by physicians. To overcome the new problems with documentation they had to spend a lot more on clinical documentation improvement programs employing highly paid CDI specialists.

Due to this overwhelming burden of documentation, physicians are not only extremely frustrated as recent surveys have shown but are also financially impacted as they are able to see far fewer patients than before.  With hospitals owning more and more physician practices, the cost of their physicians seeing fewer patients is very high.

In conclusion, such high error rates in documentation are only expected because the medical records are now being asked to be completed by physicians who are fully frustrated, not trained at all in such a task and they are under continuous pressure coping with the ever changing rules and regulations of healthcare.

Morning musings from a CEO

Hospital readmission rates are falling across the country

Sep 13, 2016 by Raghu Vir 0 Comments

Potentially avoidable hospital readmissions that occur within 30 days of a patient’s initial discharge are estimated to account for more than $17 billion in Medicare expenditures annually. Not only are readmissions costly, but they are often a sign of poor quality care.

To address the problem of avoidable readmissions, the Affordable Care Act created the Hospital Readmissions Reduction Program, which adjusts payments for hospitals with higher than expected 30-day readmission rates for targeted clinical conditions such as heart attacks, heart failure, and pneumonia. The Centers for Medicare & Medicaid Services has also undertaken other major quality improvement initiatives, such as the Partnership for Patients, which aim to make hospital care safer and improve the quality of care for individuals as they move from one health care setting to another. 

The data show that these efforts are working. Between 2010 and 2015, readmission rates fell by 8 percent nationally. Today, CMS is releasing new data showing how these improvements are helping Medicare patients across all 50 states and the District of Columbia. The data show that since 2010: 

·        All states but one have seen Medicare 30-day readmission rates fall. The rate in Vermont virtually remained unchanged. 

·        In 43 states, readmission rates fell by more than 5 percent.

·        In 11 states, readmission rates fell by more than 10 percent.

Morning musings from a CEO

CMS launches ‘Pick Your Pace’ options for physicians as part of Quality Payment Program

Sep 11, 2016 by Raghu Vir 0 Comments , ,

money-tighteningAs part of CMS’ move to link physician payments to patient outcomes, the Quality Payment Program put in place by CMS is set to begin on January 1, 2017. CMS has shared plans for the timing of reporting for the first year of the program. It allows Quality Payment Program to allow physicians to pick their pace of participation for the first performance period that begins January 1, 2017. During 2017, eligible physicians and other clinicians will have multiple options for participation. Choosing one of these options would ensure you do not receive a negative payment adjustment in 2019.

First Option: Test the Quality Payment Program

With this option, as long as you submit some data to the Quality Payment Program, including data from after January 1, 2017, you will avoid a negative payment adjustment. This first option is designed to ensure that your system is working and that you are prepared for broader participation in 2018 and 2019 as you learn more.

Second Option: Participate for part of the calendar year

You may choose to submit Quality Payment Program information for a reduced number of days. This means your first performance period could begin later than January 1, 2017 and your practice could still qualify for a small positive payment adjustment. For example, if you submit information for part of the calendar year for quality measures, how your practice uses technology, and what improvement activities your practice is undertaking, you could qualify for a small positive payment adjustment. You could select from the list of quality measures and improvement activities available under the Quality Payment Program.

Third Option: Participate for the full calendar year

For practices that are ready to go on January 1, 2017, you may choose to submit Quality Payment Program information for a full calendar year. This means your first performance period would begin on January 1, 2017. For example, if you submit information for the entire year on quality measures, how your practice uses technology, and what improvement activities your practice is undertaking, you could qualify for a modest positive payment adjustment. We’ve seen physician practices of all sizes successfully submit a full year’s quality data, and expect many will be ready to do so.

Fourth Option: Participate in an Advanced Alternative Payment Model in 2017

Instead of reporting quality data and other information, the law allows you to participate in the Quality Payment Program by joining an Advanced Alternative Payment Model, such as Medicare Shared Savings Track 2 or 3 in 2017. If you receive enough of your Medicare payments or see enough of your Medicare patients through the Advanced Alternative Payment Model in 2017, then you would qualify for a 5 percent incentive payment in 2019.

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