Dolbey Systems, Inc. Dictation and Transcription Solutions Fri, 16 Feb 2018 22:05:14 +0000 en-US hourly 1 Dolbey Systems, Inc. 32 32 Healthgrades’ 250 top hospitals for clinical excellence Thu, 08 Feb 2018 14:15:07 +0000 By Brian Zimmerman for Becker’s Hospital Review

Healthgrades named the 250 recipients of its 2018 Distinguished Hospital Award for Clinical Excellence Jan. 23.

Hospitals recognized with this award performed among the top 5 percent in the nation for at least 21 of 32 inpatient conditions and procedures analyzed by Healthgrades.

“Consumers should prioritize hospitals and health systems that achieve high marks in clinical quality,” said Healthgrades CMO Brad Bowman, MD. “We commend these organizations for their commitment to driving better patient outcomes and high quality care.”

Below is a state-by-state breakdown of the 250 hospitals awarded Healthgrades’ 2018 Distinguished Hospital Award for Clinical Excellence. For some hospitals, Healthgrades included more than one facility in its analysis. These facilities are denoted in italics below the recognized hospital.


Banner Baywood Medical Center (Mesa)

Dignity Health-Chandler Regional Medical Center

Dignity Health-Mercy Gilbert Medical Center

Dignity Health-St. Joseph’s Hospital and Medical Center (Phoenix)

Flagstaff Medical Center

Mayo Clinic Hospital (Phoenix)


Alta Bates Summit Medical Center-Summit (Oakland)

California Pacific Medical Center-Pacific Campus (San Francisco)

Including: California Pacific Medical Center-California Campus (San Francisco)

Cedars-Sinai Medical Center (Los Angeles)

Eden Medical Center (Castro Valley)

Hoag Hospital Newport Beach

John Muir Medical Center-Walnut Creek

Kaiser Permanente Baldwin Park Medical Center

Kaiser Permanente Fresno Medical Center

Kaiser Permanente Oakland Medical Center (Oakland)

Includes: Kaiser Permanente Richmond Medical Center

Kaiser Permanente Orange County-Anaheim Medical Center

Kaiser Permanente Redwood City Medical Center

Kaiser Permanente Sacramento Medical Center

Kaiser Permanente San Francisco Medical Center

Kaiser Permanente San Jose Medical Center

Kaiser Permanente San Rafael Medical Center

Kaiser Permanente Santa Clara Medical Center

Kaiser Permanente Santa Rosa Medical Center

Kaiser Permanente South Sacramento Medical Center

Kaiser Permanente Woodland Hills Medical Center

Memorial Medical Center (Modesto)

Mercy San Juan Medical Center (Carmichael)

Methodist Hospital of Southern California (Arcadia)

Mills-Peninsula Medical Center (Burlingame)

Includes: Mills Health Center (San Mateo)

Mission Hospital-Mission Viejo

Includes: Mission Hospital-Laguna Beach

Northridge Hospital Medical Center

PIH Health Hospital-Whittier

Providence Holy Cross Medical Center (Mission Hills)

Providence Saint Joseph Medical Center (Burbank)

Providence Tarzana Medical Center

Ronald Reagan UCLA Medical Center (Los Angeles)

Scripps Green Hospital (La Jolla)

Scripps Memorial Hospital Encinitas

Scripps Memorial Hospital La Jolla

Scripps Mercy Hospital San Diego

Includes: Scripps Mercy Hospital Chula Vista

St. Jude Medical Center (Fullerton)

Stanford Hospital and Clinics

Sutter Roseville Medical Center

UCLA Medical Center, Santa Monica

UCSF Medical Center at Parnassus (San Francisco)

Includes: UCSF Medical Center at Mount Zion (San Francisco)

Washington Hospital (Freemont)


Denver Health Medical Center

Good Samaritan Medical Center (Lafayette)

Lutheran Medical Center (Wheat Ridge)

Porter Adventist Hospital (Denver)

Poudre Valley Hospital (Fort Collins)

Saint Joseph Hospital (Denver)

St. Anthony Hospital (Lakewood)

St. Anthony North Hospital (Westminster)

University of Colorado Hospital-Anschutz Inpatient Pavilion (Aurora)


Hartford Hospital

Middlesex Hospital (Middletown)

Norwalk Hospital

Saint Francis Care (Hartford)

The Hospital of Central Connecticut at New Britain

Includes: The Hospital of Central Connecticut at Bradley Memorial (Southington)

Yale-New Haven Hospital

Includes: Yale New Haven Hospital Saint Raphael Campus


Christiana Care Health System-Christiana Hospital (Newark)

Includes: Wilmington Hospital


Cape Coral Hospital

Delray Medical Center (Delray Beach)

Flagler Hospital (St. Augustine)

Florida Hospital Orlando

Includes: Celebration Health, Florida Hospital-Altamonte, Florida Hospital-Apopka, Florida Hospital East Orlando, Florida Hospital Kissimmee and Winter Park Memorial Hospital

Lee Memorial Hospital (Fort Myers)

Includes: HealthPark Medical Center (Fort Myers)

Mayo Clinic (Jacksonville)

NCH Downtown Naples Hospital

Includes: NCH North Naples Hospital

Orange Park Medical Center


Athens Regional Medical Center

Emory University Hospital (Atlanta)

Emory University Hospital Midtown (Atlanta)

Emory Saint Joseph’s Hospital (Atlanta)

Northeast Georgia Medical Center (Gainesville)

Piedmont Fayette Hospital (Fayetteville)


St. Luke’s Boise Medical Center

Includes: St. Luke’s Meridian Medical Center

St. Luke’s Magic Valley Medical Center (Twin Falls)


Advocate Good Samaritan Hospital (Downers Grove)

Advocate Lutheran General Hospital (Park Ridge)

AMITA Health Alexian Brothers Medical Center Elk Grove Village

Carle Foundation Hospital (Urbana)

Evanston Hospital

Includes: Glenbrook Hospital (Glenview), Highland Park Hospital

Northwest Community Hospital (Arlington Heights)

Palos Community Hospital (Palos Heights)

Presence Resurrection Medical Center (Chicago)

Riverside Medical Center (Kankakee)

AMITA Health St. Alexius Medical Center Hoffman Estates


Franciscan Health Indianapolis

Franciscan Health Lafayette East

Indiana University Health Ball Memorial Hospital (Muncie)


Great River Medical Center (West Burlington)

Mercy Iowa City

St. Luke’s Hospital (Cedar Rapids)

UnityPoint Health-Allen Hospital (Waterloo)


Providence Medical Center (Kansas City)

Stormont Vail Health (Topeka)

The University of Kansas Hospital (Kansas City)

Via Christi Hospital St. Francis (Wichita)


East Jefferson General Hospital (Metairie)

Ochsner Medical Center (New Orleans)

Includes: Ochsner Health Center-Elmwood (New Orleans and Ochsner Medical Center-West Bank Campus (Terrytown)


Frederick Memorial Hospital

Holy Cross Hospital (Silver Springs)

Howard County General Hospital (Columbia)

Johns Hopkins Bayview Medical Center (Baltimore)

MedStar Franklin Square Medical Center (Baltimore)

MedStar Good Samaritan Hospital (Baltimore)

Peninsula Regional Medical Center (Salisbury)

The Johns Hopkins Hospital (Baltimore)

University of Maryland St. Joseph Medical Center (Towson)


Baystate Medical Center (Springfield)

Lahey Hospital and Medical Center (Burlington)

Lawrence Memorial Hospital of Medford

Includes: Melrose-Wakefield Hospital

MetroWest Medical Center-Framingham Union Hospital

Includes: Leonard Morse Hospital (Natick)

Newton-Wellesley Hospital

Saint Vincent Hospital (Worcester)

Southcoast Hospitals Group-Charlton Memorial (Fall River)

Includes: Southcoast Hospitals Group-St. Luke’s (New Bedford) and Southcoast Hospitals Group-Tobey (Wareham)

UMass Memorial Medical Center (Worcester)

Including: UMass Memorial Medical Center-Hahnemann (Worcester) and UMass Memorial Medical Center-Memorial Campus (Worcester)


Beaumont Hospital-Royal Oak Campus

Beaumont Hospital-Troy Campus

Henry Ford Allegiance Health (Jackson)

Henry Ford Macomb Hospital (Clinton Township)

Holland Hospital

Michigan Medicine (Ann Arbor)

Providence-Providence Park Hospital, Southfield Campus

Includes: Providence-Providence Park Hospital, Novi

Spectrum Health Medical Center-Butterworth Hospital (Grand Rapids)

Includes: Spectrum Health-Blodgett Hospital (Grand Rapids)

St. Joseph Mercy Ann Arbor (Ypsilanti)


Abbott Northwestern Hospital (Minneapolis)

AllinaHealth-Mercy Hospital (Coon Rapids)

AllinaHealth-Unity Hospital (Fridley)

Fairview Ridges Hospital (Burnsville)

Fairview Southdale Hospital (Edina)

HealthEast Care System-Saint John’s Hospital (Maplewood)

Mayo Clinic Health System in Mankato

Mayo Clinic Hospital-Saint Mary’s Campus (Rochester)

Includes: Mayo Clinic Methodist Hospital (Rochester)

Park Nicollet Methodist Hospital (St. Louis Park)

Regions Hospital (St. Paul)

St. Cloud Hospital


Mercy Hospital Springfield

Mercy Hospital St. Louis

Mosaic Life Care (St. Joseph)

Saint Luke’s Hospital of Kansas City


Faith Regional Health Services-West (Norfolk)

Includes: Faith Regional Health Services-East (Norfolk)

New Jersey

AtlantiCare Regional Medical Center-Atlantic City

Includes: AtlantiCare Regional Medical Center-Mainland (Pomona)

Morristown Medical Center

Overlook Medical Center (Summit)

New Mexico

Presbyterian Hospital (Albuquerque)

New York

John T. Mather Memorial Hospital (Port Jefferson)

Lenox Hill Hospital (New York City)

NYU Winthrop Hospital (Mineola)

Rochester General Hospital

Stony Brook University Hospital

Vassar Brothers Medical Center (Poughkeepsie)

North Carolina

Alamance Regional Medical Center (Burlington)

Carolinas Medical Center-Mercy (Charlotte)

Duke Regional Hospital (Durham)

Mission Health (Asheville)

Novant Health Matthews Medical Center

Pardee UNC Healthcare (Hendersonville)

The Moses H. Cone Memorial Hospital (Greensboro)

Includes: Annie Penn Hospital (Reidsville), Cone Health-Women’s Hospital (Greensboro) and Wesley Long Hospital (Greensboro)

Vidant Medical Center (Greenville)

Wake Forest Baptist Medical Center (Winston Salem)

Includes: Davie Medical Center (Bermuda Run) and Davie Medical Center-Mocksville


Atrium Medical Center (Middletown)

Bethesda North Hospital (Cincinnati)

Blanchard Valley Hospital (Findlay)

Christ Hospital (Cincinnati)

Cleveland Clinic

Fort Hamilton Hughes Memorial Hospital

Good Samaritan Hospital (Dayton)

Mercy Health-Fairfield Hospital

Mercy Health-West Hospital (Cincinnati)

Miami Valley Hospital (Dayton)

Mount Carmel St. Ann’s (Westerville)

ProMedica Flower Hospital (Sylvania)

ProMedica Toledo Hospital

Southwest General Health Center (Middleburg Heights)

Summa Akron City Hospital

The Jewish Hospital (Cincinnati)

University Hospitals Case Medical Center (Cleveland)

University Hospitals Elyria Medical Center

University Hospitals Geauga Medical Center (Chardon)

West Chester Hospital


Saint Francis Hospital (Tulsa)


Adventist Medical Center (Portland)

Kaiser Sunnyside Medical Center (Clackamas)

Providence Portland Medical Center

Providence St. Vincent Medical Center (Portland)

Salem Hospital


Aria-Jefferson Health-Torresdale (Philadelphia)

Includes: Aria-Jefferson Health-Bucks County (Langhorne and Aria-Jefferson Health-Frankford (Philadelphia)

Bryn Mawr Hospital

Chambersburg Hospital

Chester County Hospital (West Chester)

Geisinger Wyoming Valley Medical Center (Wilkes Barre)

Jeanes Hospital (Philadelphia)

Lancaster General Hospital

Lankenau Medical Center (Wynnewood)

Milton S. Hershey Medical Center

Paoli Hospital

PinnacleHealth Harrisburg Hospital

Includes: PinnacleHealth Community General Osteopathic Hospital (Harrisburg)

Reading Hospital (West Reading)

Riddle Memorial Hospital (Media)

St. Luke’s Hospital-Bethlehem Campus

Includes: St. Luke’s Hospital-Allentown Campus

Temple University Hospital (Philadelphia)

Includes: Temple University Hospital-Episcopal (Philadelphia)

Thomas Jefferson University Hospital-Jefferson Health (Philadelphia)

Includes: Jefferson Hospital for Neuroscience-Jefferson Health (Philadelphia) and Methodist Hospital-Jefferson Health (Philadelphia)

UPMC McKeesport

Rhode Island

Miriam Hospital (Providence)

Rhode Island Hospital (Providence)

South Carolina

Bon Secours St. Francis Health System-St. Francis Downtown (Greenville)

McLeod Health-McLeod Regional Medical Center (Florence)

Roper Hospital (Charleston)

South Dakota

Sanford USD Medical Center (Sioux Falls)


Indian Path Medical Center (Kingsport)


Houston Methodist Hospital

Memorial Hermann-Texas Medical Center (Houston)

Memorial Hermann Healthcare System-Southwest (Houston)

Includes: Memorial Hermann Northwest Hospital (Houston), Memorial Hermann Southeast Hospital (Houston) and Memorial Hermann The Woodlands Hospital (Shenandoah)

Memorial Hermann Memorial City Medical Center (Houston)

St. David’s Medical Center (Austin)

Includes: Heart Hospital of Austin and St. David’s Georgetown Hospital


University of Utah Health Care (Salt Lake City)

Includes: University Orthopaedic Center (Salt Lake City)


University of Vermont Medical Center (Burlington)


Augusta Health (Fishersville)

Bon Secours-Mary Immaculate Hospital (Newport News)

Bon Secours-Memorial Regional Medical Center (Mechanicsville)

Bon Secours-St. Francis Medical Center (Midlothian)

Carilion New River Valley Medical Center (Christiansburg)

Henrico Doctors’ Hospital (Richmond)

Includes: Parham Doctors’ Hospital (Richmond) and Retreat Doctors’ Hospital (Richmond)

Inova Alexandria Hospital

Inova Fair Oaks Hospital (Fairfax)

Inova Fairfax Hospital (Falls Church)

Inova Loudoun Hospital (Leesburg)

Sentara Leigh Hospital (Norfolk)

Sentara Obici Hospital (Suffolk)

Sentara Princess Anne Hospital (Virginia Beach)

Sentara RMH Medical Center (Harrisonburg)


EvergreenHealth Medical Center-Kirkland

Harborview Medical Center (Seattle)

Legacy Salmon Creek Medical Center (Vancouver)

Swedish Medical Center-First Hill Campus (Seattle)

Includes: Swedish Medical Center-Ballard Campus (Seattle)

Valley Medical Center (Renton)

Virginia Mason Medical Center (Seattle)

West Virginia

CAMC General Hospital (Charleston)

Includes: CAMC Memorial Hospital (Charleston) and CAMC Women and Children’s Hospital (Charleston)

Thomas Memorial Hospital (South Charleston)


Aurora Saint Luke’s Medical Center (Milwaukee)

Including: Aurora Sinai Medical Center (Milwaukee) and Saint Luke’s Medical Center (Cudahy)

Columbia Saint Mary’s Hospital Milwaukee

Columbia St. Mary’s Hospital Ozaukee (Mequon)

Froedtert Community Memorial Hospital (Menomonee Falls)

Froedtert Health-Froedtert Hospital (Milwaukee)

Meriter Hospital (Madison)

St. Agnes Hospital (Fond Du Lac)

St. Mary’s Hospital (Madison)

Waukesha Memorial Hospital

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HIMSS18 puts women front-and-center as conference keynotes, speakers Thu, 08 Feb 2018 13:30:57 +0000 By Jessica Davis for Healthcare IT News

Women innovators from CMS, NASA, IBM Global Healthcare, Cleveland Clinic and Health 2.0 — among a long list of others — will share insights from interoperability to patient engagement at the annual health IT conference in Las Vegas.

This year’s CES Conference, one of the biggest technology conferences in the country, and the JPMorgan Healthcare Conference had one major flaw in common: A lack of women in leading speaking roles.

Not one CES keynoter was a woman, while 94 percent of the 540 people presenting at JPMorgan were men.

At HIMSS18, however, women have a prominent presence. Not only are there at least 10 women keynoters at both the HIMSS Media events and the conference itself, the event will be dotted with networking and mentoring events.

Women are also leading presentations that range from nursing informatics to health system strategy.

Here are some of biggest presentations not to miss from healthcare’s leading women.

Notable keynotes

McKinsey Senior Expert Jessica Kahn will take the stage alongside Micky Tripathi, Massachusetts eHealth Collaborative president and CEO in an opening keynote at the HIMSS/SHIEC Interoperability and HIE Symposium.

Kahn and Tripathi will discuss both efforts to advance nationwide interoperability — and where things need better coordination. They’ll also discuss the tech with the most promise. The pair will present “Leverage Points to Advance Interoperability” at 8:15 am. March 5 in the Las Vegas Venetian Convention Center — Lando 4301.

Opening HIMSS Media Patient Engagement and Experience Summit at HIMSS18 is Adrienne Boissy, Cleveland Clinic Health System’s chief experience officer.

Boissy’s opening keynote titled “How to Disruptively Design the Human(e) Experience,” will discuss the crucial disruptions in healthcare necessary to delivering the best experience for frontline caregivers, patients and their families. She’ll speak at 8:20 a.m. March 5 in the Wynn’s Petrus room.

Vice Admiral Raquel Bono, Defense Health Agency director will join U.S. Department of Veterans Affairs Secretary David Shulkin, MD, in the final day of HIMSS18 with a keynote titled: “Delivering 21st Century Coordinated Care for Those in and out of Uniform.”

Bono — a former surgeon who now leads a joint integrated Combat Support Agency — will speak on military health advancements designed to deliver seamless data delivery and care coordination. The pair will speak at 8:30 a.m. March 9 in the Venetian Convention Center – Palazzo Ballroom.

Monday’s presentations will end with three closing keynotes led by Liz Murray, best-selling author of Breaking Night; Indu Subaiya, Health 2.0 executive vice president; and Goshen Health Chief Financial Officer Amy Floria.

Murray, who survived being homeless to eventually graduate from Harvard, will share how support and perseverance can help overcome adversity and how adjustments to mentality can help with leading a more purposeful life. Her keynote is scheduled for 2:30 p.m. March 5 at the Wynn Convention Center’s Latour Ballroom.

“Health Happens Everywhere,” part of the HIMSS18 Innovation Symposium, will be led by Subaiya. She’ll discuss how rising consumer expectations are creating a more distributed health data ecosystem and changing the conversation and business of healthcare. Subaiya’s talk is tapped for 3:15 p.m. March 5 at the Venetian Convention Center, Galileo 901.

Floria’s keynote, “Supply Chain Economics: A Remedy for What Ails You,” is part of the HIMSS18 Business of Healthcare Symposium. She’ll discuss strategies for leading a product evaluation to drive supply chain strategy, in addition to explaining how to effectively leverage data for physician engagement and compliance.

Floria will present these ideas at 3:15 p.m. March 5 at the Las Vegas Venetian Convention Center — Delfino 4002.

What not to miss

The number of women health IT leaders speaking at HIMSS18 is too many to list, but here are some of the event’s most notable speakers:

Seema Verma, Centers for Medicare and Medicaid Services administrator, is scheduled to discuss the agency’s interoperability efforts and patient ownership of healthcare data at 8:30 a.m. March 6 in the Venetian Convention Center — Palazzo K.

Another leading policy wonk, U.S. Deputy Surgeon General RADM Sylvia Trent-Adams will speak at the Nursing Informatics Symposium at 3:15 p.m. March 5 in the Venetian Convention Center. She’ll speak on the role of health data in disaster relief and the role of nurses in improving public health.

Attendees can get an inside look at NASA’s telemedicine program with Shannan Moynihan, the deputy chief of Space and Occupational Medicine and deputy chief medical officer of NASA’s Lyndon B. Johnson Center and KBRwyle Department Manager of Flight and Medical Operations.

The pair is scheduled to speak at 10 a.m. March 8 in the Venetian Convention Center — Palazzo K.

Judy Murphy, IBM Global Healthcare chief nursing officer, is set to open the Coordinated and Connected Care Symposium at 8:15 a.m, March 5 in the Venetian Convention Center – Murano 3301. Murphy will outline the paradigm shift from episodic, to predictive – to preventive care, while comparing the value of dynamic trending data to static clinical data.

Cleveland Clinic’s Julie Rish and Susannah Rose will present “Improving Healthcare through Co-Design,” at 11:30 a.m. March 6 in the Venetian Convention Center’s Palazzo L. The pair will speak on Cleveland Clinic’s “patients first” guiding principle to drive patient satisfaction and value.

Jody Hoffman, senior vice president and managing director of Wexler Walker, will speak at HIMSS Media’s Digital & Personal Connected Health Forum on Monday with the presentation titled: “The Latest on Connected Health, Telehealth, 21st Century Cures Act and More.”

Hoffman, who previously served on the Clinton/Gore campaign’s Health Care Advisory Group, will speak on the strides made in digital health policy last year despite the chaos in Washington, D.C. She’s scheduled to speak at the Wynn’s Alsace room at 12:10 p.m. March 5.

Battelle’s Human Centric Design Thought Leader, Amy Schwartz — a leading cognitive psychologist focused on humanizing technology — is also slated to speak at the Digital Health Forum.

Attendees can also listen to women leaders discuss advice for the aspiring female executive, insights into health system strategy going into 2018, the key issues for selecting and developing the right alternative payment model and how to improve an organization’s patient engagement programs.

Special events

There are three major events both celebrating women and providing an opportunity for women leaders to network.

At 9:30 a.m. March 8, attendees can join the Women in Health IT Mentor Meetup in the Venetian Convention Center – Lido 3104. Here, attendees can meet with influential women in the industry to network, expand their knowledge and engage in those thought-provoking conversations.

The Most Influential Women in Health IT Award will be presented as part of the HIMSS18 Awards Gala at 6:30 p.m. March 8 in the Wynn Hotel and Resort – Latour Ballroom.

And attendees won’t want to miss the annual HIMSS18 Women in Health IT Networking Reception held at 6:30 p.m. March 7 at the Venetian Convention Center – Palazzo Pool. The event gathers innovators, leaders and entrepreneurs from the industry for a night of thought leadership.

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Why Apple will succeed where other tech giants have failed: Helping people track their health info Thu, 08 Feb 2018 12:45:12 +0000 By Steve Kraus for CNBC

Apple made a big splash in health care circles this past week when it announced that the company is entering the personal health record space with Apple Health, a new feature that will interface with electronic health records at a dozen hospitals.

For the past two years, Apple has been making under-the-radar moves to bolster its health care efforts, starting with its 2016 acquisition of a personal health record start-up called Gliimpse Health.

In the wake of the announcement, my Twitter lit up with many proclamations that Apple’s moves would bolster consumer engagement in health care. But I noticed an equal number of skeptics who argued that this time would be no different than a decade ago when technology players like Microsoft and Google tried, and struggled, to push this personal health record idea forward.

As you can see from my exchange with a fellow venture capitalist, I hold the view that Apple’s entry into the space could be a game-changed for the industry. And I don’t say that lightly. In fact, I believe that when we look back on this moment a decade from now, it will be viewed as a landmark day in the history of this still-nascent health care IT market.

So why is this time different?

The health-technology landscape has dramatically changed

Ten years ago, when Microsoft and Google were battling to make the personal health record idea resonate with consumers, much of the basic infrastructure needed to spur adoption did not exist. In 2007, less than a third of all doctors and other health care providers used an electronic medical record.

The passage of the HITECH Act, another key health care IT event, would take place two years later and would spur on widespread adoption of EMRs. Without the mandate and accompanying incentives to finally capture health data in digital form, developing personal health record systems would be a fruitless effort. On top of this, there were few interoperability standards, so even if you had health data, it was a huge challenge to share it with anyone else, including the patient.

Apple’s arrival changes the game

Another important piece of technology that had only just hit the market a decade ago? You guessed it. It’s the iPhone. Apple released the first version of the iPhone in the summer of 2007, and today it has grown its user base to over 500 million people.

Most of us love our iPhone, as evidenced by the fact that we use our iPhone a LOT. A recent study shows the average U.S. consumer now spends 5 hours per day on their mobile device. With such incredible penetration into our daily lives, it should come as little surprise that the mobile phone you currently have in your hand is still the “most valuable piece of real estate in the entire world,” to borrow a phrase from my investment partner Byron Deeter.

Some health care experts in my network have wondered why established medical record vendors, like Epic or Cerner, are better positioned to succeed. After all, these companies already have personal health portals built out and deployed. In my view, vendors like Epic and Cerner put the health care provider first — and rightfully so as they are the ones who pay the bills — when designing these products. Apple, on the other hand, is incentivized to put the consumer first.

The era of the health care consumer is here

Apple’s skeptics have also pointed out to me that the company will run into an inevitable stumbling block: Getting consumers to engage in their health. I agree with them that consumer or patient engagement has been a notoriously tough nut for health technology providers to crack.

But, here again, I think this time may be different. Why? With the rise of high deductible health plans, consumers are bearing a much larger share of health care costs these days. Ten years ago, only 10 percent of consumers had a deductible of $1,000 or more. Today that number is hovering around 50 percent of all consumers.

As consumers reach into their wallets to pay for health care services, I believe they will become much more active in decision-making. And what better place to start than to engage with personal health data.

The brilliance of Apple’s approach thus far is to open up their software and services to developers to build apps for consumers, and allow the consumer to push their data to these apps. I believe the same paradigm will exist in health care, where consumers will push their personal health records to apps to open up a much more personalized and engaging product experience.

If I were an Apple health developer, the first place I would look to build an app is any area of health care cost that hits the consumer’s wallet and where personal health data can be leveraged. Take, for example, building a digital prescription medicine discount card app that features personalized targeting and dynamic pricing based on the patient’s drug history data from their health record.

It has always struck me that we as consumers use our phones to purchase many things in our life but almost nothing when it comes to health care. With arrival of Apple on the scene, I believe this will finally change. And this time, it will truly be different.

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Risks Associated with Critical Care Coding Wed, 07 Feb 2018 22:30:27 +0000 By Deborah Grider, CPC, CPC-H, CPC-I, CPC-P, CPMA, CEMC, CCS-P, CDIP, Certified Clinical Documentation Improvement Practitioner for ICD10 Monitor

Questions abound when reporting critical care services.

Reporting Adult Critical care can be complicated. It is not only the coding but the rules and that go along with critical care.  Many questions come up when reporting critical care services. You would think it would be fairly straightforward since there are only two codes for adult critical care, 99291 for the first 30-74 minutes and 99292 for each additional 30 minutes in a calendar date.  But questions always arise when a practitioner is performing critical care.

Supporting Medical Necessity for Critical Care

According to CPT® 2017: “Critical care is the direct delivery by a physician(s) or other qualified health care professional of medical care for a critically ill or critically injured patient. A critical illness or injury acutely impairs one or more vital organ systems such that there is a high probability of imminent or life-threatening deterioration in the patient’s condition. Critical care involves high complexity decision making to assess, manipulate, and support vital system function(s) to treat single or multiple vital organ system failure and/or to prevent further life-threatening deterioration of the patient’s condition.”

According to CMS and other payers, critical care must be medically necessary and is a service as service that encompass both treatment of “vital organ failure” and “prevention of further life-threatening deterioration of the patient’s condition”.

Examples that would meet the criteria for critical care include the following:

  • Central nervous system failure,
  • Circulatory failure,
  • Shock, and
  • Renal, hepatic, metabolic, and/or respiratory failure.

If a patient has a potential of further deterioration is that critical care?  What about the patient who is on a vent but is stable?  Does this qualify for critical care? A patient who you are providing chronic ventilator management may not be considered critical unless they meet the critical care definition even if they are being managed in the critical care unit.  A patient who had surgery and is placed in critical care for constant observation might not meet the definition if there is not a potential of life threatening deterioration.  So understanding what constitutes critical care is vital in reporting the services accurately.  A patient on dialysis or hemodialysis would not be considered critical unless the patient’s condition is more than long term management of dialysis dependence.

It’s all about the Documentation

Although there are no key component requirements for critical care, when the patient is admitted to critical care or meets the definition of critical care such an acute MI arriving in the ER, a complete history and physical examination should be documented along with any lab results, bedside procedures even if included in the critical care time, a detailed assessment and comprehensive plan of care.  For all subsequent visits whether on the same date or different date the documentation should reflect the critical status of the patient, an examination, any change in treatment plan, labs and/or bedside procedures.  As always total time spent should be documented for each critical care encounter and the codes billed (99291 and 99292) should reflect the total time spent on the date of service.

What I find many times when reviewing documentation is the physician who put patients in critical care even if not critical are still billing for critical care services which during a payer audit can result in recovery of dollars from the practitioner.  Just because the patient is in critical care or was critical two days ago does not mean today he/she is critical.

The key is the status of the patient.  Once the patient is no longer critical coding should change to the subsequent hospital care codes 99231-99233 based on documentation and the complexity of the patient no matter where the patient is located in the hospital. For example, if the cardiologist billed critical care yesterday for example and then discharges the patient using CPT codes 99238-99239 it sends a “red flag” to the payers.  The question arises, why would a physician discharge a critically ill patient?

Critical Care documentation should always include the following:

  • The organ system(s) at risk
  • Which diagnostic and/or therapeutic interventions were performed, including rationale
  • Critical findings of laboratory tests, imaging, ECG, etc., and their significance
  • Course of treatment (plan of care)
  • Likelihood of life-threatening deterioration without intervention

A patient who is critically ill typically has a laundry list of comorbid conditions. When coding for critical care services, it is appropriate for the physician to code and report the patient’s underlying or comorbid conditions even if the physician is managing only one condition, such as respiratory distress, acute myocardial infarction, stroke, injury or any condition that requires critical care.

The International Classification of Diseases, 10th Edition, Clinical Modification (ICD-10-CM) can accommodate more specificity when describing acute, subacute and chronic conditions. Documentation of the reason for providing the critical care services should include the principle/first listed diagnosis followed by any comorbidities that affect the patient’s care. Often the physician reports only the condition he/she is managing, but this does not always provide a true picture of the patient’s condition

How do you Document Time?

Adult Critical care is time based.  It is reported for all patients who are critically over the age of 5 years old.  If the patient is under 5, the neonatal or pediatric critical care codes are reported. As stated earlier 99291 if reported for the first 30-74 minutes of critical care time and 99292 is reported for each additional 30 minutes. Per CPT Guidelines, if the critical care patient is managed less than 30 minutes in a calendar day, a subsequent hospital visit codes 99232-99233 based on the key components documented is reported.   Once the patient is no longer critical status the subsequent care codes should be reported. Time can be documented as total time or start and stop times.  Many consultants recommend start and stop times, but CPT and CMS do not mandate start and stop times. However, you should carve out the time spent performing procedures or services not bundled into critical care and make certain the documentation reflects that the time was not counted.


Critical care time: 134 minutes 99291-25 and 99292-25 x 3
93503 (Insertion and placement of flow directed catheter (e.g., Swan-Ganz)
for monitoring purposes (16 minutes)
Total time spent: 2 hours, 30 minutes

This clearly differentiates the critical care time from the Swan-Ganz Catheter which is not bundled into critical care and can be reported separately. It is helpful to document the time spent in performing a procedure not bundled into critical care as well as critical care time. Don’t forget to append Modifier 25 to the E/M services to identify that the E/M service is significantly identifiable from the procedure. The procedure note should also be well documented.

Keep in mind however, if the procedure is included in the critical care services such as gastric intubation (42752 or 42752) count the time while performing the procedures in your critical care time but do not report the procedure separately as it is bundled into critical care.  However, the procedure should be well documented. You can find the services that are bundled into critical care in the American Medical Association Current Procedural Terminology (Professional 2017).

Services included in the calculation of critical care time should include following:

  • Providing medical care at the patient’s bedside.
  • Discussing the patient’s medical condition with other practitioners or other members of the care team when on the unit and immediately available to the patient.
  • Reviewing diagnostic tests and data related to the patient.
  • Performing procedures that are bundled into the payment of critical care including procedures performed at the bedside.
  • Discussions with the family if the discussion with the family involves obtaining history that the patient is unable to give or discussion with the family required because a family member must make medical decisions for the patient.
  • Writing or dictating notes in the chart or electronic health record.

In order to report critical care, the practitioner must be immediately available to the patient.  That means the practitioner cannot be at home talking to another physician in the ICU about the patient, cannot see other patients on the floor or in other units of the hospital.  Critical care does not need to be continuous.  It can be intermittent and provided at various times during the calendar date of service.  To finish the billing for your critical care patient for the particular date of service, total all time for that date and report based on total time.

Only one practitioner may bill for critical care during a specific time period even if more than one physician is managing the patient who is critical.  For example, if a cardiologist is managing a critical care patient from 10:00 pm-11:00 pm, and a pulmonologist is managing the patient at the same time, only one physician can bill for that time frame.  But if the cardiologist is managing the critical portion from 1:00-1:45 and the pulmonologist manages their portion of the service from 2:30-3:15 both practitioners can bill for critical care services as long as they are managing different conditions.  The diagnosis play a significant role in differentiating that they are managing separate problems.

When to Use Critical Care Codes:

  • Patients who are critically ill or unstable with a high probability of imminent life-threatening deterioration.
  • i.e., treatment of “vital organ failure” and “prevention of further life-threatening deterioration” (Medicare)
  • For critical care services 30 minutes or greater.
  • Physician provides his or her full attention; cannot provide services to other patient at the same time.
  • Total time spent in the treatment of the patient should be documented in the patient’s record; Constant bedside attendance is not required.

 When NOT to Use:

  • Patients in the ICU who do not meet the definition of critical care.
  • Patients who are in the post-operative global period and the critical care is related to the surgery.
  • When critical care services do not equal or exceed 30 minutes. Use the appropriate E/M code.
  • Rounding in the critical care unit when the patient is not critical. This is reported as subsequent hospital care (9923x) if not related to an operative procedure (non-global care).

 Services that may not be included in critical care time include the following:

  • Updating family members who are not making medical decisions
  • Teaching time with interns, residents and other providers
  • Researching the patient’s condition
  • Time spent off the unit not providing care directly related to the patient
  • Time spent caring for other patients either in the unit or in another area of the hospital
  • Time spent performing procedures for which a separate charge is made (services not included in critical care time
  • Time spent in typical follow up for all patients
  • For Medicare patients, time spent in caring for complications that are related to a procedure


Understanding what meets medical necessity for a critical care service is imperative when reporting critical care.  Critical care service contain higher are scrutinized by payers because the RVU’s are significantly higher.  Make certain documentation for chart entry includes the status of the patient and enough detail in the documentation to support medical necessity for billing critical care and once the patient’s status changes from critical to stable no matter where the patient is located in the hospital, report the subsequent visit codes.

Total time should be documented every time the patient is managed by the practitioner and the total time should be the factor when selecting 99291-99292.  Keep up to date on changes to critical care guidelines for CMS and other payers.  A good source of reference is the CMS Internet Only Manual; Publication 100-4; Chapter 12: Section 30.6.12 and the CPT Guidelines.

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Dolbey is Once Again Recognized by KLAS Research for Speech Recognition and Computer-Assisted Coding Wed, 07 Feb 2018 21:41:13 +0000 KLAS Research is a healthcare information technology data and insights company providing the industry with accurate, honest and impartial research on the software and services used by providers and payers worldwide.  Every year, KLAS collects evaluations from healthcare providers to rank vendors across several categories.  This year, Dolbey is honored to announce that KLAS has ranked its software as #1 KLAS Category Leader for Front End Speech Recognition for Imaging and #1 KLAS Category Leader for Computer-Assisted Coding.

“We recognize that the awards come from KLAS, but are based on the surveys of our customers,” states Robert Leslie, Vice President and General Manager at Dolbey.  “For that, we are very grateful to our customers for the recognition.”

Dolbey delivers solutions to healthcare that support the entire cycle of a patient’s chart.  Its solutions specialize in physician-facing applications for speech recognition and dictation as well as solutions for document creation and transcription, clinical documentation improvement (CDI) and computer-assisted coding (CAC).

Heather Eminger, Product Manager at Dolbey, states “The road ahead is exciting! We are moving into the age of smarter software through machine learning and artificial intelligence.  With our advancements with this technology, our speech recognition and coding solutions have become more interactive and intuitive, allowing for greater accuracy and improved efficiency.”

About Dolbey

Dolbey’s award-winning healthcare suite of solutions improve productivity while delivering better documentation which improves patient care. Since 1914, Dolbey has consistently evolved its products incorporating the latest technologies available to meet the demands of the healthcare community. Today, our suite of products includes Speech Recognition (premise or cloud-based), CAPD, CDI, CAC, Transcription and Dictation.

About KLAS

KLAS is a research and insights firm on a global mission to improve healthcare delivery by amplifying the provider’s voice. Working with thousands of healthcare professionals and clinicians, KLAS gathers data and insights on software, services and medical equipment to deliver timely reports, trends and statistical overviews. The research directly represents the provider’s voice and acts as a catalyst for improving vendor performance. Follow KLAS on Twitter at

For further information, please contact:

Traci Miller, Marketing Executive
800-878-7828 x119/*protected email*

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Are You Moving the CDI Needle? Thu, 25 Jan 2018 14:15:45 +0000 Three questions to consider when evaluating a clinical documentation improvement program.

By Lisa A. Eramo, MA for For the Record

Review the record. Query the physician. Obtain the diagnosis. Repeat. Does this clinical documentation improvement (CDI) workflow sound familiar?

Productivity is the hallmark of a good program. Or is it? On the surface, CDI specialists take the proper steps, but do their actions ultimately translate into documentation that reflects the most accurate clinical picture?

Experts agree that establishing clear and consistent performance metrics is the only way to find out. Evaluating a CDI program not only helps justify return on investment but also pinpoints opportunities for education and process improvement and perhaps even justifies the need to hire additional CDI specialists.

Organizations should consider three questions when evaluating CDI effectiveness.

Are CDI Performance Metrics Being Monitored Consistently?

All organizations should measure the following seven program metrics from the onset of any CDI efforts and throughout the duration of the program:

Query rate/volume. Definition: Of the cases reviewed by CDI specialists, how many include a query?

Before measuring this metric, decide how the organization will calculate it, says Fran Jurcak, MSN, RN, CCDS, vice president of clinical innovation at Iodine Software. For example, will it count the total number of cases that include a query, or will it count the total number of queries per case? Counting individual queries more accurately indicates how much time CDI specialists spend reviewing each case, Jurcak says.

Remember that it’s not only about the number of queries, says Glenn Krauss, RHIA, BBA, CCS, CCS-P, a senior consultant at Federal Advisory Partners, who notes that organizations must also examine the clinical validity of those queries. Do the queries actually improve the quality of the documentation so that it most accurately reflects patient severity? Krauss defines quality documentation as having the following four attributes:

  • valid chief complaint;
  • physical exam and assessment, both of which are congruent with the history of present illness;
  • definitive or provisional diagnosis with appropriate specificity; and
  • plan of care that’s congruent with the assessment.

“To me, that’s CDI—progress notes that tell the progress of the patient,” Krauss says.

If organizations intend to use the query rate/volume as a barometer of performance, they must ensure that all CDI specialists know when a query is appropriate, Jurcak says. “People are very subjectively making decisions about what they’re going to query as opposed to saying, ‘I want documentation integrity across the board regardless of how many queries are needed on an individual case,'” she says.

When CDI specialists don’t pose queries consistently, it becomes difficult to rely on the query rate/volume as a metric for effectiveness, Jurcak says. Posing queries inconsistently also sends mixed messages to physicians. For example, a CDI specialist decides not to query for heart failure because he or she has already reached the maximum severity of illness and risk of mortality. “You send a message to the provider that you query for heart failure only when it matters [for reimbursement], and then you wonder why providers don’t comply,” Jurcak says.

Review rate. Definition: Of the total number of cases, how many did CDI specialists review?

Don’t be fooled into thinking that a high review rate indicates an effective CDI program, Jurcak says. “You have to know that your staff are reviewing records, but you don’t want them spinning their wheels on cases that don’t benefit from CDI,” she explains. “It’s about reviewing the right records every day.”

Leveraging technology with artificial intelligence to prioritize cases can help matters, says Jurcak, who suggests manually eliminating cases from the workflow that typically have limited documentation opportunities (eg, elective joint replacement surgeries with a length of stay of fewer than three days, first-day admissions for which a physician hasn’t yet documented a history and physical).

Jurcak, who was a nurse before moving into CDI, views performance metrics differently now that she works for a technology company. Organizations shouldn’t strive to review 100% of their cases because many won’t benefit from CDI, she explains. In fact, organizations leveraging technology to prioritize cases for CDI may ultimately witness a decrease in their review rate but an increase in their query volume, Jurcak says.

Response rate. Definition: Of the cases queried, how many solicited a physician response?

Physician responses to queries are critical; however, Jurcak says organizations must take a closer look at the type of responses they receive. A high response rate doesn’t mean an organization is necessarily improving documentation quality.

For example, many programs use query templates that automatically provide the option of “unable to determine” or “other.” When physicians check one of these nonspecific boxes, they’ve technically responded, but they may not have provided additional information to improve the quality of care or documentation specificity. Rather than default to these options on every template, consider including them only when necessary, Jurcak says.

For example, when a CDI specialist poses a compliant query with appropriate clinical evidence, it may not make sense to provide an answer of “unable to determine.” Jurcak says providing this option allows an easy out for physicians who don’t understand the query or who aren’t willing to take the time to accurately document the conditions being monitored and treated.

Krauss cautions organizations using this metric to consider the following question: Even when a query yields a codable diagnosis, does the documentation enable the organization to defend that diagnosis in the event of an audit? “If the clinical information, facts of the case, and context surrounding the diagnosis do not paint a picture of acuity in support of the diagnosis, the fact that the diagnosis is charted by the physician as a direct result of a query serves very little, if any, purpose,” he says. “The outside reviewers will simply refute the diagnosis and remove from the claim, thereby downcoding the diagnosis-related group (DRG).”

Agreement rate. Definition: Up for debate.

Experts say there is no consensus within the industry on how to define this metric. Some organizations say agreement occurs when a physician provides a codable diagnosis rather than stating the clinical indicators aren’t relevant. Others say agreement occurs when a physician provides the anticipated or assumed diagnosis. A third interpretation is that agreement occurs when the physician agrees with the query—even when appropriate documentation is absent from the medical record.

The absence of a uniform definition makes nationwide program comparisons nearly impossible, Jurcak says. This metric is meaningful only when organizations take the time to formally define it—and then train staff on how to report data consistently, she says.

Complication or comorbidity (CC) or major complication or comorbidity (MCC) capture rate. Definition: Of the cases queried, how many yielded a CC and/or MCC?

Theoretically, the CC/MCC capture rate should increase as CDI efforts are initiated, says Amber Sterling, RN, BSN, CCDS, director of CDI services at TrustHCS. However, organizations shouldn’t assume that a low CC/MCC capture rate equates to ineffective CDI. In some cases, CCs and MCCs may simply be absent in the population.

Case-mix index (CMI). Definition: What is the average relative weight of all DRGs reported during a defined period of time?

In theory, the CMI should increase as CDI specialists capture additional CCs and MCCs. However, there are other factors that can influence CMI, such as the volume of surgical patients, removal of a service line, and the seasonality of certain diagnoses—none of which CDI specialists can impact using queries, Sterling says.

Financial impact. Definition: How does the working DRG compare with the final-coded DRG?

The challenge with this metric is that staff assign impact inconsistently, Sterling says. “It seems relatively simple, but there are a lot of gray areas,” she says. “You see a lot of variance in CDI staff practice. It takes diligence by the program managers to continually educate and audit their team.”

For example, will the organization count the financial impact anytime a CDI review yields a CC or only when the review yields a CC that’s the only CC on the case (thus shifting the DRG)?

“If you’re saying there’s a dollar impact on this case, the case must meet your standards for how you’re reporting impact,” Sterling says. “If you report $20 million of impact, but then you find out later there was an error on how things were reconciled and it was actually $12 million, your C-suite is not going to appreciate that. I’ve seen it happen. It can be significant.”

Have Metrics Evolved as CDI Priorities Change?

In the past, CDI programs were focused on queries that directly increased reimbursement. Now, some programs have expanded that scope to include queries that impact quality and risk adjustment—two big factors in value-based purchasing. But have program performance metrics evolved to reflect these new goals?

Not quite, Jurcak says. “We talk about the increased scope of practice, but then we still hold our employees accountable to the same metrics we used 10 years ago,” she says.

Krauss agrees. “The problem with programs today is that they’re based on invalid and unreliable measures of CDI. The fact that you touched a record, left a query, and received a documented clinical condition in the chart doesn’t necessarily mean you have improved documentation,” he says. “Solidifying a diagnosis in and of itself does not constitute CDI. What really matters is the quality and completeness of documentation that best communicates the patient care.”

Why haven’t programs moved beyond the basic key performance indicators? Krauss says it all goes back to revenue. “Can you sell a program to a CFO based on the quality of the documentation? You can’t,” he says.

Hospital CFOs need to understand the long-term effects of documentation, says Tiffany McCarthy, RHIT, manager of HIM solutions at GeBBS Healthcare Solutions. Even if organizations gain revenue in the short term, what happens when documentation indicates that outcomes are consistently poor? Insurance base rates could decrease, causing a loss of millions of dollars the following year, McCarthy says.

It’s irresponsible for organizations to continue to rely on traditional key performance indicators during the shift to value-based reimbursement, Krauss says. Episodic reimbursement necessitates the need to improve documentation quality across the board—not simply to shift a single DRG, he says.

Organizations also must contend with publicly available quality ratings. When consumers see that an organization has poor outcomes, they may seek care elsewhere, McCarthy says. “We’re in the age of information, and more and more people are using this information when they seek care,” she says.

How should today’s CDI programs define success? Krauss provides the following metrics:

  • low rate of hospital-acquired conditions;
  • low rate of patient safety indicators; and
  • decreased medical necessity denials (ie, denials due to insufficient documentation).

Organizations with quality-driven CDI programs also can measure success through a lower conversion rate from observation to inpatient status, Krauss says. That’s because these programs drive quality documentation from the onset of the patient encounter, helping to establish a reasonable expectation that the patient will stay at least two midnights.

Do Analyses Take a Deeper Dive Into the Data?

Drilling down into the data provides organizations with the insights they need to drive process improvement. This includes burrowing into data by facility, specialty group, individual physician, and coder, says Sterling, who recommends examining CC/MCC capture rates by payer.

“You don’t want to have your staff spend their time on things that are not going to provide results,” Sterling says. Identify where CDI specialists have the most impact and then streamline CDI efforts accordingly, she adds.


According to HIM industry experts, health care organizations must be on the lookout for the following pitfalls when evaluating their clinical documentation improvement (CDI) programs.

Failure to Look Beyond the Data

Data tell a story, but do they tell the entire story? Not necessarily, which is why organizations need to examine anecdotal data as well, says Tiffany McCarthy, RHIT, manager of HIM solutions at GeBBS Healthcare Solutions. For example, ask physicians, CDI specialists, and coders to evaluate whether everyone works collaboratively. If not, what are the challenges and hurdles?

Fran Jurcak, MSN, RN, CCDS, vice president of clinical innovation at Iodine Software, agrees that interaction is key. “There’s still that level of engagement at the physician level that needs to occur. There still needs to be communication between CDI specialists and coders,” she says. “Helping each other to understand the clinical and coding issues related to appropriate documentation in a medical record is key to success for the organization.”

Assuming Increased Revenue Equates to Success

Although increased revenue may be the goal of a CDI program, organizations should consider how they compare with other facilities, says Amber Sterling, RN, BSN, CCDS, director of CDI services at TrustHCS. What do PEPPER and MedPAR data reveal? How does the organization compare with state, regional, and national averages? Does the analysis indicate any data anomalies that could raise a red flag with auditors?

Failure to Formalize Metrics in a Policy

Jurcak says a program policy should include the following:

  • specific metrics;
  • the definition of each metric;
  • clarification of the relationship between these metrics and the CDI program’s mission; and
  • bench-marking sources (eg, professional associations, MedPAR data, and internal averages).

Creating a policy ensures all CDI staff report data consistently. It also helps organizations compare themselves with other facilities, Sterling says. For example, if the organization calculates query volume as the number of queries per case, it doesn’t make sense to compare this number with a facility that uses the number of cases queried.

Misaligning Metrics and Mission
The CDI mission refers to the program’s overarching goal. For example, is it to increase reimbursement? Improve quality? Both?

Once defined, the mission can help organizations choose appropriate metrics to measure performance. Financial impact, for example, becomes less important when the mission is to improve quality, Jurcak says. “If you truly understand the mission, you can better hold your staff accountable,” she notes.

Reviewing Metrics Too Frequently — or Infrequently
While daily reviews don’t provide insight into larger trends, Jurcak says analyzing metrics monthly allows for quick adjustments.

However, don’t expect immediate improvements after an intervention. “Instant change isn’t going to necessarily result in instant benefits or improvements in the metrics next month. You have to watch it over time,” Jurcak says.

— Lisa A. Eramo, MA, is a freelance writer and editor in Cranston, Rhode Island, who specializes in HIM, medical coding, and health care regulatory topics.

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7 statistics on medical coder salary, growth potential Thu, 25 Jan 2018 13:30:08 +0000 By Laura Dyrda for Becker’s ASC Review

Professional coders are more likely to see compensation increases when they achieve higher credentials, and the percent increase in year-over-year compensation is higher for the most-credentialed individuals, according to the AAPC 2016 Salary Survey.

The survey was completed by 9.2 percent of AAPC membership, and 2.2 percent hold three or more credentials. Here are statistics on the average 2016 compensation for Certified Professional Coders based on credentials, as well as the percent increase over the previous year:

  1. Certified Professional Medical Auditor: $64,444 (3.4 percent)
  2. Certified Physician Practice Manager: $67,143 (3.8 percent)
  3. Certified Professional Compliance Officer: $75,680 (5.8 percent)
  4. Specialty credentials: $57,524 (2 percent)
  5. One AAPC credential: $52,605 (1.9 percent)
  6. Two or more AAPC credentials: $60,305 (3.3 percent)
  7. Three ore more AAPC credentials: $66,999 (2.1 percent)
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Natural language processing tools take aim at value-based care through risk-sharing programs Thu, 25 Jan 2018 12:45:12 +0000 By Bill Siwicki for Healthcare Finance News

Natural language processing technology is being integrated with electronic health records and finding its way into the big data and analytics realms, often focusing on enhancing provider workflow and clinical documentation. And for the last few years, tech vendors including 3M, Apixio, Dolbey Systems, Health Fidelity, Linguamatics and Nuance, as well as enterprise IT big guns IBM and Microsoft, have been bringing NLP tools to the healthcare market.

NLP has challenges, of course, but it can offer important benefits when used wisely, said Anupam Goel, vice president of clinical information at Chicago-based Advocate Health Care.

Another is where NLP is gaining traction is among health systems reaping is the of NLP technologies to advance value-based care initiatives.

NLP for value-based care

Mount Sinai Health Partners announced this week that it is implementing a natural language processing-powered risk adjustment system to advance is value-based care initiatives.

With more than 300,000 members enrolled in various risk-sharing programs across multiple payers, Mount Sinai Health Partners, a clinically integrated network formed by Mount Sinai Health System, was seeking to develop a risk adjustment program that could maximize the performance of its existing risk arrangements and expand its participation in value-based care programs.

Mount Sinai Health Partners specifically wanted to leverage natural language processing technology in an attempt to optimize the accuracy and completeness of its risk capture. As a result, the IDN entered into a multi-year arrangement with Health Fidelity to help set up a comprehensive program with the Health Fidelity HF360 Risk Adjustment natural language processing software.

Health Fidelity initially conducted an HF360 Blueprint assessment to identify and quantify the risk adjustment optimization opportunity, which Mount Sinai Health Partners said helped it recognize the potential of a successful risk capture strategy.

“We needed to develop a holistic risk adjustment strategy as we continue our growth in this market,” said Michael Berger, vice president of population health informatics and data science at Mount Sinai Health Partners.

NLP: Now is the time

While NLP can offer value-based care and advanced diagnostic benefits, it depends heavily on the specifics of how clinicians enter their documentation, Advocate’s Goel said.

That said, Goel added that now is the time for NLP.

The technology has satisfactorily evolved to be useful rather than counterproductive, and the benefits – ease-of-use, a shorter window between clinical documentation and the activation of care teams – make it a worthwhile investment.


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A Call for Victory for HIM Professionals in 2018 Wed, 24 Jan 2018 21:45:28 +0000 For HIM and CDI professionals, 2018 looks to offer a gift of the tremendous opportunity for success.

By Bonnie S. Cassidy, MPA, RHIA, FAHIMA, FHIMSS for ICD10 Monitor 

For movie buffs, the film Darkest Hour offers a tremendous view into the early days of World War II, when the fate of Western Europe hangs on the shoulders of newly appointed British Prime Minister Winston Churchill, who must decide whether to negotiate with Hitler or fight on against incredible odds.

As we embark on our new year, it is very inspirational and motivational to remember the words of Churchill: “victory at all costs, victory in spite of all terror, victory however long and hard the road may be; for without victory, there is no survival.”

There is no new year’s hangover in the world of health information management (HIM) – only striving for Victory! The healthcare industry represents 17.9 percent of the nation’s gross domestic product, and it is still growing – and this will surely dominate the news in 2018, as it has for much of the past decade.

Some 2018 areas of focus for exploration and learning for HIM and clinical documentation improvement (CDI) professionals include the following:

Clinical Documentation Integrity in the Outpatient Settings

Where there is confusion in the industry, there is an opportunity for HIM/CDI. There is no roadmap to success in this area, and there are only one or two technology enablers.

Given the confusion, HIM and CDI can assess their organizational needs and determine how to measure improvement associated with planning efforts. Every provider organization is different, so there is no right or wrong approach, given current initiatives and obligations, workflow, and staffing. Learning about the different reimbursement models for observation, the emergency department, outpatient clinics, and physician practices is vital. Reach out to understand what payer contracts your organization has and how much risk-adjusted reimbursement is involved. You can create CDI programs to target these areas that need a concentrated effort on clinical documentation accuracy. HIM and CDI must be proactive in all denial mitigation and avoidance programs. Understanding the reimbursement requirements gives you the opportunity to enhance your electronic health records (EHRs) and templates, and to build physician education and CDI programs.

Leveraging Technology

Provider organizations have made a significant investment in technology during the past few years, and one of the biggest involved EHRs. Take the time to research, learn, and understand how machine learning, natural language processing (NLP) engines, cloning detection, artificial intelligence, and data mining can create meaningful analytics applied to result in your organization being able to make more timely and accurate decision-making, which can drive real behavioral change. Think about how much improvement and time-saving you would have in one area, such as physician office CDI! The opportunities are endless, but you need to understand the details and leverage the investment that your organization has already made in its EHR.

Securing the Internet

Following a year marked by major, industry wide cybersecurity breaches and a 525 percent increase in medical device cybersecurity vulnerabilities reported by the government, HIM professionals now must heed the national call to action to maintain data privacy. Never before have we seen such a need to secure the thousands of connected medical devices on the healthcare enterprise provider networks and protect our patients. Cybersecurity threats are real in the Internet-connected medical devices that are playing critical roles in such tasks as patient care, medical records, and billing. HIM must work with IT to secure and lock down each connected device that represents a potential door for cybercriminals. Who better than HIM professionals to rise to the occasion?

Privacy and Security of Health Information

HIM professionals play critical roles to ensure compliance with legal mandates relevant to the privacy and security of patient information. This has proven to be challenging, considering a constantly changing legislative and regulatory environment. Most notable, and of greatest familiarity to the public, are the privacy requirements of the Health Insurance Portability and Accountability Act (HIPAA) of 1996. As mentioned, HIM professionals have a renewed focus on privacy and security given the rising presence of patient information breaches. Patients may have no idea how vulnerable they are to cybersecurity threats due to unprotected networks, patient portals, EHRs, and medical devices outside of the walls of the hospital. Even copiers and fax machines are often not included in the inventory of equipment holding patient identifying information that is not secured. HIM professionals are known privacy experts, and they now have to answer the call to create governance programs, monitor breaches, and prevent cybersecurity incidents. Such incidents must be treated as a “non-natural” disaster, resulting in the investment of more time, planning, governance, and training of personnel and the medical staff.

Patient Experience and Consumerism

As the healthcare industry transitions from pay-for-volume to pay-for-value, HIM professionals must make strategic investments to improve the patient experience within their organizations. Healthcare providers have succeeded in making administrative tasks easier and more convenient for patients. Just think of what you can do online: now patients can pay bills and schedule appointments online via email or text. 2018 will be all about redesigning the patient experience so that patient satisfaction and outcomes can be tracked and measured. Because of the knowledge of identifying management, coding, and coded data, healthcare organizations can now utilize the expertise of HIM professionals to redefine the customer-centered relationship. Bravo to the HIM companies that have made the investment to champion clinical documentation integrity, maintenance and preservation of authenticated patient information, and the appropriate release of information. Healthcare also has an opportunity to learn from other industries (consumer products, financial services, and hospitality, as examples) how to more effectively target, serve, communicate with, and retain patients.

Value-Based Reimbursement

The transition to pay-for-value will continue, and it ultimately will involve the growth of the Medicare Advantage population, wherein keeping patients healthier is critical to controlling costs. The tremendous opportunity for HIM and CDI professionals in the Medicare Advantage conversation is to understand if their organization has acquired physician practices, and of those, how many are paid “at risk,” according to the Medicare Advantage contracts. These physicians have an immediate need for a CDI program in the physician’s office to target the clinical documentation requirements for ICD-10 diagnosis coding and to optimize the hierarchical condition category (HCC) system.


Analytics will also be used more widely in 2018 by providers and payers in creating incentive programs for reimbursement. Payers will use analytics to reward providers based on their history of delivering quality outcomes. These collaborative efforts can only be done with the expertise of HIM professionals, as the goal of the initiative is to raise the overall standard of care while reducing costs and increasing patient satisfaction. Who better to be a driver for this success than HIM professionals with a strong expertise in coding and classification? A successful transition to value-based care requires that market players and consumers move beyond transaction-based treatment to the holistic health of populations, from treatment to prevention/wellness, and from individual to population health. The only path to success is to rely on the data in the EHRs, which should be standardized and monitored by HIM, and the data created through coding and used in analytics. The creation of a health information governance program of rules, standards, and guidelines, created by HIM professionals, is a must if your organization is going to rely on accurate analytics.

Fraud Management

Analytics that can help uncover patterns of fraud, waste, and abuse in health information represent a key goal for HIM professionals. Check out the American Health Information Management Association (AHIMA) Body of Knowledge and read the groundbreaking research conducted by AHIMA and the Office of the National Coordinator for Health Information Technology ONC from 2001-07. Now is the time to renew the HIM professional focus on this problem, and to seek to understand and discover new ways to deploy people, processes, and technology to decrease the potential for fraudulent activity. Fraud is a significant drain on the U.S. healthcare system.

Ten years ago, estimates by government and law enforcement agencies placed annual losses as high as $170 billion due to fraud, so you can only imagine how this has grown since. Healthcare fraud is a serious and growing crime nationwide, linked directly to the nation’s increasing healthcare outlay. Fraud is also a moving target, shifting to new and more sophisticated schemes to mask aberrant behavior. Fraudsters have a ripe opportunity to exploit healthcare information systems due to lack of governance and security needed for appropriate protection of patient data. This is an area where HIM professionals have deep domain knowledge and expertise.

Disaster Recovery for HIM

Natural disasters create devastation that lasts long after they pass. Events such as hurricanes and wildfires can wreak havoc on health systems, both in the short and long terms. Health systems that conduct proactive scenario planning can increase the pace of recovery following such disasters and avoid making premature decisions that could do harm. HIM must be involved in business continuity planning and disaster recovery of patient information systems.

Learn all you can about Blockchain Technology

A distributed ledger (also called a shared ledger, or referred to as distributed ledger technology) is a grouping of replicated, shared, and synchronized digital data geographically spread across multiple sites, countries, and/or institutions. There is often no central administrator or centralized data storage. A blockchain facilitates secure online transactions, which should represent to HIM professionals a new area to embrace and learn all that you can. A blockchain is used to record transactions across many computers so that the record cannot be altered retroactively without the alteration of all subsequent blocks and the involvement of the network. Why? Well, there are some dramatic improvements that are predicted in the healthcare industry with blockchain technology, so you will want to be a leader in this area. Some of its features include:

  • Interoperability: Blockchains could enable data exchange systems that are cryptographically secured and irrevocable. This would enable seamless access to historic and real-time patient data while eliminating the burden and cost of data reconciliation.
  • Claims processing: Blockchain-based systems can provide realistic solutions for minimizing medical billing-related fraud. By automating the majority of claim adjudication and payment processing activities, blockchain systems could help eliminate the need for intermediaries and reduce administrative costs and time required of providers and payers.
  • Privacy and cybersecurity: Blockchain-enabled solutions have the potential to bridge the gaps of device data interoperability while ensuring security, privacy, and reliability.

We can only learn about blockchain technology from other industries and dream about the possibilities. This is a must for HIM professionals in their journey of lifelong learning.

Looking Ahead

Be aware of dramatic reductions in workforce in the HIM/CDI industry going forward. HIM directors and management are experiencing job eliminations these days in the context of hospital restructuring, as well as the elimination of HIM and CDI lines of business for companies serving the healthcare industry due to lack of demonstrated value. Job growth in the sector slowed dramatically in 2017, especially during the second half of the year, and unfortunately, the outlook for 2018 is bleak. Admissions and lengths of stay continue to fall as more care moves to outpatient settings. Pressure to keep price increases low remains strong. Margins are narrowing, so HIM professionals must think fast and be loud in differentiating themselves and demonstrating value to their organizations. All HIM and CDI professionals must assess their organizations’ ambulatory clinical documentation integrity in the facility-based outpatient settings and hospital-owned physician practices.

Ten years ago, the nation’s former healthcare IT chief urged HIM professionals at the annual meeting to “continue to lead” and to make their efforts “larger, louder and faster.”

“You are at a flexion point,” David J. Brailer, MD, told an audience of hundreds of AHIMA members.

HIM professionals have made progress, but once again are being called to be “larger, louder and faster” – and to prove to the industry the value of health information management.

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Loss of net neutrality could slow telehealth access Wed, 24 Jan 2018 21:00:25 +0000 By Meg Bryant for Healthcare Dive

December is a time to reflect on the coming new year and make resolutions for the coming year to enact change. For the federal government, the repeal of net neutrality rules by the Federal Communications Commission was one decision that will continue to create aftershocks in 2018.

Net neutrality barred broadband providers from slowing information slow or exacting higher payments for speedy delivery. The move could have serious ramifications for telehealth and other digital health services, particularly in rural and under-served communities. And with CMS’ penalty structure for readmissions in place and the move to consumerism, providers need to figure out their digital strategy and what the FCC’s decision means for them.

Why net neutrality matters to healthcare

Under net neutrality, no carrier could randomly charge more than another for access to broadband. With its removal, broadband servers can now block content, offer “fast lanes” for preferred customers and slow data for those who can’t afford to pay for faster transmission. Subscriber-based video streaming services like Netflix and AT&T’s DirectTV Now could be prioritized over a rural public hospital facility seeking to transmit images or conduct a telehealth consult.

“The ability for hospitals to access internet service providers and bandwidth is a ‘has to’ in healthcare,” says Robert Annas, chief operating officer of Eagle Telemedicine and senior managing director at SOLIC Capital, adding a tier-based ability to pay by nature will have a negative impact on providers.

In rural markets, small physician practices branching out into telehealth won’t be able to absorb those costs and will pass them along to the patient, putting such outpatient services out of reach for some. Given the growing physician shortage, the result will be weakened ability to provide good quality care, Annas says.

On the inpatient side, larger health systems will have the ability to pay for bandwidth access, but smaller systems will suffer. The pressure to provide speedy service could accelerate the trend of consolidation and hospital closures.

Internet as a social determinant of health

The loss of net neutrality will force healthcare organizations to rely more on electronic health record (EHR) vendors like Cerner and Epic to provide them with the technological support they need to be able to move health records electronically, and consumers will pay for that cost, says Beatriz Mallory, SVP and managing director at Sensis Health.

It will also exacerbate the rate at which internet access is a social determinant of health, because there will now be entire communities with less access to preventive care, prenatal care and chronic disease management, she tells Healthcare Dive. “What you’ll see is more reliance on episodic care” and use of emergency rooms, she says.

FCC Chairman Ajit Pai defended the commission’s 3-2 vote along party lines to end net neutrality by citing a 5.6% decline in internet investment during the two years the policy was in effect. “This is especially hard on rural and low-income urban communities, parts of the country that already find themselves on the wrong side of the digital divide,” he said in a video explaining the commission’s adoption of his Restore Internet Freedom proposal.

Could healthcare be an exception?

“What’s fascinating to me is that the government has mandated electronic health records and has provided incentives for years to do that and those systems require bandwidth,” Annas tells Healthcare Dive. He and others believe healthcare should have a separate lane with different rules.

It stands to reason the government would isolate certain sectors like healthcare and telemedicine from a net neutrality-type package because it reduces access to healthcare, rather than increases it, he explains. Not doing so goes against the grain of logical thinking.

Ron Exler, principal analyst at ISG Research, sees such a carve-out as a possibility. “Potentially, healthcare applications could be given the very priority many worry creates inequities,” he told Healthcare Dive via email. He notes there are other significant obstacles to connected healthcare such as reimbursement, privacy protection and interoperability that also need to move forward. Moreover, many connected applications, such as asset management, rely on RF technology rather than broadband.

Practical steps

But for telehealth and many other day-to-day healthcare activities, access to speedy bandwidth is essential.

To that end, providers should continue to make their voices heard on the need for priority bandwidth access in healthcare, experts say. Health systems should also be actively negotiating with their internet providers to get the best deal possible for now. In a non-neutral environment, it will boil down to how well one negotiates and what kind of dollar volume they bring to bear.

A Senate bill to reverse FCC’s net neutrality decision will see its day on the Senate floor. Sen. Claire McCaskill (D-Mo.) announced on Monday support for the bill, totaling the measure’s support to 30 senators, ensuring a Senate floor vote.

While the outcomes of that vote is unclear, the FCC’s decision still stands for now. As such, providers need to think outside the box.

Smaller hospitals and physician practices should consider banding together with hospitals of similar size to expand their purchasing power. Rural hospital associations can create bandwidth consortiums that buy bandwidth in bulk, increasing access to all members.

A substantial incremental investment is needed in telemedicine and more uptake by providers who have lingered on the sidelines, says Mallory, adding that whatever happens to the Affordable Care Act, CMS’ penalty structure for readmissions is not going away.

“Eliminating the net neutrality rules goes against the thought of reducing healthcare costs, because reducing healthcare costs is done when you are in front of disease — not behind it,” says Annas.

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