Patient Safety Indicators, or PSIs, provide insight into safety events that occur during care delivery. Health care organizations can use PSIs to assess potential complications and events to improve their care. Today, we define PSIs and their importance. We also discuss how health care organizations can use Present on Admission data to alleviate being unfairly compared to other organizations regarding care outcomes.

Guest speaker:

Terry Golde, MBA, RN, CCDS

Consulting Director

Vizient

Moderator:

Tomas Villanueva, DO, MBA, FACPE, SFHM

Principal

Clinical Operations and Quality

Vizient

Show Notes:

[00:53] Definition

[01:14] Importance of PSIs

[01:44] What PSIs measure

[03:07] Development of PSIs

[03:36] What lower PSI rates mean for hospital performance

[04:14] How PSI data is collected

[07:10] Hospital Rate in PSIs

[08:07] Calculating PSI rates

[09:13] Adjust for patient characteristics – so hospitals will compare fairly

[10:01] Using Present on Admission (POA) data

[11:08] Effect of PSIs on reimbursement and performance ranking

[11:49] PSIs as a useful measure

Links | Resources:

To contact Modern Practice: [email protected]

Terry Golde’s contact email: [email protected]

Patient Safety Indicators (AHRQ) Click here

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When a clinical diagnosis or procedure is not validated in the medical record, resulting in a claim denial, the health care organization loses reimbursement, the physician or clinician involved may come under scrutiny and the reputations of both clinician and hospital may suffer. Errors in documentation needlessly contribute to this problem. On this episode, we discuss what clinicians and organizations can do to avoid claim denials.

Guest speaker:

Erica Braun, MS, RN, CCDS

Consulting Director

Vizient

Moderator:

Tomas Villanueva, DO, MBA, FACPE, SFHM

Principal

Clinical Operations and Quality

Vizient

Show Notes:

[01:11] Clinical validation denial

[01:31] Implications for denials: downgraded DRGs and lower reimbursement

[02:31] Avoiding denials

[03:25] When diagnoses are at high risk for denial

[03:59] Examples of disputed diagnoses

[04:30] Establishing criteria for diagnoses

[05:15] What physicians can do to help improve documentation

[06:17] What to do when a denial occurs

[07:29] Negotiating and coordinating with payers

Links | Resources:

To contact Modern Practice: [email protected]

Erica Braun’s contact email: [email protected]

Fact sheet on Vizient’s clinical documentation improvement services: Click here

Clinical Validation: The Next Big Challenge in Inpatient Coding (American Academy of Professional Coders, AAPC): Click here

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A strategy to achieve regulatory and accreditation compliance is important more than ever, especially in the wake of COVID-19 when regulatory agencies ramp up their efforts again. On this episode, we’ll discuss how health care organizations can face the challenges they face in achieving compliance.

Guest speaker:

Diana Scott, MHA, RN, CPHQ

Associate Vice President

Accreditation and Regulatory Services

Vizient

Moderator:

Tomas Villanueva, DO, MBA, FACPE, SFHM

Principal

Clinical Operations and Quality

Vizient

Show Notes:

[00:37] Challenges are not new, with infection prevention at the forefront

[02:48]  Cleanliness of ice machines

[03:25] Dialysis: orders, water management, disinfecting equipment

[04:23] Behavioral health: suicide risk

[05:31] Medication management

[06:26] Perinatal standards

[07:27] New requirements/developments

[09:24] Vizient resources

Links | Resources:

To contact Modern Practice: [email protected]

Diana Scott’s contact email: [email protected]

Vizient Accreditation Services: Click here

The Joint Commission: www.jointcommission.org

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Health care organizations need a comprehensive strategy to achieve regulatory and accreditation compliance. At stake are crucial certification and approval ratings and, more crucial, patient and workplace safety. On this two-part series, we’ll examine the current status of regulatory and accreditation organizations and the latest challenges organizations face in their efforts to reach compliance.

Guest speaker:

Diana Scott, MHA, RN, CPHQ

Associate Vice President

Accreditation and Regulatory Services

Vizient

Moderator:

Tomas Villanueva, DO, MBA, FACPE, SFHM

Principal

Clinical Operations and Quality

Vizient

Show Notes:

[01:17] Status on accreditation and surveys

[02:38] Update on survey methods: the hybrid model

[05:38] Impact of decreasing COVID infection rates

[06:39] Surveyor expectations

[07:32] Clinical workforce issues and expectations

[09:40] Water management, fire safety/sprinkler systems and workplace safety

Links | Resources:

To contact Modern Practice: [email protected]

Diana Scott’s contact email: [email protected]

Vizient Accreditation Services: Click here

The Joint Commission: www.jointcommission.org

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The last episode of this two-part series covered why readmissions occur. This episode explores those causes in more depth – the clinical and social issues underneath readmissions—and what health care organizations can do to prevent these from happening.

Guest speaker:

Tod Baker, BS

Principal

Operations and Quality

Vizient

Moderator:

Tomas Villanueva, DO, MBA, FACPE, SFHM

Principal

Clinical Operations and Quality

Vizient

Show Notes:

[00:40] Addressing clinical issues

[02:59] Addressing social issues

[04:38] Best practices/new approaches in risk stratification

[09:00] Engaging the family or community to manage the patient

[10:11] Where to start

[12:17] Post-acute care

Links | Resources:

To contact Modern Practice: [email protected]

Tod Baker’s contact email: [email protected]

Designing and Delivering Whole-Person Transitional Care (AHRQ) Click here

Vizient’s Clinical Data Base (CDB) and readmissions Click here

CMS Hospital Readmissions Reduction Program Click here

Amy Boutwell, MD, MPP, presents six videos on Multi-visit Patients (MVPs) and readmissions Click here

Contact Dr. Amy Boutwell at: [email protected]

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The value of reducing readmissions to the hospital has been well-established: lowering health care costs, eliminating wasted resources, improving quality and increasing patient satisfaction. However, organizations still wrestle with the causes for readmissions, whether it is poor care coordination or poor patient follow-up after discharge. This next two-part series will examine why readmissions occur and what organizations can do to improve on them.

Guest speaker:

Tod Baker, BS

Principal

Operations and Quality

Vizient

Moderator:

Tomas Villanueva, DO, MBA, FACPE, SFHM

Principal

Clinical Operations and Quality

Vizient

Show Notes:

[01:11] Defining readmissions

[01:48] Issues resulting from readmissions

[02:17] Misaligned incentives and compartmentalization

[03:27] New energy for reducing readmissions

[04:46] Getting started

[05:49] Effective risk-stratification

[07:13] Impact of social issues

Links | Resources:

To contact Modern Practice: [email protected]

Tod Baker’s contact email: [email protected]

Designing and Delivering Whole-Person Transitional Care (AHRQ) Click here

Vizient’s Clinical Data Base (CDB) and readmissions Click here

CMS Hospital Readmissions Reduction Program Click here

Amy Boutwell, MD, MPP, presents six videos on Multi-visit Patients (MVPs) and readmissions Click here

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On this episode, we continue our discussion on mortality by addressing hospice and palliative approaches as a way to provide improved care for patients and improve hospital mortality scores.

Guest speaker:

Aman Sabharwal, MD, MHA, CPHM

Executive Principal

Operations and Quality

Vizient

Moderator:

Tomas Villanueva, DO, MBA, FACPE, SFHM

Principal

Clinical Operations and Quality

Vizient

Show Notes:

[00:35] Hesitancy in leveraging palliative and hospice care

[01:08] A success story with palliative care

[01:51] Vizient Clinical Data Base analytic can pinpoint use of palliative and hospice care in an organization

[02:22] The advanced directive process: everyone’s responsibility

[03:04] Surgeons and the medical record

[04:05] Triggering palliative care consults

[05:28] Patients discharged to hospice do not factor into hospital mortality index

[06:02] Mortality review – best practice

Links | Resources:

To contact Modern Practice: [email protected]

Aman Sabharwal’s contact email: [email protected]

Mortality Measures Hospital-Specific Reports (CMS) Click here

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

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

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

Guest speaker:

Aman Sabharwal, MD, MHA, CPHM

Executive Principal

Operations and Quality

Vizient

Moderator:

Tomas Villanueva, DO, MBA, FACPE, SFHM

Principal

Clinical Operations and Quality

Vizient

Show Notes:

[00:46] Role of documentation and coding

[01:52] Example from neurosurgery notes

[03:20] Gaming the system accusation

[04:12] Ignorance about coders and coding process

[05:10] Surgeons and the medical record

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

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

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

Links | Resources:

To contact Modern Practice: [email protected]

Aman Sabharwal’s contact email: [email protected]

Mortality Measures Hospital-Specific Reports (CMS) Click here

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

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

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

Guest speaker:

Aman Sabharwal, MD, MHA, CPHM

Executive Principal

Operations and Quality

Vizient

Moderator:

Tomas Villanueva, DO, MBA, FACPE, SFHM

Principal

Clinical Operations and Quality

Vizient

Show Notes:

[01:32] Importance of mortality scores

[02:50] Putting the pandemic aside

[03:09] Mortality weighs heavily in rankings

[04:08] Mortality scores and payers

[04:30] The O/E Ratio

[06:11] Four workstreams to address mortality

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

Links | Resources:

To contact Modern Practice: [email protected]

Aman Sabharwal’s contact email: [email protected]

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

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

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

Guest speaker:

Angela Hunt, RN, MBA, CCDS

Principal

Operations and Quality

Vizient

Moderator:

Tomas Villanueva, DO, MBA, FACPE, SFHM

Principal

Clinical Operations and Quality

Vizient

Show Notes:

[00:43] RAF scores defined

[01:22] Importance of RAF scores for reimbursement

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

[04:07] Risk adjusting patients

[06:07] Payment structures in commercial policies

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

[07:59] The future of HCCs and documentation

Links | Resources:

To contact Modern Practice: [email protected]

Angela Hunt’s contact email: [email protected]

Hierarchical Condition Categories Coding (AAFP) Click here

HCC Fact Sheet (Vizient) Click here

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