old town conference oct 2009
TRANSCRIPT
Old town/New world
The Internetand
Our Community
Healthcare
Vocabulary
• Personal Health Record: controlled by the patient
• Electronic Medical Record: controlled by the provider
• Electronic Health Record: shared, comprehensive, secure
DHEC
FenwayPark
Urgent CareCenter
Medicare
Blue Cross
Aetna
CVS
DiagnosticCenter
Doctor’sOffice
HospitalA
Walgreen’s
HospitalB
OpenSource
Where does the information come
from?
Where Does the Information Come From?
1.Chart Abstraction
Where does the OLD Information come from?
2. Billing Data, aka Administrative
Data
International Classification of Disease 9th Edition (ICD-9)
13,000 Diagnosis Codes
3,000 Procedure Codes
16,000 ICD-9 Codes
Medicare Severity Diagnosis Related
Groups
MS-DRG’s 538 Diagnosis-Related Groups
Calculating Severity of Ilnessand
Risk of Death
• Select 335 “Core” DRG’s
• Based on the Principal and Secondary ICD-9 Diagnostic Codes, age, and gender, assign patient to one of four severity levels within his or her DRG
• 4 x 335 = 1340 Distinct Risk Populations
Assign Severity/Risk to Each of the Resulting 1340 Categories, Based on the Actual Mortality and Complication Rates of Several Million Previous
Patients
1 2 3 4
765 766
1340
The Lake Woebegone Phenomenon
“All of my patients are sicker than average.”
Apples to Apples
• The mortality or complication rate in each box is the “expected” rate
• Categorize all the patients of a hospital, medical group, or individual physician into one of the 1340 boxes and record the “observed” mortality or complication rate
• Compare the “observed” to the “expected” rate…a ratio of less than one is better than “expected”
ICD-10 is Coming (2013)
• 68,000 Diagnosis Codes
(v. 13,000 ICD-9)
• 72,000 Procedure Codes
(v. 3,000 ICD-9)
• Specifically created to support quality and outcomes analysis, including “value-based purchasing” and “pay for performance”