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”