The Healthcare Cost and Utilization Project also called “H-CUP” is the largest health care database system and related software tools that is develop through the Federal-State partnership. HCUP is sponsored by the Agency for Healthcare Research and Quality which the lead Federal agency that is charge with the responsibility of improving the safety and quality of America’s Healthcare system. HCUP gathers data from all levels of healthcare facilities, State data organization, hospital associations, private data organization, and the Federal government to create a national information resource for encounter level healthcare data. ("HCUP-US, 2016".) HCUP has the largest collection of hospital care data in the United States, today, dating back …show more content…
HCUP provides reliable comprehensive information for hospital, clinics and research organization (HCUP, 2015). These facilities can use the data that HCUP have collected to answer question they have about the use of healthcare, access, outcomes, and the cost that is related the hospital inpatient stay, emergency department visit and ambulatory surgery and services. They are several reports that HCUP produce to help aid the medical facilities. The HCUP statistical briefs reports is a short report that focuses on topics associated to hospital use and cost for specific conditions or populations (HCUP, 2015). For example it reports medical condition treated and procedures performed in the hospital, and quality of care. The projection report uses longitudinal HCUP data to project national and regional estimates on healthcare priorities (HCUP, 2015). “HCUP methods series reports address methodological issues regarding use of HCUP databases, software tools and supplemental files” (HCUP, …show more content…
It’s a software tool used in many different projects to analyze data on diagnoses and procedures performed in the hospital. CCS is used to identify population for diseases and develop statistical reports for procedures specific studies. As a tool for exploring data it can be very useful in categorizing conditions for reporting statistical information on hospitalization.
The Clinical Classification Software for Services and Procedures was developed by the American Medical Association for coding services it was designed to provide a method for classifying current procedural terminology codes and for Healthcare Common Procedure Coding System (HCPCS). CPT/HCPS have over 9,000 codes and 6,000 of those codes are HCPS codes that are collapsed into 244 clinically meaningful categories that may useful when presenting descriptive statistics ("HCUP-US Tools and Software Page CCS-Services and Procedures," n.d.).
The Clinical Classification Software for Mortality reporting reports illnesses and conditions into 260 mutually categories ("HCUP-US Tools and Software Page CCS-Services and Procedures," n.d.). CCS mortality reports can identify populations for disease-specific studies and to better understand the distribution of conditions across disease
While the data was collected by identifying patients with the highest medical costs, lowering medical costs was never Brenner’s goal; “he was more interested in helping people who received bad health care” (Gawande, 2011). Although a clearly defined list of action steps is not outlined in the literature (Gawande, 2011; “Jeffrey C. Brenner,” 2013; Robert Wood Johnson Foundation, 2014) Brenner clearly began by using his funds to hire a staff and increase his pool of data, identified the most vulnerable patients by health care cost and emergency room and hospital visit frequency, met with the most vulnerable patients, acquired information about all of the factors affecting the patient’s health through forming relationships, and then based on the client’s needs, utilized a custom case plan to improve the delivery of health care services to the patient (Gawande, 2011; “Jeffrey C. Brenner,” 2013; Robert Wood Johnson Foundation,
The purpose of financial measurement in healthcare is to provide the community with the services it needs, at a clinically acceptable level of quality, at a publicly responsive level of amenity, at the least possible cost. This is done by providing healthcare finance managers with accounting and finance information to help accomplish the purpose of the organization (Nowicki, 2015). When making accounting decisions about budgeting and inventory control, an understanding of economics, statistics, and operations research is needed. Major Financial Measures
As a certified medical coder (CCA 11/2012), I have contributed to the HIMS department by helping code inpatient encounters from patients in the Residential Rehab Unit as well as outpatient encounters from the other clinics at this VA applying the official coding conventions outlined in the International Classification of Diseases 9th revision handbook as well as in the VHA’s Official Coding Guidelines, V11.0 dated August 10, 2011. Having coded many encounters over the past 3 years, I can easily determine the main condition after study that is chiefly responsible for a patient’s admission to the hospital. ICD-9-CM defines this as the primary diagnosis code and I find that it is most important to list this code first in your documentation
Regulate the clinical data by enforcing stringent data management practices and mitigate the deviation in data collection and recording. The study protocol will define the source of data collection with Case Report Forms (CRFs), method of storage paper/ electronic and information retained for data archiving. Each subject will be identified with unique ID and Subject Identification Log will be maintained separately from trail analysis documents. The DMS prevents unblinding of specific documents, which protect the privacy and confidentiality of the subject, unless required by the study protocol. Identifiable documents and records will be maintained in accordance with the data retention period as specified in the protocol and the requirement of the regulations and IRB. Any update or changes implemented will be recorded in the revision history of the respective documents. The clinical trial team will be trained on clinical documentation and
On account of theses limits other tools that are more efficient, objective and accurate are necessary to enhance acute hospital care. The National Institute for Health and Clinical Excellence (NICE 2007) have highlighted the importance of a systemic approach and advocated the use of EWS to efficiently identify and response to pa...
data matching - using available sources including the AMA and CMS, Community First compares procedures, treatments and other billed services for reasonableness; and
E31.25, S. (2012). ASTM E2369-12 Standard Specification for Continuity of Care Record (CCR). ASTM Internation, http://www.astm.org/Standards/E2369.htm.
This led to the development of a new method that takes into account anything that affects the cost of delivering patient helathcare services. This includes what is called a case mix which is an interrelated set of patient attributes such as the severity of illness, risk of mortality, prognosis, treatment difficulty, need for intervention, and resource intensity. This helped also with the development of the APR DRG system which is a clinical model with four severity of illness and risk of mortality subclasses for each base APR DRG. These subclasses are broken down into four levels to include minor, moderate, major, and extreme. APR DRGs were used by hospitals for internal quality improvement and by many states for public reporting. Severity of illness describes the extent of the physiologic decompensation or organ system loss of function. The risk of mortality indicates the patient’s likelihood of dying. The systems are differentiated by trajectory of development, clinical logic, severity classification structure, and level of complexity. There were other severity adjusted systems within this system. Implemented with discharges on or after October 1, 2007, The Medicare Severity DRGs (MS-DRGs), was adopted for use with Medicare’s Inpatient Prospective
The purpose of stage 1 is to capture the health data in a coded format. Stage 2 applies data to patient care and further the exchange of information between providers and other healthcare entities. The stage 3 known as exact measures are still in the opening stages will focus on Clinical Decision Support (CDS) application during point of care to improve the healthcare results and equip patients with self management tools.
The Office of the National Coordinator for Health Information Technology (ONC) and CMS have adapted SNOMED CT as a medical terminology for Meaningful Use Stage 2, Electronic Health Record (HER) system, and health information exchange (HIE). SNOMED CT offers the clinical detail and terminological sophistication necessary for more effective use of clinical data to support timely, effective, and high-quality care. For example, SNOMED CT is an efficient documentation system that is highly recommended towards patient’s history and clinical procedures. When the ICD-10 CM was implemented, it impacted everyone who used it for diagnosis or inpatient procedure codes. In addition, SNOMED CT is not the only terminology that is used for healthcare needs, but RxNorm and LOINC are also
According to Castro (2013), initially there were 23 MDCs which represented the body system as well as a group for DRGs that corresponded with all of the MDCs and pre-MDC, for example disease and disorders of the digestive system (p.128). In an updated version of the DRG system the Human Immunodeficiency Virus Infections and Multiple Significant Trauma categories were added. The next part of the MDC group is divided into two groups known as medical and surgical (p. 128). The final level divides the DRGs into surgical and medical in the 25 MDC groups, for example, surgical procedures that were performed on the patients and medical diagnosis for when the patient was admitted (p.128). The title, geometric length of stay, arithmetic mean length of stay, relative weight, and ICD-10-CM code range that drive the DRG assignment are the component of each DRG version (Evolution of DRGs (2010 update), 2010). The principal diagnosis, surgical procedures, or diagnosis procedure combinations are to be included in the code range (p.128). The DRG system has been beneficial to healthcare facilities, but in 2008, the Centers for Medicare and Medicaid (CMS) introduced a new system called the Medicare Severity Diagnosis Related Groups
Clinical Documentation Improvement ensures that their health care system provides the accurate recording of medical records. The health information management industry (HIM) thrives over the improvements towards clinical documentation as medical assistance validates healthcare and optimizes their medical processing system. Clinical documentation specialist (CDS) is essential in order to alter the medical landscape in a positive measure as they provide detailed documentation and medical coding. Documentation requirements for Health Information Management (HIM) professionals intend on making the healthcare data obtainable from the additional diagnoses, which will require an enhancement of the documentation system. Thus, the ICD-10 is a new tool
There are many challenges when it comes to our health care system that define the future strategic direction. The one chosen for this paper are reform and legislation, information technology advancements such as the electronic medical record (EMR)/ electronic health record (EHR), access to health care including the uninsured and those in the poverty levels, maintaining a skilled workforce and Pay for performance. These challenges pose threats to our health care system planning for the future.
A standardize language and framework in healthcare is necessary to communicate efficiently with other organizations around the world. Reference terminologies and coding systems are proper solutions to avoid any miscommunications and to have a standardize classification system. Complex healthcare services such as billing and payments, quality assurance, research and public health reporting that contain health information must be capable of delivering a cost-effective and safer results. This can be obtained by adapting an appropriate up to date medical coding classification system based on the purpose and the service provided by each clinical facility. In order to deliver critical information needs of a healthcare organization, adapting and maintaining
The HCPCS is a classification system required by the Centers for Medicare and Medicaid (CMS). The use of the codes ensure that claims are processed in a consistent manner. The code set has two active levels, as well as an obsolete third level. The first level consists entirely of the CPT code set developed by the American Medical Association. The second level is for non-physician services, such as ambulance services and prosthetic devices. A third level had been active prior to 2003 for use by non-CMS entities, but is no longer in use.