Tips for Ensuring Quality Encounter Data Submission in Medicaid Managed Care Programs
One area of data management within the healthcare industry that is getting new emphasis and interest from regulators is a focus on encounter data. Today, the majority of Americans receiving healthcare services funded through the Medicaid program are enrolled in some form of managed care. Under this scheme, states contract with MCOs that take on … Tips for Ensuring Quality Encounter Data Submission in Medicaid Managed Care Programs
Episodes of Care – Appendicitis
Evaluating the relationship between episode of care and length of stay in Appendicitis: In previous posts we have discussed some of the ways episodes of care can be used to compare two different networks and underlying practice patterns. We’d like to dive further on this thread and look at how episodes of care can be … Episodes of Care – Appendicitis
Ambulatory Care – Measuring Quality and the Impact of Nursing
The shift of medical care from the inpatient to outpatient setting coupled with the emphasis on transformative designed patient-centered medical home models provides measurement challenges and opportunities. The challenges are how to effectively measure quality in this setting given the range of services that are provided—from routine preventive care to complex surgical and invasive procedures. … Ambulatory Care – Measuring Quality and the Impact of Nursing
Admissions from the ED
The New York Times recently reported on allegations that a hospital chain was unnecessarily admitting patients from the emergency department (ED) to increase revenues from Medicare and Medicaid[1]. According to the article, one hospital was accused of maintaining a scorecard to keep track of physicians who did not meet a target of admitting at least … Admissions from the ED
Medicaid Population Management
In previous blogs, we’ve discussed Population Management concepts and given specific examples of pediatrics, ACO, and clinical populations. In this blog we turn to the Medicaid population. Medicaid has unique characteristics because of the nature of the financing and because of the social demographics of the population served. This population is going through big changes … Medicaid Population Management
Eliminating Waste in the Healthcare System
Healthcare spending in the United States far exceeds that in other developed countries and the American health care system is widely recognized as wasteful. The Congressional Budget Office has concluded that up to 30 percent of the healthcare in the U.S. is unnecessary. Such estimates of waste are generally based on aggregate data such as … Eliminating Waste in the Healthcare System
