Hospital quality leaders will be left frustrated knowing that so much rides on quality measures that have been proven invalid, but more accurate measures are not coming any time soon. The best defense in the meantime is to optimize your hospital’s coding, says Bradford Winters, MD, PhD, associate professor of anesthesiology and critical care medicine at Johns Hopkins Medicine in Baltimore. He is lead author of a recent study that found only one of 21 quality measures reliably indicated a hospital’s patient safety profile.
“Try to improve your coding process, particularly with present-on-admission indicators. That seems to improve the accuracy of how one of these measures reflects your own hospital’s quality and safety,” Winters says. “Failing to pay close attention to present-on-admission coding can leave the hospital looking responsible for outcomes and adverse events that are not the hospital’s fault.”
Hospitals should make coders aware of how their coding influences reimbursement and public scores, emphasizing what an important part of the organization they are and why attention to detail is so important, Winters suggests. But clinicians also must be reminded that their documentation can make or break the coding process.
“Coders are not clinicians. They read the chart and try to determine based on what’s in the chart what ICD-9 — now ICD-10 — codes apply. If the doctors and nurses don’t do a good job of documenting whether something was present on admission, exactly what happened, and exactly what the complication was, the coders have to make an interpretation. The more information the clinicians provide, the better job the coders can do and hopefully you get more valid results with these measures.”
That advice is seconded by Thomas W. Feeley, MD, head of anesthesiology and critical care and head of the Institute for Cancer Care Innovation at the University of Texas MD Anderson Cancer Center in Houston.
“If your coding is really good and subject to appropriate screening, peer review — and I would suggest physician peer review — of the data being put out there to the public, then you might be in the position you can achieve while we rely on these measures,” Feeley says. “But if you’re a consumer trying to compare hospitals, how do you know if any one hospital is doing a good job of screening their data or not?”
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