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Top 12 Healthcare Quality Concerns in 2012

Cheryl Clark, for HealthLeaders Media, January 4, 2012

8. ICD-10

Our list would not be complete without a tip of the hat to ICD-10 adoption efforts, scheduled to go into high gear later this year in anticipation of the Oct. 1, 2013 date for the big switch.

Quality and chief information officers say this effort is monopolizing large chunks of their workday, even as the costs for installing and understanding the system make everyone nervous.

Down the line, however, ICD-10 data will gather power with volume datasets and enable providers to capture much more precise information on patients' conditions and procedures.  It will be tougher for hospitals to lump patients into more severe categories, a current practice that may enable higher reimbursement, will more quickly identify fraud, waste and abuse in healthcare and will enable better hospital and physician quality comparisons.

9. Emergency department speed, accuracy

Much of what happens to patients in hospital settings happens to them first in the ED.  So it matters a lot how long they have to wait to be seen, how long it takes to correctly diagnose them with labwork, imaging or other functional tests, and how long it takes to process the paperwork, get them in an inpatient bed and provide whatever medications or procedures they need.

But until very recently, there have been very few ways in which ED quality has been formally measured, other than in time to antibiotic for a pneumonia patient, or door to balloon for heart attack patients.

That is about to dramatically change.  In the next year, the Centers for Medicare and Medicaid Services will require hospitals to begin tracking and reporting their median times for two National Quality Forum benchmarks in emergency care.

1. The number of minutes between the "door," the time the patient arrives at the ED to the moment they "depart" the premises of the ED to be admitted to the hospital

2. The time between the moment a decision is made by the ED physician to admit the patient to a hospital bed to the time the patient departs the ED and is actually placed in an inpatient bed, a period sometimes referred to as "boarding."

Look for these results to become publicly reported on Hospital Compare. For now, CMS has not said it will impose a payment adjustment or penalty for slower hospitals, but that may come with future Outpatient Prospective Payment System rules, perhaps the one released for 2013.

Along the way, hospital emergency room providers, including physicians and nurses, are gathering consensus over terminology, so that everyone means the same thing when a patient is said to come in the "door."

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