Big changes in healthcare mean big changes in the way providers and payers talk. Many terms being bandied about don't have clear or solid meanings, but this guide helps sort things out.
This is the year the Patient Protection and Affordable Care Act will get into full swing. Healthcare providers are already creating their own jargon to convey some of the complex concepts behind the law.
Some of it is starting to sound familiar, but what it all means is not exactly clear.
To get ready for 2014's buzzwords, here's Part 1 of list of PPACA argot, insider idioms, and provider patois that just might help get you through the year.
See Also: Top Healthcare Buzzwords for 2014, Part 2
1. High Outliers
Some 158 "high outlier" hospitals were singled out by the Office of Inspector General in a November report because on average, $1 out of every $8 they received from Medicare came in the form of outlier payments. For 13 of these hospitals, outlier payments amounted to more than $1 in $5, because the hospital received charges rather than what Medicare typically pays for a patient with that diagnosis.
The report said the disparity "raises concerns about why charges for similar patient-care cases vary substantially across hospitals," and called for "increased scrutiny" from the Centers for Medicare & Medicaid Services. CMS agreed.
2. MSPB
"MSPB" or Medicare Spending Per Beneficiary sounds obtuse, but it translates to money for your hospital. It is a ratio indicating how much any one facility's Medicare beneficiaries cost the government over a span of time from three days before admission to 30 days post discharge. Unfair, some industry groups complain. How can they control what services patients receive outside their walls?
CMS disagrees. On authority of the PPACA, the agency gave this measure a 20% weight in the equation determining whether hospitals receive incentive payments under value-based purchasing starting this Oct. 1. The formula is designed to make sure hospitals monitor and guide their physicians to not duplicate expensive imaging tests and to move patients to home care rather than skilled nursing care when appropriate.
3. Flipping Healthcare
Healthcare should be flipped, that is, delivered in a way that's convenient for patients, not their providers, says Institute for Healthcare Improvement president and CEO Maureen Bisognano, who used the phrase in her National Forum keynote last month.
The idea, borrowed from education ( "flipping the classroom,") is that healthcare should be provided in a way that meets what the patient wants, and providers should be allowed to teach caregivers what they need and that caregivers should listen.
That could mean providing care to the patient in the home, for example getting the patient a new chair that reduces risk of injury, rather than treating the consequences of injury.
"We need to flip from focusing on the medical condition to focusing on the patient," Bisognano says.
4. Financial Harm
Patient harm is usually considered a medical intervention that hurts the patient, such as administering a contraindicated medicine. But with medical debt now the biggest reason for bankruptcies, some doctors admonish their colleagues to look out for healthcare that may cause "financial harm" and stress to the patient.
Providers should appreciate financial harm as a real quality and safety issue, and screen for this with the same fervor with which they try to prevent central line infections, these physicians argue.
Writing in JAMA, hospitalists Christopher Moriates and Vineet Arora, and OB/GYN Neel Shah all involved with the Costs of Care project to reduce unnecessary healthcare spending, also say providers should take responsibility for knowing how much certain services actually cost.
"In my view, financial harm is a real form of harm," Shah says.
5. Billing Optimization
Also known as "documentation improvement" or "documentation integrity."
In the last month, we've heard numerous physicians and hospital executives talk about the push from their accounting departments to document—legally of course—complex comorbidities that will generate a more lucrative reimbursement. This is especially important with declining revenue from loss of incentive payments and disproportionate share funding, readmission penalties, and upcoming financial cuts for hospitals with rates of higher hospital-acquired conditions.
Better documentation also may impact risk adjustment equations that may help a hospital's score on certain public reports, reflecting that their patients are indeed sicker than their competitors' patients.
6. Servant Leader
Robert Wachter, MD, chief of both medical service at UCSF Medical Center and of the Division of Hospital Medicine, says that while the phrase "servant leader" is not that new, it is the latest catch phrase heard within the C-suite. "It describes a leader who is there to serve the employees and the company, rather than be a larger-than-life, Lee Iacocca type," he says.
References around the Web suggest such a person is an executive who provides his or her teams with the resources they need, from staffing to sophisticated electronic health record systems, to support through respect and recognition.
7. Choosing Wisely
Imagine each physician specialty and primary care society comes up with a list of five procedures or tests that their own members should avoid, and discourage if their patients request them. Keep in mind these services would have produced revenue and may have been performed under the assumption that more care is better care, however marginally beneficial.
That's exactly what the American Board of Internal Medicine Foundation has accomplished with its Choosing Wisely campaign, which ABIM officials say is "revolutionizing" healthcare. The initiative seeks to inform providers and patients on evidence based practice in an effort to avoid harm, needless interventions and waste, and reduce cost.
The effort began in 2011 and 2012 with nine practice organizations, but took off in 2013 with some 46 primary and specialty societies putting in their lists of five or more procedures, and more expected in 2014.
Tomorrow: Part 2