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Top Healthcare Buzzwords for 2014, Part 2

 |  By cclark@healthleadersmedia.com  
   January 03, 2014

Do you know your PROs from your CACs? Big changes in healthcare mean big changes in the way providers and payers talk. This guide helps sort things out.


Harlan Krumholz, MD

The language of change is getting to sound familiar, but precisely what all the new terms mean is not exactly clear. Since these words and phrases will be more widespread in the coming year, it's helpful to get some clarity. The first seven are covered in Part 1. Here's Part 2:

8. The Hospitalization Toxic
You've heard the expression, "the treatment was successful, but the patient died," right? Yale-New Haven Hospital's Center for Outcomes Research and Evaluation director Harlan Krumholz, MD, has noticed the worrisome "Post-Hospital Syndrome" phenomenon, which he described last January in the New England Journal of Medicine.


See Also: Top Healthcare Buzzwords for 2014, Part 1


After patients are appropriately treated for their condition and discharged, they "have heightened risks of myriad conditions, many of which appear to have little in common with the initial diagnosis," he believes.

Krumholz refers to this as "the hospitalization toxic," a combination of new metabolic disorders, pneumonia, gastrointestinal maladies, mental illness, and other problems that often bring the patient back to the hospital within 30 days.

He postulates that sleep deprivation, multiple medications, inactivity, and monotonous hospital surroundings, especially in the intensive care unit, may be contributing factors.

Associated words to describe this sequence include "deliriogenic" and "SICU psychosis."

9. PROs or Functional Outcomes
From language in the SGR repeal proposal to Meaningful Use quality measures, the idea that provider payment should depend on a "PRO," or patients' reported outcome, is gaining momentum at a dizzying pace.

An example of a PRO is how soon and how far a patient can walk after hip replacement surgery.

Bill Kramer, Executive Director for National Health Policy for the Pacific Business Group on Health and a member of the National Quality Forum, says such measures are already being used by systems such as Dartmouth-Hitchcock health system. They present opportunities for performance improvement and treatment effectiveness comparisons.

10. CACs, CECs, In-Person Assisters, and Navigators
Certified Application (or Enrollment) Counselors, In-person Assisters, and Navigators are specified under health insurance exchange regulations to help patients make appropriate choices when purchasing plans through federally facilitated and state exchange marketplaces.

Some may be hospital employees; some may be volunteers. All presumably receive training and undergo assurance testing to guard protected health information. Many are financed through a variety of federal, state and private grant programs.

11. Coding Migration
By Oct. 1, all HIPAA covered entities will be expected to change all codes used to report medical diagnoses and inpatient procedures from ICD-9 to ICD-10, provoking a "coding migration," with all expected pitfalls, glitches and eventually, fixes.

This expensive transition is requiring massive amounts of training, losses of productivity for a time, and a lot of patience.

After ICD-10 is implemented, diagnoses specificity will be much more exact and codes will identify procedures and conditions that didn't exist when ICD-9 began in 1979.

Public health tracking will be more efficient, fraud may be reduced, and identification of unsafe products will mean they can more quickly be removed from the marketplace.

12. Moral Hazard
Used mainly in economics, this term applies to a situation in which a person is more likely to take a risk because he or she won't be affected by the costs of a negative consequence. The phrase is now being applied to healthcare in a variety of ways, one of which refers to people with health issues or a risky lifestyle who choose not to buy health coverage because the individual mandate penalty they'd pay through taxes the following year is less than their premiums.

If they eventually need expensive healthcare, society and providers along with government funding borne by society, will bear that cost.

13. Second Victim
Just as a patient and family members suffer from a medical error, the healthcare provider who makes that mistake is a second victim, often riddled with destabilizing shame, perhaps ridicule from co-workers, and an impaired ability to remain effective.

Soon we'll have guidance from the Joint Commission on the need for hospitals to create appropriate guidelines and rapid response systems for healthcare providers involved in adverse events and the training and certification those programs should have to appropriately intervene.

Second victim advocate and Johns Hopkins research center director Albert Wu, MD, says that the creation of more understanding healthcare environments can encourage personnel involved in such incidents to report medical hazards. Doing so not only minimizes their own suffering, but helps assure those same errors don't happen again.

14. Narrow Networks
These are also called "high-value provider networks" by members of the health insurance industry. This is a phenomenon by which patients enrolled in the health insurance exchanges discover they may only be covered for certain services through a limited group of physicians and hospitals, often excluding more expensive academic medical centers.

See Part 1 here.

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