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Star Ratings: Are they misleading patients?

With the recent release of the hospital star ratings from CMS, consumers need to understand that these ratings are not as accurate as they seem. As more and more aspects of the healthcare realm get rated and ranked, it is important to know what these numbers mean and if they are a true reflection of the care being delivered and that you want to receive.

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Accurate clinical documentation helps hospitals and patients measure quality of care

CMS released star ratings for thousands of hospitals around the U.S. in July, receiving mostly negative feedback. This feedback has come from everyone from industry stakeholders to care providers to members of Congress who believe the ratings aren’t fair. I’m supportive of the push for transparency, but I have to say I agree with them in regards to fairness.

I understand why CMS felt this was necessary. As the consumerization of healthcare continues to gain momentum, it makes perfect sense that people would want to know which hospital will give them the best care simply by looking at its rating, as they would when selecting a movie or restaurant. However, there is a big problem with treating your healthcare in that same way: boiling down quality to a star rating will not give you an accurate view of a hospital or health system, and there are a number of reasons why not.

 

You can’t measure performance if your data isn’t accurate

Having been a chief medical officer at five different healthcare organizations, I understand the pressures hospitals face to not only provide quality care but also achieve top rankings. I also know that the CMS star ratings, and others like them, are based on billing data. That’s a problem. Probably the biggest issue with these ratings is the fact that it assumes all of the hospital’s billing data is correct and that everyone is documenting the same way.

In fact, this data is often incorrect and incomplete due to a disconnect between clinical and billing speak. Physicians tend to document clinically, and while that may be crystal clear to another physician, this does not translate accurately to billing data. There can be miscommunications between which codes impact Diagnosis-Related Groups through ICD-10 and which do not. Physicians often times do not document with a billing-focused mindset, so things can be interpreted by coders in a different way than they were intended by the physician.

Every time I’ve implemented a Clinical Documentation Improvement (CDI) program, I’ve seen significant, positive change in quality metrics, such as perceived mortality. But the amazing part is that I didn’t do anything to change the care that was given – just the way it was documented. This goes to show that these ratings will, of course, be skewed if the data behind them is not accurate and complete.

 

Comparing apples to oranges

Averaging out quality across different areas is not a true reflection of care. What I mean is there are 64 measures of all different types. They paint different pictures. Certain hospitals could be exceptional at mortality and average in-patient experience, or vice versa. The rating system takes these two separate things, for example, lumps all the information together, and then averages it. The problem is that doing so negates individual things that are vitally important to the overall care a hospital provides, and that likely are very important to consumers when deciding where to go for care. Consumers may see a high rating, and assume that provider will deliver the best care, but they are being misled because they cannot know if the rating is high due to exceptional care or exceptional patient experience.

We all have different wants and expectations—for example, one patient may want a hospital that is exceptional at a certain type of surgery, but doesn’t mind if it is considered “average” for patient experience. Another patient may be looking more for an exceptional experience, and is comfortable with more of an average rating on the procedure they intend to receive. Today’s ratings don’t provide this level of detail and leave consumers thinking they have the answers without  a way to distinguish what kind of care they will receive at one hospital versus another.

 

Let’s do it right the first time

Make no mistake—this is a complicated situation. It is understandable that the government and the industry want to simplify things for consumers. We should start by capturing patient information correctly at the front end of documentation so physician notes paint an accurate picture of a patient’s needs including patient severity. For coders, having this clarity from the start decreases the number of variables they will have to worry about later and produces more accurate billing. Then the whole process improves. The earlier the information is correct and complete, the better it is for care and quality measures in the long run, and then comparing hospitals will be based on a level playing field.

The answer is not to leave consumers on their own. But star ratings and others like it have oversimplified things to the point where it’s not accurate. Thankfully, we live in a world today with different technologies that can easily and fully capture a patient’s story. If we can get the healthcare system aligned to understand how important this is, then eventually these star ratings could become more reflective of the truth.

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Nuance Healthcare’s Mission is to serve as the trusted strategic partner for healthcare organizations by delivering world-class clinical documentation solutions that optimize clinical and financial outcomes in the global shift to value based care. We are in a great position to drive that change by improving the physician experience and driving language and meaning back into the patient record. That is our purpose and we achieve it in tight partnership with our EMR partners and clients. Our people, our purpose is to support our clients’ mission of caring for patients, and we do that by impacting clinical documentation and driving quality and financial outcomes that are pivotal to their success. This “client-in” culture at Nuance Healthcare underlies all we do, make, sell and share, and it’s why we ended up in this week’s Healthcare Informatics HCI Top 100 issue as one of the “Most Interesting Vendors of 2015.” This is an honor we attribute to our clients who are striving to make healthcare better and improve the patient experience in partnership with us. This article features one of our clients, Dr. R. Hal Baker, senior vice president, clinical improvement and CIO of WellSpan Health, who shares how important language is to convey caring and context and certainty in healthcare. “Nuance helped us insert back into the patient record, spoken language, and from that language, technology can pull data and make it actionable rather than favoring the business side of healthcare over the clinical. We are making people feel cared for and safe. That is our mission. We are caring for people, not just caring for a business or disease,” says Baker. What drives our healthcare teams is our commitment to helping hospitals, clinics, radiology centers, physician practices, and large organizations deliver high quality care to their communities. By bringing revolutionary technology and clinical solutions to the forefront, we keep them from buckling under the demands for data. These innovations enable physicians to practice the art of medicine, focus on patients, and avoid the distraction of documentation, computer screens or billing codes. That’s getting much harder for them to do. Beyond speech recognition, we leverage clinical language understanding (CLU) and AI to bring decisions and information to the forefront and drive insights and meaning into the hands of physicians, helping them efficiently engage patients and other physicians. For patients this means that rather than looking at the doctor’s back during a visit, you look at his/her eyes, and you feel that personal touch when dealing with an already intense situation. We at Nuance Healthcare envision a day when the doctor and patient are engaged in a very compassionate conversation, and technology and solutions assist in the background completely capturing the interaction in a note, and communicating it properly in different ways, all while the doctor stays focused on the patient. Gone are the days where we just captured information and put it in resting place. Now with technology and cognitive computing and AI, we are able to improve clinical notes, annotate them, and leverage virtual assistants — all with the intent of improving the quality and efficiency of the physician note to help both the clinical and financial side of healthcare. We pride ourselves in driving better quality of documentation and better clinical and financial outcomes. As Dr. Baker so articulately shared, Nuance supports healthcare as a business, medicine as a science and healing as an art. It is an honor for Nuance to be named the Most Interesting Vendor of 2015. As a company, we will continue our relentless pursuit of reinventing the clinician experience to allow them to spend more time with patients.
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CSpeak- Anywhere-mhealth
mHealth app spotlight: CSpeak Anywhere
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How mobile access to medical images saved a baby’s life
Medical teams are relying on clinical image exchanges to provide quality care, quicker
history-of-medical-imaging-technology
From glass plates to the cloud: Celebrating International Day of Radiology 2014
100+ years of evolution for medical imaging technology
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Does healthcare quality matter more today?
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patient-care
Putting patients back at the centre of care
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PrognoCIS mhealth app
mHealth app spotlight: PrognoCIS
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What one of the world’s funniest men can teach us about depression
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Three essential components for structuring ICD-10 education plans for the upcoming year
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Physicians don’t act on business motives, they act on patient care motives
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