The series begins today on Talk Ten Tuesday with ChristianaCare.
The Agency for Healthcare Research and Quality (AHRQ) is the lead federal agency under the U.S. Department of Health and Human Services (HHS) with the mission to produce evidence to make healthcare safer, of higher quality, and more accessible, equitable, and affordable.
Some iteration of quality indicators has been in place since 2000. AHRQ has resources and toolkits available to assist organizations in improving the care they offer to their patients.
ICD10monitor and Talk Ten Tuesdays is excited to introduce a new series aimed at assisting institutions in understanding and managing their Patient Safety Indicators (PSIs). PSIs address potentially avoidable safety events related to in-hospital occurrences. Many are related to procedures, including childbirth.
A Talk Ten Tuesdays listener recently approached me and asked if I had advice on PSI 04: Death Rate among Surgical Inpatients with Serious Treatable Complications. I had to confess that I had never really looked into this particular PSI, nor had I had occasion to address it when I was a physician advisor. So, I reached out to my LinkedIn connections, and Dr. Varadarajan (Raj) Subbiah, vice president of Utilization Management and Quality of ChristianaCare, contacted me. His organization had turned its attention to this metric and markedly improved its ranking, and they were willing to share their experience and expertise on PSI 04 – and other PSIs as well.
I am going to remind you all that there are two ways that PSIs (and any quality metrics in general) can be improved. The first is improving clinical care. If your organization has too many wound infections, the answer isn’t to manipulate the denominator of the observed-to-expected ratio; it is to have the providers wash their hands more thoroughly! The numerator (i.e., observed) is dependent on the actual care provided.
The second way PSIs improve is denominator management (i.e., expected), which requires organizations to ensure that all exclusions are being captured, that documentation is optimized, and that attention is focused on the entire population.
In my conversations with the knowledgeable staff at ChristianaCare, I discovered something very interesting regarding the aforementioned PSI 04. The related conditions are shock/cardiac arrest, sepsis, pneumonia, gastrointestinal hemorrhage/acute ulcer, and deep vein thrombosis/pulmonary embolism. Our experts will explain the stratification and how they attacked the denominator population.
My observation was that an issue with PSI 04 can be an unintended consequence of squeezing the balloon. This is an analogy that my friend Dr. Dick Gregg taught me. When you attend to individual metrics in healthcare, it can be like squeezing a balloon. An issue with CDI (clinical documentation integrity) can make the balloon bulge out. If you squeeze the balloon in that area (like with a query), that section may be pressed back into alignment, but on the opposite side, a different region, say, quality can pop out. You push that in, and, voilà, over there, compliance gets knocked out of position.
Institutions that still cling to the definitions of Sepsis-2 and SIRS (systemic inflammatory response syndrome)may overcall sepsis. This may increase their case mix index (CMI), but it may also threaten PSI 04, because sepsis is one of the conditions that jeopardize a surgical patient, triggering PSI 04. Similarly, if a surgical patient has atelectasis, and CDI queries for an uncertain diagnosis of pneumonia, they may find themselves with a major comorbid condition or complication (MCC), and another encounter with PSI 04.
I am looking forward to ChristianaCare sharing with us how their multidisciplinary approach improved their patient safety, which was reflected in their data. They plan to touch on PSIs 03, 04, 11, 12, and 13, and composite measure PSI 90. We hope you will find this series educational and actionable.
Programming note: Listen to live reports on the new PSI series beginning today on Talk Ten Tuesdays and continuing Nov. 1, 15, and 22.
EDITOR’S NOTE: Dr. Erica Remer was, for nearly seven years, the cohost with Chuck Buck on Talk Ten Tuesday and a member of the ICD10monitor
Hanlon’s Razor, a principle often summarized as “never attribute to malice that which can be adequately explained by incompetence,” offers a refreshing perspective for tackling
Please log in to your account to comment on this article.
Prepare your organization for the 2025 OPPS updates with expert insights from Tiffani Bouchard, CCS, CRCR, a Revenue Integrity Professional with over 30 years of experience. This webcast will address critical challenges in charge capture and coding, providing clarity on APC policies, C-APC packaging, exclusions, and payer-specific requirements. Attendees will learn actionable strategies to ensure compliance, optimize reimbursement, and mitigate risks of claim denials. Gain the knowledge needed to implement updates effectively, educate your team, and maintain seamless revenue cycle operations in the face of evolving OPPS complexities.
Join Beth Wolf, MD, CPC, CCDS, for an in-depth webcast on the FY2025 spinal fusion MS-DRG updates. Discover key changes in DRG classification, understand impacts on documentation and CMI, and learn strategies to ensure compliance.
Join Angela Comfort, DBA, MBA, RHIA, CDIP, CCS, CCS-P, as she presents effective strategies to strengthen collaboration between CDI, coding, and quality departments in acute care hospitals. Angela will also share guidance on implementing cross-departmental meetings, using shared KPIs, and engaging leadership to foster a culture of collaboration. Attendees will gain actionable tools to optimize documentation accuracy, elevate quality metrics, and drive a unified approach to healthcare goals, ultimately enhancing both patient outcomes and organizational performance.
Optimize your outpatient clinical documentation and gain comprehensive knowledge from foundational practices to advanced technologies, ensuring improved patient care and organizational and financial success. This webcast bundle provides a holistic approach to outpatient CDI, empowering you to implement best practices from the ground up and leverage advanced strategies for superior results. You will gain actionable insights to improve documentation quality, patient care, compliance, and financial outcomes.
The 2025 Medicare Physician Fee Schedule brings significant changes to payment rates, coverage, and coding for physician services, impacting practices nationwide. Join Stanley Nachimson, MS., as he provides a comprehensive guide to understanding these updates, offering actionable insights on new Medicare-covered services, revised coding rules, and payment policies effective January 1. Learn how to adapt your practices to maintain compliance, maximize reimbursement, and plan for revenue in 2025. Whether you’re a physician, coder, or financial staff member, this session equips you with the tools to navigate Medicare’s evolving requirements confidently and efficiently.
Dr. Ronald Hirsch provides critical details on the new Medicare Appeal Process for Status Changes for patients whose status changes during their hospital stay. He also delves into other scenarios of hospital patients receiving custodial care or medically unnecessary services where patient notifications may be needed along with the processes necessary to ensure compliance with state and federal guidance.
Healthcare organizations face complex regulatory requirements under the No Surprises Act and Price Transparency rules. These policies mandate extensive fee disclosures across settings, and confusion is widespread—many hospitals remain unaware they must post every contracted rate. Non-compliance could lead to costly penalties, financial loss, and legal risks. Join David M. Glaser Esq. as he shows you how to navigate these regulations effectively.
Protect your facility from unwanted audits! Join Becky Jacobsen, BSN, RN, MBS, CCS-P, CPC, CPEDC, CBCS, CEMC, and take a deep dive into both the CMS and AMA guidelines for reporting post operative pain blocks. You’ll learn how to determine if the nerve block is separately codable with real life examples for better understanding. Becky will also cover how to evaluate whether documentation supports medical necessity, offer recommendations for stronger documentation practices, and provide guidance on educating providers about documentation requirements. She’ll include a discussion of appropriate modifier and diagnosis coding assignment so that you can be confident that your billing of post operative pain blocks is fully supported and compliant.
Copyright © 2025 ICD10monitor. Powered by MedLearn Media.
Prepare for the 2025 CMS IPPS Final Rule with ICD10monitor’s IPPSPalooza! Click HERE to learn more
Get 15% OFF on all educational webcasts at ICD10monitor with code JULYFOURTH24 until July 4, 2024—start learning today!
CYBER WEEK IS HERE! Don’t miss your chance to get 20% off now until Dec. 2 with code CYBER24
