Hospital Business Acumen-10 Healthcare Terms You Should Know! Part 2

This is part 2 of our blog on understanding the vast array of new healthcare terms, acronyms and abbreviations that are being introduced and bantered around. If you missed Part 1 click here and the link will take you to the article.

We hope that these definitions and explanations reduce your anxiety and increase your knowledge base. In italics are the reasons why each term, acronym and abbreviation is important.

6. Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS)

HCAHPS started because the Agency for Healthcare Research (AHRQ) was asked by the Centers of Medicare and Medicaid Services (CMS) in 2002 to develop a standardized survey instrument and data collection methodology. The goal was to measure patient perception of care that complemented rather than competed with quality improvement instruments already in place.

All hospitals except specialty hospitals that report clincial data to CMS are eligible to participate in HCAHPS. For a hospital to have their data reported publically they must have a minimum of 300 completed surveys every 12 months. Since 2007 most hospitals have been required to submit HCAHPS results in order to receive full Medicare payment.

Why are HCAHPS significant?

  • It standardized the survey process so hospitals can see how they compare to others through the “lens” of the patient.
  • Public reporting of the data encourages hospitals to continuously improve their scores by providing better care.
  • The results are tied to quality and clinical outcomes. For example there are specific questions about pain management, medications, cleanliness, etc. This allows hospitals to target specific areas for improvement.
  • Public reporting provides transparency to the quality of care being delivered so that patients have objective and meaningful criteria on which to base their decision to use one hospital over another.

While there is currently no penalty for negative HCAHPS results most insiders believe that HCAHPS will transition from a pay-for-reporting to HCAHPS pay-for-performance.

7. Telemedicine –mHealth & Telehealth

The American Telemedicine Association defines Telemedicine as “the use of medical information exchanged from one site to another via electronic communications to improve a patients’ clinical health status.” In essence it’s the use of telecommunications by physicians and medical institutions to provide health care to their patients through electronic or digital means.

There are three primary types of telemedicine:

  • Store & Forward: These are healthcare services that can be done offline without the provider or the patient being available simultaneously. They are for non-emergency situations such as distribution of X-Rays, scans, reports etc.
  • Remote Monitoring: This is a facility that actively monitors patients from a remote location.
  • Two-Way Real Time: This is the ability to provide consultation, diagnosis or treatment via videoconferencing or the transmission of videos or images over the internet.

Another term that is often bantered about is mHealth, a process that is often used as a descriptor for everything from mobile computing to video conferencing and remote monitoring. Others refer to it only in the world of mobile health apps.

To add further confusion Telehealth is another term that is widely used throughout the industry. It’s the use of electronic information and telecommunications technologies to support long-distance clinical healthcare, patient and professional health related education, public health and health administration. Telehealth includes store and forward, videoconferencing, streaming media and wireless and landline communications.

Regardless of the term used the idea is to provide remote care and education using technology such as video, video-voice and data to improve health care outcomes.

8. The International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM)

The ICD-10-CM is a revision to the ICD-9-CM used by physicians and other health care providers to classify and code all diagnoses, symptoms and medical procedures recorded in conjunction with hospital care in the U.S. The ICD-10-CM like its predecessor the ICD-9-CM is based upon the International Classification of Diseases, which is published by the World Health Organization (WHO). Both use alphanumeric codes to identify diseases and other health problems. Once this information is retrieved it can be used to report national mortality and morbidity statistics.

The movement to ICD-10-CM is important because it expands the number of diagnostic codes from 14,000 to 68,000. The current ICD-9 codes have limited data about patients’ medical conditions and hospital inpatient procedures and it is outdated with many current medical practices. In addition, it includes twice as many categories and several new ones. The new codes will provide greater specificity and detail and allow information for clinical decision making and outcomes research. This will require significant training and education for coders, billers, practice managers, physicians and other health care personnel to fully implement the code changes. It is a major undertaking for all involved.

9. Revenue Cycle Management (RCM)

Revenue Cycle Management encompasses the entire medical billing process that manages all claims eligibility, submission, processing and payments. In a hospital the process begins when the patient enters the facility; in a physician office it begins when the patient makes an appointment. In both situations the patient provides their name, contact information and insurance company. RCM ends when the balance on the account is zero.

For a hospital or provider it’s their respiratory system because it assures that they get paid for what they do and that they get paid in a timely manner.

10. Meaningful Use

The goal of meaningful use is to promote the adoption of electronic health records by eligible professionals or eligible hospitals to improve health care in the U.S. Meaningful use is the set of standards defined by the Centers for Medicare and Medicaid Services (CMS) Incentive Programs that governs the use of these electronic health records and perceived level of quality care provided which when combined allows these eligible professionals and hospitals to earn incentive payments by meeting specific criteria.

There are three (3) stages of Meaningful Use:

  • Stage 1: 2011-2012
    • Data capture and sharing of data
    • Stage: 2014
      • Advanced clinical processes
      • Stage 3: 2016
      • Improved outcomes

This is important because it provides the following benefits:

  • Complete and accurate information: Providers will have the most current and thorough information about a patient before they see them.
  • Better access to information: Electronic medical records allow health information to be shared amongst providers thus speeding up delivery of care and eliminating redundancy.
  • Patient empowerment: Patients will have access to their medical records and can take an active role in their care through improved knowledge and by sharing their information with family members.

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