Whether you call it lingo, jargon, or nomenclature, there is no denying that health care professionals often speak their own language. Cheryl Clark, senior quality editor at HealthLeaders Media, narrowed it down to 14 buzzwords for 2014, and we at Sleep Diagnosis and Therapy have trimmed it to a tidy top 10.
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.
“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.
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.
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) 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.
10. 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.