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Study Shows Value of NLP in Pinpointing Quality Defects

Posted on August 25, 2011 I Written By

For years, we’ve heard about how much clinical information is locked away in payer databases. Payers have offered to provide clinical summaries, electronic and otherwise, The problem is, it’s potentially inaccurate clinical information because it’s all based on billing claims. (Don’t believe me? Just ask “E-Patient” Dave de Bronkart.) It is for this reason that I don’t much trust “quality” ratings based on claims data.

Just how much of a difference there was between claims data and true clinical data hasn’t been so clear, though. Until today.

A paper just published online in the Journal of the American Medical Association found that searching EMRs with natural-language processing identified up to 12 times the number of pneumonia cases and twice the rate of kidney failure and sepsis as did searches based on billing codes—ironically called “patient safety indicators” in the study—for patients admitted for surgery at six VA hospitals. That means that hundreds of the nearly 3,000 patients whose were reviewed had postoperative complications that didn’t show up in quality and performance reports.

Just think of the implications of that as we move toward Accountable Care Organizations and outcomes-based reimbursement. If healthcare continues to rely on claims data for “quality” measurement, facilities that don’t take steps to prevent complications and reduce hospital-acquired infections could score just as high—and earn just as much bonus money—as those hospitals truly committed to patient safety. If so, quality rankings will remain false, subjective measures of true performance.

So how do we remedy this? It may not be so easy. As Cerner’s Dr. David McCallie told Bloomberg News, it will take a lot of reprogramming to embed natural-language search into existing EMRs, and doing so could, according to the Bloomberg story, “destabilize software systems” and necessitate a lot more training for physicians.

I’m no technical expert, so I don’t know how NLP could destabilize software. From a layman’s perspective, it almost sounds as if vendors don’t want to put the time and effort into redesigning their products. Could it be?

I suppose there is still a chance that HHS could require NLP in Stage 3 of meaningful use—it’s not gonna happen for Stage 2—but I’m sure vendors and providers alike will say it’s too difficult. They may even say there just isn’t enough evidence; this JAMA study certainly would have to be replicated and corroborated. But are you willing to take the chance that the hospital you visit for surgery doesn’t have any real incentive to take steps to prevent complications?

 

EMR’s Affect on Medical Billing Costs

Posted on September 29, 2008 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I received an email not too long ago from a medical billing company who talks about the crazy costs associated with medical billing. In their email they offered the following statistics on the costs of medical billing.

The statistics below represent industry averages taken from the MGMA.

Claims Rejected on 1st Submission – 30 %
Underpayed Claims – 20%
Gross Collection Rate – < 60%
Preventable Denials - 90%
Denials that are Recoverable - 67%
Average days in A/R - 52.32
Cost per claim - $5-$7
Cost per FTE physician - $30,000-$60,000
Cost of billing operations - 18-22%
Cost of Billing Personnel - 58-62%
Cost of Technology/ Practice Management Solution - 18-22%

Source: Avisena whitepaper

I must admit that billing is far from my expertise, but it’s a well described necessary evil for almost any practice. Plus, the better you do it, the more money your clinical practice can make.

Of course, my question is how did implementing an EMR in your clinic either help or hurt these various costs? Were you better able to process claims, because the charting was done electronically and the coding done at the time of visit? Were you able to process claims at a higher rate because your documentation was more complete using an EMR? Could you more quickly process denied claims because it was electronic? Did you need more or less employees to do your billing after implementing an EMR?

I guess it would also be important to know if you decided to go with an integrated Electronic Medical Record and Practice Management System or if you tried an interface between your legacy system and a new EMR system.