Biomedical subjects

Daniel P Lorence

Publications and source records attributed to Daniel P Lorence.

9 recordsLinked to original sources

PubMed2003

Benchmarking variation in coding accuracy across the United States.

The objective of this study was to measure the consistency of coded medical data through information managers' reports of the overall coding error level in patients' medical records. Using a cross-sectional design, we examined the reported percent of records containing coding errors significant enough to change a diagnostic related group (DRG). Results indicate about 87 percent, 9 percent, and 5 percent of respondents reported that significant coding errors existed in less than 5 percent, 6-10 percent, and greater than 10 percent of the medical records in their institutions, respectively. Significant variation was found in the accuracy and consistency of coding practice and associated data quality across key demographic and organizational variables. Significantly large error rates in coded data exist in some organizations. Given variations across key demographic characteristics, providers may tend to distrust all coded data, when aggregated. As the United States moves toward an evidence-based medicine environment, the use of current patient data classification methods may be of limited value without increased attention to coding practices.

Benchmarking↗

PubMed2003

Disparity in coding concordance: do physicians and coders agree?

Increasing demands for large-scale comparative analysis of health care costs has led to a similar demand for consistently classified data. Evidence-based medicine demands evidence that can be trusted. This study sought to assess managers' observed levels of agreement with physician code selections when classifying patient data. Using a non-sampled research design of both mailed and telephone surveys, we employ a nationwide cross-section of over 16,000 accredited US medical record managers. As a main outcome measure, we evaluate reported levels of agreement between physician and information manager code selections made when classifying patient data. Results indicate about 19 percent of respondents report that coder-physician classification disagreement occurred on more than 5 percent of all patient encounters. In some cases, disagreement occurred in 20 percent or more instances of code selection. This phenomenon shows significant variation across key demographic and market indicators. With the growing practice of measuring coded data quality as an outcome of health care financial performance, along with adoption of electronic classification and patient record systems, the accuracy of coded data is likely to remain uncertain in the absence of more consistent classification and coding practices.

Data Collection↗

PubMed2003

Identifying barriers to billing compliance.

Programs designed toward the control of health care fraud are leading to increasingly aggressive enforcement and prosecutorial efforts by federal regulators, related to over-reimbursement for service providers. Greater penalties for fraudulent practices have been touted as an effective deterrent to practices that encourage, or fail to prevent, incorrect claims for reimbursement. In such a context, this study sought to examine the extent of compliance management barriers through a national survey of all accredited US health information managers, examining likely barriers to payment of health care claims. Using data from a series of surveys on the stated compliance actions of more than 16,000 health care managers, we find that the publication and dissemination of compliance enforcement regulations had a significant effect on the reduction of fraud. Results further suggest that significant non-adoption of proper billing compliance measures continues to occur, despite the existence of counter-fraud prosecution risk designed to enforce proper compliance. Finally, we identify benchmarks of compliance management and show how they vary across demographic, practice setting, and market characteristics. We find significant variation in influence across practice settings and managed care markets. While greater publicity related to proper billing procedures generally leads to greater compliance awareness, this trend may have created pockets of "institutional non-compliance," which result in an increase in the prevalence of non-compliant management actions. As a more general proposition, we find that it is not sufficient to consider compliance actions independent of institutional or industry-wide influences.

Data Collection↗

PubMed2002

Regional variation in medical systems data: influences on upcoding.

Attempts to minimize over-reimbursement to health care providers have resulted in highly publicized prosecution of health care providers and provider organizations. Such prosecution has led many to propose that upcoding influences exerted upon health care information managers would largely disappear, both within and external to the provider organization. This study seeks to examine the degree of both intra- and extraorganizational influences on reimbursement optimizing practices through a national survey of accredited health information managers. Results suggest that significant upcoding influence continues to occur within organizations, despite the risk of severe counterfraud penalties designed to eliminate such practices. We examine variation in intra- and extraorganizational optimizing influences, finding such influence was found to exist both within and external to the provider organization. We also examine how optimization influences vary across demographic, practice setting, and market characteristics. We find significant variation in influence across practice settings and managed care markets. Ramifications for reimbursement assessment are discussed.

Abstracting and Indexing↗

PubMed2002

EPR adoption and dual record maintenance in the U.S.: assessing variation in medical systems infrastructure.

The growing adoption of evidence-based medicine in the United States is acting to cause fundamental changes in the delivery of healthcare management services. With the increasing incorporation of electronic patient records (EPRs) into the day-to-day practice of medicine, it necessitates greater dependence on adequate functioning of such resources, as they become more frequently used as a clinical complement in the practice of medicine. Assessing the patterns of adoption of EPRs is likewise of increasing importance, with the recent imposition of uniform government data collection and management requirements. The medium of data storage and maintenance within many organizations is a critical factor in the ultimate delivery of service, with a like need for an integrated, designated medium for the management of data becoming paramount. This study examines, on a nationwide basis, variation in reported adoption of EPRs within U.S. healthcare organizations, and the related maintenance of dual electronic/paper record systems.

Database Management Systems↗

PubMed2002

Variation in coding influence across the USA. Risk and reward in reimbursement optimization.

Recent anti-fraud enforcement policies across the US health-care system have led to widespread speculation about the effectiveness of increased penalties for overcharging practices adopted by health-care service organizations. Severe penalties, including imprisonment, suggest that fraudulent billing, and related misclassification of services provided to patients, would be greatly reduced or eliminated as a result of increased government investigation and reprisal. This study sought to measure the extent to which health information managers reported being influenced by superiors to manipulate coding and classification of patient data. Findings from a nationwide survey of managers suggest that such practices are still pervasive, despite recent counter-fraud legislation and highly visible prosecution of fraudulent behaviors. Examining variation in influences exerted from both within and external to specific service delivery settings, results suggest that pressure to alter classification codes occurred both within and external to the provider setting. We also examine how optimization influences vary across demographic, practice setting, and market characteristics, and find significant variation in influence across practice settings and market types. Implications for reimbursement programs and evidence-based health care are discussed.

Behavior Control↗

PubMed2002

Assessing managed care market variation in reports of coding accuracy.

The implementation of larger, faster and more comprehensive databases in healthcare delivery settings is an emerging outgrowth of evidence-based medicine. This study seeks to assess, at a national level, the degree of uniformity across markets in utilization and management of coded medical information. Implications for managers and policymakers, related to comparative managed care data benchmarks, are reviewed.

Benchmarking↗

PubMedDate not supplied

Information in medical decision making: how consistent is our management?

BACKGROUND: The use of outcomes data in clinical environments requires a correspondingly greater variety of information used in decision making, the measurement of quality, and clinical performance. As information becomes integral in the decision-making process, trustworthy decision support data are required. METHODS: Using data from a national census of certified health information managers, variation in automated data quality management practices was examined. RESULTS: Relatively low overall adoption of automated data management exists in health care organizations, with significant geographic and practice setting variation. Nonuniform regional adoption of computerized data management exists, despite national mandates that promote and in some cases require uniform adoption. Overall, a significant number of respondents (42.7%) indicated that they had not adopted policies and procedures to direct the timeliness of data capture, with 57.3% having adopted such practices. CONCLUSIONS: The inconsistency of patient data policy suggests that provider organizations do not use uniform information management methods, despite growing federal mandates to do so.

Administrative Personnel↗

PubMedDate not supplied

Manager's reports of variation in coding accuracy across U.S. oncology centers.

Advances in high-speed data processing capabilities, and the increasing reliance on information systems in comparative data assessment, are creating greater dependence on information systems, with a related need for more timely assessment of coding quality. Assessing the accuracy of coded and classified data becomes critical as the implementation of government compliance management requirements, along with the growing adoption of evidence-based medicine in error detection, serve to challenge healthcare researchers to consider the quality of coded data in management assessments. The implementation of larger, faster and more comprehensive databases in healthcare delivery settings is one response to this changing environment, but at a national level there will need to be some degree of uniformity in their utilization and management, if researchers are expected to rely on comparative benchmarks to fully assess organizational performance. In a nationwide survey of health information managers we found about 81 percent of respondents reported that significant coding errors existed in 5 percent or less of the records in their institutions. About 11 percent of respondents, however, reported that the coding errors existed in six to ten percent of their records. Regional and practice setting variation in reported coding error ranged widely, occurring across organizations as well as area locations. Related impact on comparative data-driven management assessment is discussed.

Abstracting and Indexing↗