I kind of like stories like this as it’s yet one more reminder to clean up the math we use today and a good reason to check out the bill software that is sold to both doctors and hospitals. I’m not a big fan of Prime Healthcare as they buy hospitals on their last leg with no money and cut out a ton of services and create “Cadillac ER” rooms but on this one I think they made their point. What are these hospital buying today for risk assessments? The EHR gets certified but not the rest of it.
Bad Algorithms in Healthcare Payment Systems and Risk Assessments–Did the Hospital Bill Fraudulently or Were They Sold Formulas That Did Not Conform
Kwashiorkor is the big diagnosis case here and heck even Kaiser and Stanford had a bunch of these at one of their facilities.
Prime Healthcare Billing Processes Under Question as 25% of Medicare Patients are Showing Malnutrition- Profit Algorithms?
It’s the software and the algorithms that do this based on matching clinical input, but duh folks! Nobody wants to talk math and algorithms and instead we get stories as such in the news that “dances” around math and tries to tell a story, pathetic by all means but it starts in Congress with the digital illiterate pace they set. You can read on to where a hospital had the same issue with too many of these types of diagnoses in Maryland…If we had just a few more folks that would entertain math we would be miles ahead!
Duh! It’s the software and the algorithms folks…want me to repeat this one more time??? In this case it appears to be the software from 3M at the heart of most of the issues. Here’s another good example, rely on those Doctor rating sites…well look again at the flawed data…
HealthGrades And Other MD Rating and Referral Sites List “Dead Doctors” on Their MD Information Pages And Even Include the Insurance Plans the “Dead Doctors” Honor
I’m not going to fault California Watch as they are just using flawed information given to them as they are here to watch out for us over all, but I bet they might just join in on this issue of “flawed data” as it creates conflict where it should not exist. As a matter of fact if you are still one of those naïve folks out there that believes every report and all the statistics today, listen in to the audio below and get up to snuff here as marketing and algorithms for profit have diluted using math for being 100% available to prove accuracy. There’s a ton of healthcare addressed here.
“Numbers Don’t Lie, But People Do”–Radio Interview from Charles Siefe–Journalists Take Note, He Addresses How Marketing And Bogus Statistics Are Sources of Problems That Mislead the Public & Government
Actually this was a good response for Prime Healthcare in bringing this out into the open as it seems like of late the Medical Quack is doing a lot of talking about “flawed and unethical use of data and the algorithms” out there today. Somebody needs to do it so I guess this blog is the place. I just keep seeing it so that is why of late it’s in the headlines here a lot as we don’t live in denial around this blog and those who do will not feel comfortable reading for long sadly as they will miss the education process. BD
ONTARIO, Calif., Oct. 24, 2011 /PRNewswire/ -- California Watch has once again relied on faulty data, illogical comparisons, and baseless conclusions in its attempt to smear Prime Healthcare by comparing certain billing practices at Kernan Hospital, alleged (but not proven) in United States v. Kernan Hospital, to the billing practices of Prime Healthcare's hospitals.
There is no logical basis for any claim that the billing practices of Kernan Hospital parallel Prime Healthcare's billing practices. For example, the lawsuit alleges that Kernan put in place its own computer system. Prime Healthcare's hospitals utilize coding software developed by 3M, which is widely used across the United States and accepted by Medicare, and have not modified this software in any way. Likewise, Prime Healthcare's hospitals utilize practices that are consistent with the principles adopted by AHIMA including those related to physician queries.
Comparing billing practices of Maryland hospitals and California hospitals compares apples to oranges because Maryland relies on a different reimbursement methodology system than utilized in California (i.e., APR-DRG versus MS-DRG). Also, Maryland's APR-DRG methodology applies to both Medicare and Medicaid reimbursement in Maryland. Medi-Cal (California's Medicaid program) does not utilize a DRG reimbursement methodology.
In addition, as Prime Healthcare advised California Watch on March 3, 2011, the publicly available data for California tells a much different story:
- According to the 2009 OSHPD Data, Eisenhower Medical Center in Rancho Mirage, California (an area with an average age of 56) reported 240 cases of Kwashiorkor in 2009 with 89.58% of the cases occurring in patients 35 years old or older and 62.1% (or 149 out of 240) of the cases occurring in patients 65 years old or older.
- According to the 2009 OSHPD Data, Kaiser Foundation Hospital – Anaheim reported 146 cases of Kwashiorkor with 96.58% of the cases occurring in patients 35 years old or older and 58.2% (or 85 out of 146) of the cases occurring in patients 65 years old or older.
- According to the 2009 OSHPD Data, St. Joseph's Hospital – Orange reported 138 cases of Kwashiorkor with 89.86% of the cases occurring in patients 35 years old or older and 61.6% (or 85 out of 138) of the cases occurring in patients 65 years old or older.
- According to the 2009 OSHPD Data, Stanford University Hospital reported 70 cases of Kwashiorkor with no less than 87.14% (61 out of 70) of the cases occurring in patients 35 years old or older and 34.3% of the cases occurring in patients 65 years old or older.