The complicated process of reporting complications

Dear colleagues:

As the Patient Protection and Affordable Care Act implementation progresses, the quality and outcomes of care face increasing public scrutiny. Policymakers will determine our complication rates and publicize them on the Internet, influencing public perception of our competencies and quality. Don’t believe me? Read in the Atlanta Journal-Constitution about some Georgia hospitals’ “high” pneumonia, heart failure, and myocardial infarction mortality (http://tinyurl.com/GA-mortality). See your own cost efficiency and quality profile on United Healthcare’s website (www.uhc.com) under the “Find a Physician” tab. Where is information to make these determinations obtained? It’s from ICD-9-CM codes assigned by our hospitals based upon documentation. Consequently, we have a vested interest in ensuring that complication codes are submitted accurately.

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