TOOLS FOR IMPROVING QUALITY - Class 5
Tools for improving quality include: Evidence Based Medicine or critical pathways or care maps or medical guidelines, Benchmarking, Electronic Medical Records and Total Quality Management (TQM) and Continuous Quality Improvement (CQI)
The following is derived from Karen K.
Kraemer, “Predicting Levels
of High Risk,” Health Management Technology (
 | This article is about disease management – whether it should address entire populations or target just those individuals at greatest health risk. This article looks at a nonprofit health pan in Minnesota with 680,000 members, Health Partners, that does both by using technology to predict levels of risk combined with case management to increase the health plans profitability by lower hospital admissions – uses education of patient, intervention, etc. Using technology to predict levels of risk combined with other things including nurse interviewing patients and assigning patients to a risk level from likely to be hospitalized within the next three months to beyond two years. Return on income increase. |
The following is derived from ”All-Around Efficiency,” Health
Management Technology (
| This article gives a glimpse of behind the scenes operationally of a OB/GYN
practice in Massachusetts that has six doctors, four nurse midwives, three
nurse practitioners who practice in two office locations and one hospital in
Northampton, Mass. Malpractice
premiums increased 50% last year. The
use of information technology, using Greenway’s PrimeSuite system because
it was user friendly and ability to integrate electronic medical record (EMR)
with administrative, financial components, HIPAA compliance, train staff,
resulted in overall improvements in practice organization, workflow,
scheduling and billing. Time
spent by staff processing charges and claims reduced by 50%, scheduling
appointments decreased from 6 minutes to 2 minutes per appointment, register
patients saved $10,ooo in staff expense with new system, fledible, decreased
accounts receivables from 62 days to 41 days, able to generate custom
reports to track contracts and fee schedules of 25 different payers, proper
coding (before 32% of codes were underbilled, 15% overbilled, 53% billed
correctly and if were billed correctly with the old system, practice would
have increased revenue by 9.5%). One of the
most important reports run on the Greenway system is a report that
compares billable providers to rendering care providers because when doctors
contract with a payer they are
assigned an identification number and because midwives and nurse
practitioners are not always assigned individual numbers they often bill
under their physician’s number; previously
when run reports based on what billed, would identify charges provided by a
nurse midwife but listed under a doctor’s name which impede ability to
determine the productivity of the nurse midwives or nurse practitioners and
now can run reports based on rendering care provider. |
