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Saturday, October 26, 2019

Improving Medicare?

Interesting episode.

I first came to Medicare analytics 26 years ago in 1993, signing on with what was then called the Nevada Peer Review (shortly thereafter re-branded as the HealthInsight Medicare QIO). QIO's, "Quality Improvement Organizations," were mostly state-level non-profits contracted by the then-"HCFA" (Health Care Financing Administration / CMMS Centers for Medicare and Medicaid Services). It would be my first of three tenures with them.
The new "QIO's" were intended to evolve past the Peer Reviews' traditional "beat cop" review / sanction function into progressive QI facilitators. The results were a mixed bag.
In addition to my duties as our Novell LAN administrator, I ground up tons of mostly UB-82 statewide hospital encounter quarterly claims data, using SAS and Stata platforms, resulting in periodic summary tabular, graphics, and narrative reports like this one (pdf).

A quarter century later, we're still fussing over stuff like "hospital readmission rates." I'm not sure that the widespread penetration of EHR's and HIE's has made all that much of a difference.
"Who knew health care could be so complicated?" - President Donald Trump

More to come...

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