Whether an individual physician or a major university health system you are being measured for your value to the community and it has been so for decades – only we haven’t had to worry so much about an effect on reimbursement until recently with Hospital Acquired Conditions (HACs) and other Value Based Purchasing initiatives. The accuracy of ICD coding based on validity of assignment of these for the purpose of medical necessity hasn’t been challenged until recently with the Recovery Audit Contractors (RACs). And this appears to be a trend with all payors.
Clinical Documentation Programs can have an effect on the Value Based Purchasing initiative. In so doing, medical staff leadership is essential. From severity adjusted mortality and complication data, to bundled payment strategies to limiting of readmissions, to compliance with quality initiatives, to treating the patient in the correct environment, to patient satisfaction – it all counts and it all depends on the physicians understanding of what it’s all about and how they can participate effectively and still maintain a practice. As we always say, without the physician diagnosis, there is no data, there are no codes.
CDI is supposed to help the docs provide that accuracy of diagnosis that will affect all of these purposes. To be effective it has to be directed to all docs of all persuasions dealing with all patients of all payers. It has to be incorporated with the measurement of quality data, the avoidance of patient harm, the proper designation of financial class and the overall, holistic approach to true case management. It must be pervasive to be effective.