Healthcare is in the middle of a sea of change when it comes to the revenue cycle. As the industry moves from fee-for-service to population-based management and billing - as evidenced by the rise of accountable care organizations (ACOs) and bundled payments - physicians are now under even more pressure. By Anthony F. Oliva, DO, MMM, FACPE Regional Medical Director, Nuance
By Anthony F. Oliva, DO, MMM, FACPE Regional Medical Director, Nuance
Healthcare is in the middle of a sea of change when it comes to the revenue cycle. As the industry moves from fee-for-service to population-based management and billing - as evidenced by the rise of accountable care organizations (ACOs) and bundled payments - physicians are now under even more pressure.
Yes, physicians will have to focus even more on quality. Yes, physicians will have to coordinate care even better than before. But, they’ll also have to focus on an area they may not thinks is in their domain: clinical documentation and the transition to ICD-10.
If you’re a physician on the front lines of patient care, you’re thinking, "Why are we moving to a new, complicated coding system and what does this have to do with me?" If you’re managing physicians, you’re thinking, “I need accurate information so that we get paid for our services correctly.”
The bottom line is that ICD-10 and the resulting specificity in clinical documentation will impact revenue and quality - and most importantly for the physician’s career - his or her profile.
For physicians, they don’t need specificity to get the job done, but without specificity in the patient chart, hospitals will certainly see dips in reimbursement and the case mix index.
Physicians and physician managers need to look at accurate and detailed clinical documentation from a clinical perspective first, versus a primary coding perspective. Only then, will they understand that good documentation gets at the heart of accurately assessing and reporting severity of illness (SOI) and expected versus observed mortality rates to determine true hospital and physician performance.
How do we make it easier for physicians to understand the importance of clinical documentation? The foundation is a clinically-focused and driven documentation system with documentation specialists who support physicians. Physicians are not meant to be coders, but they can work in partnership with documentation specialists who are clinically trained to ensure documentation is accurate, specific, and detailed to reflect SOI and the level of care given.
We then need to bring the issue down to what matters to them: their career and reputation. If a CMO is looking at hiring physicians for an ACO, he or she wants physicians who show a track record of high quality and low cost care. That type of data will come from their focus and attention to clinical documentation. It’s that simple.
For the physician manager, they need to see that mortality rates are not only a quality problem, but also a documentation problem which can have a dramatic impact on the results. Yes, we can decrease observed mortality through quality care initiatives, but overlooking how documentation improves the SOI expected mortality part of the ratio is a missed opportunity.
As we continue the switch to a population-based approach to care versus fee for service, physicians will have to part of the effort to define how sick the population is in order to take care of them right. If we undervalue the population, then the government will do the same.
What can hospitals do to gain physician buy-in sooner than later?
First, show physicians the data. Medicare sells Medpar data once a year and, for the first time, it contains physician identifiers. Look at this report card with the physician and see what is being reported. Does it accurately reflect their performance and work?
Second, sit down with physicians and ask them to look past where they are today and understand that people will decide if they get hired based on mortality rates and outcomes data. If they don’t get this right, their performance will look worse than their peers. When they realize that, they will be open to change.
Third, let them know they will get help. Physicians need to learn early what efforts are being undertaken at the hospital to develop and implement practical solutions through information systems, HIM solutions, CDI enhancements, and process interventions, as well as be encouraged to participate in the development processes.
Fourth, create opportunities for direct physician education. Physicians learn best from physicians on a peer-to-peer basis. That is why physician education for clinical documentation and ICD-10 must be clinically delivered. Each subspecialty must understand the specific documentation necessities for their specialty.
Fifth, develop an integrated approach to ensure complete documentation at the time care is delivered through the collaborative efforts of coding, documentation specialists, nursing, and other clinical departments and physicians.
Finally, utilize technologies that make it easier on the physician. The integration of physician speech recognition software can save physicians valuable time by capturing the physician narrative via dictation to improve the speed, accuracy, and completeness of documentation.
