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When DRGs were introduced in the early 1980s, they dramatically changed the role of HIM professionals—thrusting them into the center of revenue cycle management. Another paradigm shift in payment systems is on the horizon with pay-for-outcomes.
Payers have begun to institute programs where provider payment is modified based on quality outcomes and care performance, noted Richard Averill, senior vice president of clinical and economic research at 3M Health Information Systems.
Averill, a principal researcher for the Centers for Medicare and Medicaid Services who helped create the DRG system, explains in this audio interview how pay-for-outcomes and new payment policy will impact HIM and healthcare.
All healthcare employees at an institution, from nurses and physicians to HIM professionals, must work to improve quality and protect financial revenue streams, Averill said.
“Continuous quality improvement taught us one thing, more often than not it is not one individual [that needs to improve], it is an institution,” he said. “So that means the institution as a whole needs to understand the processes that allow [payment adjustment] to happen.”