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New pay-for-outcomes reimbursement structures looming over the healthcare industry will call for more specific coding – which must be backed up by more specific documentation.
Though the transition to the more granular ICD-10-CM/PCS code set may help, documentation processes at most hospitals will need an overhaul to support the type of pay-for-outcomes coding needed to reflect the care delivered and the severity of illness for patients.
Quality measures are about more than just reimbursement for many providers. While the money is important, many physicians and healthcare organizations take the results of pay-for-outcomes quality measures personally, said 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 HIM professionals can use personal talking points to drive home the importance of adequate record documentation by physicians.
The only way a clinical documentation improvement (CDI) program can succeed is if it gets physician buy in. And many HIM professionals know well that providing financial reasons for CDI won’t convince most physicians. But bring up how documentation affects quality measures and a physician’s reputation for care, and most will listen, Averill says.
This interview, recorded with Journal of AHIMA Editor-in-Chief Chris Dimick during the 84th AHIMA Convention and Exhibit in October, is the fourth and final installment in this audio series.