AUDIO: Coders Face Major Change with Pay-for-Outcomes

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.”


  1. I am currently in a HIM program and I will be completing my studies soon. How does an enthusiastic professional become more knowledgeable about the new pay-for outcomes?

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  2. I am going to school for HIT right now and I agree that as a whole unit should work together to reach their goal. So if somebody is not doing their job I feel that it is the teams responsibily to help that person if possible. Let them know it is a team effort. And work together to build a great repore with each other.

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  3. I am currently a HIT student and I firmly believe that team work is power. In team work, tasks can be divided into groups. This will ultimately complete a task faster than working independently and still keep all team players busy. Working together also creates trust. If trust is broken in a team, productivity will most likely decrease. In healthcare, team work usually results in good quality patient care. If done right, team work brings positive results. If Pay-for-Outcomes is based on relative performance, working as a team can make the new payment policy a good impact.

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