Clinical Documentation for Value-based

Clinical Documentation for Value-based
Reimbursement: Why It Takes a Village to Ensure
Success
By James P. Fee, MD, CCS, CCDS, and Wendy Clesi, RN, CCDS, CDIP
Like it or not, the transition to value-based healthcare is well underway. In January 2015, the Department of Health
and Human Services (HHS) announced its Better, Smarter, Healthier campaign with clear goals and a timeline for
shifting Medicare reimbursement from volume to value. Through a variety of programs, HHS set a goal of tying 85
percent of all traditional Medicare reimbursement to quality or value by 2016, and 90 percent by 2018.
Providers, payers, and patients alike are working towards the same three-fold vision as stated by the campaign’s
October 2015 update: incentivize quality of care over quantity of services, promote coordination and integration, and
share health information.1
So far, the industry is ahead of schedule as verified by HHS’s March 2016 announcement.2 But what is the impact
of value-based reimbursement on health information management (HIM) and clinical documentation professionals?
This article outlines immediate impacts for health information workflow and physician relationships within the era of
pay for performance. It also lays out three practical steps for hospitals and health systems to move closer to value based care.
From Jog to Sprint
In the years to come, the gradual jog toward value-based payments will likely become more of a sprint. Physician
documentation will play an even bigger role in four areas: capturing patient severity, identifying risk, justifying
resources, and demonstrating outcomes. Organizations must ensure their clinical documentation accurately reflects
the care provided across the continuum—or run the risk of jeopardizing their reimbursement.
This monumental change in reimbursement methodologies has direct implications for HIM workflow. Organizations
that weather the storm successfully will be those that make a concerted effort to integrate coding, quality, and clinical
documentation improvement (CDI) with the goal of complete and accurate clinical documentation for every patient,
every encounter, every claim.
It will take an entire team of professionals to drive the changes necessary to be successful under value-based
reimbursement models. Collaboration is the key, with these initial priorities:
CDI spearheads documentation improvement across all care settings.
Coding professionals apply consistent coding guidelines and establish stronger communication with non-acute
care peers.