How clinical documentation improvement prepares you for a value-based world

Clinical documentation improvement is key to improving patient care, as well as safeguarding healthcare organizations' bottom lines. This post reviews some of the areas of greatest risk for organizations shifting to value-based care and strategies to protect against them.
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How clinical documentation improvement prepares organizaations for value-based care

The transition to value-based care is putting hospitals’ performance to the test. Healthcare leaders must ensure that their organizations can maintain reimbursement levels, while effectively treating patients and gathering accurate data to prove value and assess performance. Most people don’t know where to start to mitigate the risks.

In a recent HealthLeaders survey, 38% of respondents said the greatest risk hospitals face in transitioning to Value-Based Payment (VBP) models is the payment gap from Fee-for-Service (FFS).  I spend a significant amount of time talking to leaders about how to navigate this transition — from focusing on services and volume that drive revenue to making value-based changes that will produce partial financial benefits today, but will be increasingly important to survival of providers and health systems in 2016 and 2017.

What I learned working as a CMO at several hospitals where we aligned process improvements, physician incentives, and outcomes is these all start with a strong picture of care. This transition requires a deliberate Clinical Documentation Improvement (CDI) process and data you can use to measure and manage behavior changes through many teams.

 

Value begins with the clinical record

When it comes to outcomes reporting, the clinical record is key.  Once the patient has been discharged, it’s the only thing left for the rest of the world to see.. and that’s based on what has been coded about the visit. Final bills are generated from the medical record, and that’s how outside organizations analyze care, and how patients and payers compare providers. However, the data is often wrong. Incomplete or inaccurate patient charts accelerate the risks to hospitals and physicians.

Now is the time to make CDI a priority. Every correction in clinical documentation provides a more accurate view of patient severity, and helps improve revenue in a FFS world. These improvements generate better clinical outcomes, and help providers compete in a value-based world. Accuracy from the start is critical as outcomes become more visible and directly impact reputations, patient volumes and hospital finances.

This same HealthLeaders survey found that the greatest opportunity for CDI cited by 149 healthcare executives was the financial benefit of helping organizations achieve the right reimbursement levels by providing an accurate case-mix index. The chart below shows other opportunities for improved performance through clinical documentation.

How clinical documentation improvement can improve value-based patient care

 

The path to “Top Performing Hospitals”

While preserving revenue is a byproduct of a more accurate patient record, healthcare organizations can use CDI data to improve quality outcomes, which provide clear value to clinicians and to patients. For example, accurate data enables hospitals to perform better against peer organizations on hospital rankings, which are especially important in today’s information age when patients can easily access hospital and physician performance online and choose providers based on rankings by CareChex, Healthgrades, and Thompson Reuters.

According to Dr. Georges Feghali, former chief medical officer and chief quality officer at Trihealth Medical, Case Mix Index reflects on physicians’ quality scores: their observed vs. predicted mortalities.  And the only way to improve this is to use CDI and document properly.  It’s a way of leveling the playing field.”

I believe the most strategically important action for organizations to take in 2016 is to make clinical documentation improvements that help them accurately reflect the quality of care provided and the types of patients treated so this information will help them prepare and succeed in the future.

To read the full research report based on the HealthLeaders executive survey, click here: “How CDI is Revolutionizing the Transition to Value-Based Care.”

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Dr. Anthony Oliva

About Dr. Anthony Oliva

Dr. Anthony (Tony) Oliva is the vice president and chief medical officer for Nuance’s Healthcare division. Dr. Oliva draws on more than 15 years of executive healthcare experience. As chief medical officer, he personally has been involved with the implementation and expansion of clinical documentation programs since 2004. Previously serving as chief medical officer for Borgess Health, Dr. Oliva was accountable for the clinical practice of medicine across all Borgess Health entities including ambulatory care, hospital care and extended care services. He is currently Board Certified in Family Medicine. Dr. Oliva received an M.S in Medical Management from Carnegie Mellon University Heinz School of Public Policy & Management. He is a Certified Physician Executive, a designation earned from the American College of Physician Executives.