Did the patient really need that procedure or hospitalization?

We’ve all heard of skyrocketing health costs, to which value-based care (VBC) initiatives are designed to help bring these in check. Under VBC, hospitals and physicians must demonstrate a strong correlation between patient outcomes, cost and value. A key component of this in the hospital setting is medical necessity — did the physician devise a thoughtful treatment plan in line with the patient's medical acuity? And more importantly, did the physician document enough details to support their thinking? If the answer to these questions is not easy to prove, it will cost you.
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Patient sits with doctor for examination

Not all clinicians decide the same thing at the same time, such as when to direct patients to an ER, admit them or send them home, which is why we get variations in quality, costs, and even outcomes. Value-based care and data analytics are supposed to help minimize those variations, highlighting the best care for the best value and incentivizing others to do the same.

As more providers prepare to take on risk under alternative payment models, more hospitals are turning to technology to help support them and demonstrate they are providing the best care for the best value.

 

Quality patient care

By improving the quality of clinical documentation, clinicians can improve the quality of care delivered, and find it easier to demonstrate medical necessity while easing the process for others to treat the patient. This, in turn, provides details to support downstream processes like medical coding and payment. At the same time, providing evidence for quality of care and good decision making helps minimize financial and legal risks.

Clinical Documentation Improvement (CDI) programs can address the missing pieces teams need for reporting quality outcomes, coding, billing, and payer reimbursements. All too often people tied to these important hospital functions approach the physician late in the patient’s stay or worse after discharge, asking a physician to remember decisions and add details to a patient’s record when the opportunity to impact patient care is lost. This disconnect in workflows is time-consuming and frustrating, stemming a new wave of physicians who are embracing technology that can help them.

Clinically-focused CDI programs now bring opportunities for the physician to improve documentation at the point of care using a proven combination of technology, education, and collaboration when it can still impact treatment decisions and care coordination. Advancements in speech recognition and technologies like computer-assisted physician documentation are proving their worth, making it easier for physicians to capture their thoughts right in the electronic health record. Intelligent virtual assistants help point out areas where more specificity or missing diagnoses and conditions will help better tell the patient’s story. Artificial intelligence (AI) is coming to the forefront of healthcare, and this technology can help put together details in the environment related to the patient’s conditions, family history or related symptoms that busy physicians might want to know and might otherwise miss.

 

Improved clinician experience

Technologies can arm physicians with the information and efficiencies they need up front to put their clinical judgment down in a fast, complete way. Starting in 2017 physicians are going to be publicly measured on their quality scores, so they have a vested interest in making sure their performance is rated as accurately as possible. Additional details in the physician note not only lead to more appropriate reimbursement but also have an added benefit for the physician – improved quality ratings.  Physicians who use CDI technologies appreciate the real-time prompting that helps them be more precise at the point of care.

 

Was that medically necessary?

Physicians can tell you there’s a material difference between a simple pneumonia and pneumonia with complications from the possibility of death to the complicated protocols. In the future, physician documentation and technologies to support them will make it even easier to specify that clearly, helping to support their decisions and VBC.

To learn more about how to help physicians improve clinical documentation and succeed in value-based care, join Dr. Reid Coleman and me for a webinar on January 24 to discuss a more natural approach to creating clinically-accurate information. To register, click here.

Register for this Webinar

Looking to improve clinical performance and succeed in value-based care? Advancements in cognitive technologies and services make high-quality clinical documentation a natural part of the clinical workflow, which are integral to success under value-based care. Join us for this webinar to learn how.

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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.