Documentation and The “CMS Quality Strategy 2016”

“CMS Quality Strategy 2016” was released by CMS (Centers for Medicare and Medicaid Services) in November 2015. As evidenced by recent changes in the OPPS Final Rule 2016 and other quality and value-based trends, movement has been aggressive and persistent towards value versus volume. Long-term goals for value-based payments for Medicare Fee-For-Service include:
• Goal 1: 30% of Medicare payments are tied to quality or value through alternative payment models by the end of 2016, and 50% by the end of 2018.
• Goal 2: 85% of all Medicare FFS payments are tied to quality or value by the end of 2016, and 90% by the end of 2018.

At the center of these goals is the aim of “Better Care, Smarter Spending, and Healthier People, Healthier Communities”.

In looking at the above without knowing anything about changes in PQRS, fee schedules, readmissions, or other value-based/quality initiatives, it is evident that providers have to begin implementing and working toward changing how it operates, provides and delivers services, utilizes innovation, and focuses on the patient to survive the future.

CMS has gone on to develop 6 (Six) CMS Quality Strategy Goals as part of this National Quality Strategy.

• Goal 1: Make care safer by reducing harm caused in the delivery of care.
• Goal 2: Strengthen person and family engagement as partners in their care.
• Goal 3: Promote effective communication and coordination of care.
• Goal 4: Promote effective prevention and treatment of chronic disease.
• Goal 5: Work with communities to promote best practices of healthy living.
• Goal 6: Make care affordable.

There are a few areas within this strategy that warrant an increased focus on documentation however “Goal 4” related to chronic disease is very important to pay attention to. Providers must ensure they are identifying these conditions within the documentation and coding early on and treating appropriately. This is important for targeted treatment, patient management, forecasting, and possible payment implications. Ensuring you are implementing documentation integrity processes in the clinic and other ambulatory settings as well as the acute setting is something we must do now. As mentioned by CMS, chronic conditions can include MCCs (Major Complications and Comorbidities) but also include HCCs (Hierarchical Condition Categories) for risk adjustment.
Potential Ambulatory Documentation Challenges:
1. Mental and cognitive disorders: Is this a depression that is major, situational, post-schizophrenic or other?
2. Cancer: Is this a primary or secondary cancer? Has the cancer been removed, not under treatment, and no longer active?
3. Arthritis: Is this juvenile, gouty, or other cause?
Call Recovery Analytics LLC, to begin your Quality Strategy.

By: Sharon Easterling, MHA, RHIA, CCS, CDIP, FAHIMA
Recovery Analytics, LLC

“In the long history of humankind…those who learned to collaborate and improvise most effectively have prevailed.”
–Charles Darwin

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