Five Things for Progressive Leaders to Focus on this Fiscal Year

  • Quality/Risk Adjustment

    • With the adoption  of Value-Based Purchasing, providers have many initiatives occurring that will soon collide with the Merit-Based Incentive Program which takes effect for 2017 performance. The four performance categories are: Quality (PQRS, MU, Qualified Clinical Data Registries),  Resource Use (VBM / episodes of care), Meaningful Use (EHR), and Clinical practice improvement activities.
      Risk Adjustment of patient populations translates to the sicker a patient is the more resources they will require with a focus on wellness. There are a number of entities that utilize risk adjustment as a component of their payment methodologies with the premise that patients that are healthier require less maintenance and ultimately less dollars. This process is not fully achieved for a number of reasons. One main reason is documentation and coding has not yet caught up to reflect what is occurring clinically with patients. There is a ways to go; especially in the clinic where in most cases physicians are coding and not explained the about assigning a diagnosis thoroughly. The take-away here is documentation and coding sits within all these initiatives and focus is needed within the inpatient and ambulatory arena.
  • The Aftermath and Impact of ICD-10

    • The ICD-10 code set is LIVE and hopefully going well. Monitor coding, perform quality audits utilizing (internal and external vendors), consider auditing the vendor especially if they perform a high percentage of coding of facility accounts, track DRG shifts, continue to educate, watch and know your denials (especially medical necessity), fix denial issues, know the pulse of your coders and physicians; burnout could be around the corner to name a few.
  • Documentation

    • Documentation is a critical component of continuity of care as well as the story behind what is billed. Providers must support what is done for the patient through documentation. With the implementation and development of Electronic Health Records make it a priority that your patient story is being told accurately and patient specific. Patient care goes beyond the basic template.
    • As the audit environment continues to explode with the “2 Midnight Rule”, ICD-10, and movement toward Quality, ensuring you are firming of documentation gaps is crucial to retain payments from all payors.
  • Transitioning to Patient Wellness as the “AIM”

    • To achieve the goal of population health, providers must find a way to institute wellness initiatives with coordination of care;  centralized referral and scheduling, tracking and responding to patient noncompliance through partnering with the patient and developing a relationship of trust and concern for their well being.
  • Information Governance (IG)

    • AHIMA (American Health Information Management Association) defines IG as an organization-wide framework for managing information throughout its lifecycle and supporting the organization’s strategy, operations, regulatory, legal, risk, and environmental requirements.
      Something all can agree on is that historically HIM has owned information. This certainly started out in paper form when those in the profession were known as Medical Record Librarians but continued as titles changed to Technicians and Administrators. A key part of that was ensuring we have clear policies and procedures that were reflective of the Medical Staff Bylaws, Policy and Procedure Manual as well as The Joint Commission and other regulatory agencies. As time has gone on, the record has morphed into a computerized document and in some ways regulation is still playing catch up to this technology. This has put our facilities at risk of not achieving accreditation as some no longer track and complete essential components of the record. With this, true IG goes well beyond the health record in whatever format and is more far reaching as information is data that has been collected, combined, analyzed, and/or interpreted to be used for a specific purpose or set of purposes (AHIMA) across an organization.
      IG lends the opportunity to understand how information is compiled, maintained, accessed, and disseminated. These 4 key areas are part of the building blocks around IG which touches all organizations, every department within an organization, all types of information (clinical, financial, and operational), and comes from every media source (paper, computer, etc.). The more we understand IG the better we can control costs, impact patient safety, trust our data, have sound information for the movement toward quality, be compliant in our practice and operations,maintain accreditation, and minimize risk.
    • Providers must take a hold of information within the organizations. Institute an IG Officer.
      AHIMA has developed 8 Principles of Information Governance entitled:
      INFORMATION GOVERNANCE Principles for Healthcare (IGPHC)™
      • Principle of Accountability – An accountable member of senior leadership, or a person of comparable authority, shall oversee the information governance program and delegate program responsibility for information management to appropriate individuals.
      • Principle of Transparency – An organization’s processes and activities relating to information governance shall be documented in an open and verifiable manner.
      • Principle of Integrity – An information governance program shall be constructed so the information generated by, managed for, and provided to the organization has a reasonable and suitable guarantee of authenticity and reliability.
      • Principle of Protection – An information governance program must ensure the appropriate levels of protection from breach, corruption and loss are provided for information that is private, confidential, secret, classified, essential to business continuity, or otherwise requires protection.
        Principle of Compliance – An information governance program shall be constructed to comply with applicable laws, regulations, standards, and organizational policies.
      • Principle of Availability – An organization shall maintain information in a manner that ensures timely, accurate, and efficient retrieval.
      • Principle of Retention – An organization shall maintain its information for an appropriate time, taking into account its legal, regulatory, fiscal, operational, risk, and historical requirements.
      • Principle of Disposition – An organization shall provide secure and appropriate disposition for information no longer required to be maintained by applicable laws and the organization’s policies.For more information on Information Governance (IG) download resources at AHIMA IG Resources.Reference: INFORMATION GOVERNANCE Principles for Healthcare (IGPHC)™. AHIMA IG Taskforce 2015.
    • (excerpts from NCHIMA Footprints as written by S. Easterling)

Written by: Sharon Easterling, President Recovery Analytics LLC

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