Achieving Success by Documenting Quality

FTI Consulting CDCI™ Aligning Clinical Documentation Improvement with Hospital Value-Based Purchasing Initiatives

Health Solutions

November 3, 2014

The US healthcare system is undergoing a tremendous transformation, driven by the need to control the rate of increase of health care costs while delivering quality patient-centered care. Consistent with CMS mandates and adoption of The Patient Protection and Affordable Care Act (PPACA) in 2010, healthcare organizations are partnering with experienced management teams to provide thoughtful leadership and critical thinking while creating the balance between complete and accurate physician documentation and documenting quality.

The term “value” is referenced in PPACA exactly 214 times. The Deficit Reduction Act of 2005 authorized the Secretary of Health and Human Services to develop a plan to implement value-based purchasing (VBP) commencing Fiscal Year (FY) 2009 for Medicare hospital services provided by hospitals paid under the Inpatient Prospective Payment System. It was formally implemented in July 2009 and applied to payments beginning in Fiscal Year (FY) 2013, on or after October 1, 2012. It affected payment for inpatient stays in 2,985 hospitals across the country. Additionally, CMS has implemented programs meant to further increase the quality of healthcare delivered to Medicare beneficiaries:

  • The Hospital Acquired Condition (HAC) Reduction Program expands on efforts associated with the Deficit Reduction Act (which CMS now calls DRA-HACs)
  • The Hospital Readmission Rate Program (HRRP)

CMS’s Hospital Value-Based Program represents a shifting paradigm, transforming Medicare from a passive payer of claims to an active purchaser of care. VBP which links payment to performance is a key policy mechanism that CMS is proposing. Under VBP, incentive payments to high-performing hospitals would be larger than those to lower performing hospitals. For the first time it would use the Inpatient Prospective Payment System to provide financial incentives to drive improvements in clinical quality, patient-centeredness and efficiency.

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