Clinical Documentation and Coding Improvement
Individual physician performance has a direct impact on a health system’s financial, patient safety, and care quality initiatives. It is also a key performance indicator, integral to helping hospitals deliver better care at lower costs. As the healthcare industry implements ICD‐10 and continues the shift towards reimbursement tied to value, efficiency, and clinical quality of care, the need to enlist physicians to help drive clinical practice changes and improve documentation is urgent. Forward‐thinking hospitals are looking for strategies and tools to help manage the change and to align physicians with organizational goals; they are finding that implementing a physician scorecard is a must.
The overarching objective of a physician scorecard is to drive improvements in clinical, financial, and operational performance. At a more granular level, scorecards can help management to keep a finger on the pulse of physician activity within the hospital, foster shared accountability among team members, and ensure the organization is on track to meet key targets and objectives related to value-based purchasing (VBP), hospital acquired conditions (HAC), the Hospital Readmissions Reduction Program (HRRP), and more traditional core metrics related to case mix index (CMI), charge capture, accurate and compliant code assignment, reimbursement, and regulatory compliance.
At the heart of it all is physician documentation. For example, under ICD-10, the new code sets will improve a healthcare organization’s ability to document patient quality of care, paint a more accurate clinical picture, and receive reimbursement reflective of severity of illness and utilization of resources. But in order to realize those benefits, physicians will need to change the way they document care in order to ensure the record reflects the right information related to laterality, specificity, severity of illness (SOI), and risk of mortality (ROM). Similarly, in order to “get credit” and realize potential bonuses under VBP or avoid penalties under HRRP, physician documentation must include the right information and metrics regarding clinical process of care (e.g., delivery and timing of medications and procedures); patient experience of care (e.g., communication with doctors, pain management, communication about medications, and discharge information); outcomes (i.e., safety, infections, mortality); efficiency (i.e., spending and utilization), and present on admission (POA) indicators.