Clinical documentation for value-based reimbursement

By James P. Fee, MD, CCS, CCDS, and Wendy Clesi, RN, CCDS, CDIP

Like it or not, the transition to value-based healthcare is well underway. In January 2015, the Department of Health and Human Services (HHS) announced its Better, Smarter, Healthier campaign with clear goals and a timeline for shifting Medicare reimbursement from volume to value. Through a variety of programs, HHS set a goal of tying 85 percent of all traditional Medicare reimbursement to quality or value by 2016, and 90 percent by 2018.

Providers, payers, and patients alike are working towards the same three-fold vision as stated by the campaign’s October 2015 update: incentivize quality of care over quantity of services, promote coordination and integration, and share health information.

So far, the industry is ahead of schedule as verified by HHS’s March 2016 announcement. But what is the impact of value-based reimbursement on health information management (HIM) and clinical documentation professionals?

This article outlines immediate impacts for health information workflow and physician relationships within the era of pay for performance. It also lays out three practical steps for hospitals and health systems to move closer to value-based care.



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