In a Forbes Technology Council article earlier this year, my colleague Medicomp CEO Dave Lareau discussed how the industry was abuzz with talk about how providers and health plans can “optimize” risk-adjusted payments for Medicare Advantage, and the associated “upcoding” to qualify for higher risk scores.
Dave maintained that it will not be enough to simply pick a code and be done with it. Instead, the clinical documentation must support the selected diagnosis and show that the condition was appropriately assessed and treated. In other words, merely picking a more specific code is not going to cut it when the auditors come calling.
All this reliance on codes raises a core question about what providers’ primary concern should be: Is it about the coding or is it about the caring?
Consider the role of the EHR in all of this. The clinician, while with a patient at the point of care, must search through volumes of disjointed data. With so much disorganized data, is it any wonder that clinicians struggle to find relevant history about their patients’ existing or suspected problems?
Ultimately, the EHR is little more than an inert repository of information that that does more to justify diagnoses and billing than it does to empower clinicians to improve patient care.
We’ve been focused on solving the wrong problem for too long. We’ve spent too much attention on the codes. Getting the code right. Get the next code. Managing codes. Managing lists of codes. Managing the updates of codes.
Instead, what we should be focused on is helping the clinician manage the patient.
What if the EHR was not just a clinically inert obligation, but a diagnostically interactive tool that provides the clinician with at-a-glance access to the clinical information related to a patient’s problem, as well as addresses the quality measures, documentation requirements, customized workflows, and more? That would empower the clinician to improve care.
Because it’s not about the coding. It’s about the caring.
With the growth of Medicare Advantage and other risk-based incentive programs, and the increased focus on pay-for-performance and quality, providers are increasingly charged with moving the needle on patient care. Having the right code might help to get paid, but it doesn’t move the care needle.
With the shift to value-based care models, it will be more important than ever to give clinicians a diagnostically focused view for each patient and each of their medical problems. Clinicians need these details instantly, without having to search through disparate sections of the EHR.
By empowering clinicians in this way, the EHR will become more than a clinically inert repository for codes. It will evolve into a true diagnostically interactive tool for care.
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