By Daniel Shulkin
Following the implementation of the Affordable Care Act, payers are utilizing various new payment methodologies including capitation, valued based purchasing, and coordinated care models to reduce healthcare costs. Good clinical documentation is essential to all of these models: it helps expedite the claims processing process, improve population health, and overall increase third party reimbursements. For this reason, it is integral for providers to be evaluated by a balanced scorecard, a strategic tool that measures the effects of the patient experience, a shared savings reimbursement model, and an improved clinical workflow. All together, this will help increase the efficiency and competitiveness of the organization.
The balanced scorecard reflects that multiple dimensions make up a more efficient organization. Health Information Technology (HIT) helps fuse the dimensions of the balanced scorecard as HIT is rapidly growing, evidenced by the majority of physicians and other providers that utilize an Electronic Health Record (EHR). HIT and EHR support the existing infrastructure and lay the groundwork for improving clinical documentation. Providers select from a specified list of templates and drop down menus to ensure that the entire medical history is accurately documented and claims can be efficiently paid.
The EHR inherently improves financial reimbursement and population health management by making it simpler and easier to record patient information, coordinate care amongst the entire health spectrum, and provide evidence of patient information to payers. While clinical documentation can improve population health and reimbursement, these systems may create an overly complex legal and regulatory environment. There is a balance to strike between focusing on HIT record keeping, patient centered care, face-to-face interaction, and workflow integration.
In the case of an office visit, providers are often so busy staring at a computer screen and typing notes that they lose/may lose eye contact with the patient, which hinders communication and the patient may misunderstand the provider. Health care administrators and policy makers must keep in mind the impact of these technological changes on providers and on the provider-patient relationship. As demands on providers to document care increase, these actions may negatively impact patient satisfaction and outcomes.
As we move to a more value based system for reimbursement, clinical documentation can help record outcomes of comprehensive care plans. More advanced HIT systems may help expedite payer claim processes and improve clinical documentation through use of EHR pre-crafted templates. This ensures that providers are documenting diagnoses and the rationale behind procedures as they improve population health. There will be even more potential for good record-keeping as the health system transitions to ICD-10 in October 2015, when the number of diagnosis codes will more than triple. In this way, the scorecard can become an essential and effective tool to balance the need for customer interaction and the need to meet financial objectives in a time of such change in the US healthcare delivery system.
Daniel Shulkin is a Masters of Public Administration Candidate in Health Policy and Management at the Robert F. Wagner Graduate School of Public Service of New York University with a concentration in Management/Finance. He is also a BPI Analyst at Horizon Blue Cross-Blue Shield of New Jersey. His interests include improving the efficiency and the effectiveness of healthcare services.
Disclaimer: Any views or opinions presented in this Op-Ed are solely those of the author and do not necessarily represent those of Horizon Blue Cross/Blue Shield of New Jersey.