It’s apparent that the traditional fee-for-service model for reimbursement cannot be sustained. New concepts have been introduced in the industry and some have “died on the vine,” others such as bundled payments are evolving, and new models have erupted, such as those outlined in the Medicare Access and Chip Reauthorization Act of 2015 (MACRA).
No matter how you frame it, reimbursement to health systems will change in the future and, paramount to that transition, will be the impact on clinicians, coders, clinical documentation improvement (CDI), case management, and finance. There is no change to the value proposition that compensation will be based on quality, outcomes, and cost. The two “hot” reimbursement models on the street (bundled payments and MACRA) have their challenges. But the foundation of both compensation methods is documentation and coding.
In a recent July survey with KPMG-AMA, 50 percent of healthcare systems had no knowledge of MACRA. That would seem to make sense since it is a new model from the Centers for Medicare & Medicaid Services. and everyone is keeping an eye on it but not prepared to react. The problem is that there are already changes in motion to the reimbursement, and most are not prepared.
Just to take a few moments to outline for you the challenges of MACRA and bundled reimbursement:
The transition to either compensation model is not easy:
In summary, healthcare is in constant change and never more so than now is the transparency between clinical, coding, operations, and finance on a track to more integration after the adoption of ICD-10.
But the real question remains: when do you pull the trigger, and is the juice worth the squeeze?
As discussed last week, payments to Medicare Advantage (MA) plans are adjusted to account for expected healthcare resource consumption by enrollees. Higher risk scores increase
Clinical documentation integrity (CDI) professionals work in a variety of settings, and although I mostly focus on topics related to hospital inpatient billing, this week
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