Stephanie Cecchini, CPC, CEMC, CHISP, AHIMA Approved ICD-10 Trainer – Aviacode
“Value” does not mean patients receive exceptional care or have first-rate outcomes. There are no perks if quality involves expensive services, whether those are the accepted standard of care or not. Value is defined by documenting and reporting from the approved list of CMS quality measures and keeping costs down. For example, a quality measure could include a pediatrician recommending a flu vaccination…but there is no quality measure to indicate the physician’s treatment or success with the child’s autism, which is the reason for the patient visit.
Failure to successfully report “quality data” derived in part from CPT, HCPCS Codes, and ICD-9-CM codes will result in Medicare pay cuts from all three separate programs. This is an average payment loss of 5% or more. Physicians who choose to participate are responsible for the added administrative costs. From a survey involving 48,000 physicians participating in these quality programs, more than 80% stated there was a negative impact on their practice efficiency and clinical productivity. Either way, the work of the physician has been devalued.
So what can you do? If you are not yet reporting codes for PQRS begin immediately in order to avoid an automatic payment reduction of 4% under the Value-Based Modifier program. Look for a coding partner who can assist you with the clinical documentation requirements and education your physicians need. Further, become involved socially to help communicate what “value” definitions really mean in our healthcare regulations. Patients like and trust their physicians more than politicians who are sacrificing their health to save costs, no matter how well-meaning.