Value-Based Care in Medical Specialties: Improving Hierarchical Condition Category Capture.

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Tác giả: Joseph A Randy Englert, Christopher J White

Ngôn ngữ: eng

Ký hiệu phân loại: 341.23013 The world community

Thông tin xuất bản: Netherlands : American journal of medical quality : the official journal of the American College of Medical Quality , 2025

Mô tả vật lý:

Bộ sưu tập: NCBI

ID: 697128

Risk adjustment plays a key role in payment, especially in value-based payment models, which use a practice's performance with cost and quality metrics to determine reimbursement. Inaccurate representation of a patient's medical complexity can cause a practice to fall below cost and/or quality performance targets, potentially leading to a substantial loss of shared savings dollars. This quality improvement study evaluated the effectiveness of a clinical documentation excellence program, focused on addressing hierarchical condition category diagnoses, involving the medical specialties. The program included tools in the electronic health record, metrics to monitor and provide feedback on clinician performance, and regular interactions with the nurse and physician leads for each specialty. For clinicians of medical specialties, the education program resulted in an increase in the percentage of hierarchical condition category diagnoses addressed at outpatient encounters from 25% to 62% over a 2-year period.
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