According to CMS, physicians who provide care to Medicare and Medicaid recipients would be granted increased liability protection “if they can demonstrate that they followed Established clinical guidelines based on a bill introduced in Congress recently”.

“The Saving Lives, Saving Costs Act” would create a “Safe Harbor” for physicians who “follow best practice guidelines”.  This Safe Harbor provision would also allow physicians to request that state-level malpractice suits be moved to federal courts.

In this fantasy of correct everything, committees from professional medical organizations would submit their practice guidelines to the Secretary of Health.  The Secretary would then approve such guidelines that would become the basis for a defense against malpractice.  Physicians would practice medicine based on a cookbook written by a committee and approved by non-physicians.  Does this even sound reasonable or possible in today’s ever evolving medical climate?  The reason the USA has the best medical practices in the world is because of great training, skilled practitioners and the amount of postgraduate education one must have to receive the credential from each discipline.

HSMN has worked with almost all of the faculty practices in the academic medical centers of the United States, and what we have found is not an absence of quality, but rather a presence of excellence that far exceeds clinical guidelines which are a minimum standard. We have also found that “Clinical Guidelines” are no substitute for clinical judgment in those situations where life and death are concerned.  Our concerns based on the many medical records we have reviewed over the thirty years (30) we have been in practice is often the inability of clinicians to connect clinical decision making to the requirements of clinical documentation on which all reimbursement, quality and peer reviews are based.  HSMN’s concerns fast forward to the introduction of ICD 10-CM and PCS which will require clinicians to provide the kind of clinical documentation for both inpatient, outpatient and office visits to be so specific that they may obscure the clinical decision underpinning of each diagnosis.

HSMN is working with many practices and faculty groups to create a “Bridge” between what exists today (ICD-9-CM/PCS) and the rote coding required by the book.  Instead we suggest a new program in which a synthesis of clinical judgment and interpretation can be done by coders who are not only highly skilled in coding, but also trained to be critical thinkers deeply immersed in the discipline for which they code.  HSMN calls this program CJCT or Clinical Judgment and Critical Thinking. This is a true marriage and the only real Safe Harbor.

HSMN has worked with physicians and coders in all clinical settings to help them see how to transition from ICD-9 to ICD 10 in a way that truly reflects how they practice. If your organization is interested in CJCT, contact Health Systems Management Network, Inc.

For more information call 866-908-4226 or Contact Us to set up an initial dialogue about how HSMN can help your facility or practice.