In the most ideal world patients could choose physicians on the basis of the “Quality Scores” provided by some independent entity like a “Physician Consumer Reports”. According to

a study funded by the Physicians Foundation, the data suggest that this effort should be made a priority. Furthermore physicians should be paid on the basis of consistently high standards.

In reality and on the basis of work done by Lawrence Casalino, MD, PhD and MPH from the Department of Health Care Policy which looked at both the cost and time burden on Physicians in practice is inordinately high. Furthermore there seems to be little or no agreement on quality standard measures. In the new Arena of the ACA each Insurer has unique take standards for disease entities. Most of the physicians queried by Casalino indicated no two patients are alike. This is a fact they have to record in their clinical documentation. They cannot use Micro’s to describe each patient. The OIG has found significant evidence in the use of Micro (documentation) Electronic Health Record to bring a hammer down on some. According to the report published in Medscape on March 7, 2016 the estimated cost of the physicians in the “Quality study” is $40,000.

Value Based Care seems to be the next big wave and physicians must begin to think about how they will go about doing it. For some of our clients, we are doing combined clinical/Documentation/Coding review to see whether patient encounters and procedures are documented well enough to be scrutinized for Quality just based on best practices. Some faculty practices have begun to use this approach to make sure they have not overcoded, overbilled (inaccurate claims) or in any way made them an Opportunity for the OIG and CMS to take back some money. This is also a popular wave. It make sense to have one review to include each discipline within the practice and sample of records and claims in order to satisfy all of the above considerations. This has been our business of 30 years and we pay attention to what our client hospitals and large/small practices tell us.

Contact us to see how we can help.

Source: http://www.modernhealthcare.com/article/20160307/NEWS/160309890