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Clinical Documentation for Higher Reimbursements

Karen Minich-Pourshadi, for HealthLeaders Media, October 29, 2012

As a healthcare organization moves from fee-for-service reimbursement to population health–based care, it must accurately define how sick its population is—not only to take good care of these individuals but also to be reimbursed correctly. If clinicians undervalue the population through the clinical documentation, then the government and payers will follow suit, and that can cost a hospital or health system millions.

Borgess Health, a health system based in Kalamazoo, Mich., was able to uncover more than $6 million in reimbursement by getting physicians to improve their documentation. Chances are that for your organization, it's as simple—and complicated—as that. 

Anthony Oliva, DO, CMO at Borgess Health, is no stranger to clinical documentation improvement. In 2004 he was vice president of medical affairs at Bayhealth Medical Center in Dover, Del., where the organization refocused its documentation process by taking a clinical perspective rather than concentrating on primary coding.

Bayhealth added a clinical documentation management program from J.A. Thomas to help get to the heart of assessing and reporting severity of illness (SOI) and expected versus observed mortality rates, to more accurately determine hospital and physician performance. So when Oliva arrived at Borgess Health, it was only natural that he looked at clinical documentation.

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1 comments on "Clinical Documentation for Higher Reimbursements"


Matthew Shafiroff (11/1/2012 at 4:17 PM)
This is an extremely interesting article, especially in the light of the recent CMS accusations of physician upcoding with the use of EMRs. Perhaps articles like this will help shed light upon the fact that big data (from EMRs) allows us to understand where we have been chronically under-documenting for years.