News: CMS posts Value-Based Purchasing Issues Paper

On November 25, CMS posted an Issues Paper relating to its plan to transition to a Medicare Value-Based Purchasing (VBP) program for physician and other professional services. Download the paper here.

The paper is important for CDI specialists because it contains powerful proof that the payment incentives included in the VBP program will be tied to quality documentation.

“It will cost doctors money if they don’t practice and demonstrate efficiency in all facets of medicine, which includes ordering and providing the appropriate level of care, taking into account the health status of the patient,” says Glenn Krauss, RHIA, CCS, CCS-P, CPUR, FCS, PCS, C-CDIS, senior coding and chargemaster consultant with QHR in Brentwood, TN. "It is the physician’s responsibility to accurately and effectively report the health status of their patients through clinical documentation that supports and justifies consumption of health resources, regardless of diagnostic or therapeutic service ordered and provided."

For example, many tests physicians order don’t include a firm diagnosis, only a symptom, which will not satisfy the direction physician payment is headed under VBP—payment based on quality and efficiency, instead of the current model of quantity and volume of services.

“Our job is to help physicians substantiate their practice of medicine, which they don’t always think about,” Krauss says. “The (VBP) methodology hasn’t been established, but your best defense is for the physician to document what he or she is thinking.”