Healthcare organizations face many challenges, from ICD-10 and meaningful use, to accountable care (ACOs) and value-based purchasing, and all of these initiatives impact health information management (HIM) and carry a common theme: data.
With the focus on quality metrics, it has become a strategic advantage to place a high value on HIM because the revenue cycle both begins and ends with clinical documentation from the patient's medical record. The HIM workflow must have the resources and processes in place to provide measurable overall improvements in revenue cycle performance, making HIM a critical success factor in both patient care and appropriate reimbursement.
The advent of ACOs requires cross-functional thinking, operations and data analytics across the continuum of care. ACOs are going to be very data driven and will require HIM professionals to have the data analytics expertise required to build an infrastructure and reports that demonstrate the ACOs position and metrics towards improving patient outcomes, decreasing costs, ensuring patient safety, enhancing the patient experience, and contributing to community health and wellness goals.
The success of an ACO will be measured with metrics that will either drive incentive payments for high- quality and low-cost growth, or penalties for those that do not achieve success with the outcomes. HIM professionals have the domain expertise in data analytics to be a valued member of the team.
A critical success factor for data analytics is a strong data and information governance program to ensure data integrity under the leadership of HIM. As healthcare moves away from fee-for-service and toward value-based reimbursement, it has become clear that HIM is no longer just about getting a bill out on time.
Success under Patient-Centered Medical Homes (PCMHs), ACOs and other new value-based purchasing reimbursement models will require HIM professionals to be recognized as the stewards of patient data. The expanding HIM influence in the revenue cycle-starting from the moment a patient enters the system-can open opportunities to improve data integrity, productivity, and ultimately, reimbursement.
Data governance encompasses the high-level, corporate, or enterprise policies and strategies that define the purpose for collecting data, the ownership of data, and the intended use of data. Information governance is the "value add" provided by the HIM professionals in a healthcare enterprise. Providing the oversight for health information integrity is the sweet spot of the HIM professionals, and it is their ethical obligation to assure compliance via organizational health information policies, processes, dictionaries, rules and regulations, playbooks, decision rights and responsibilities. It is the work of the data stewards, on a daily basis, that ensures the appropriate use and management of health information.
The HIM professional's role in meeting the revenue cycle goals is defined by their ability to provide oversight for Information Governance by combining emerging technologies with innovative processes. HIM professionals are ideally suited to be leaders in information governance to help ensure integrity across all types of data and stakeholders.
The Patient Protection and Affordable Care Act (known as ACA) requires providers to meet certain standards such as increased use of electronic health records (EHRs). This requires information governance to maintain full and accurate records that are kept confidential and secure. Now, new information governance roles are emerging that require HIM expertise in the transition to ICD-10 and computer-assisted coding (CAC), clinical coding compliance, and reporting for meaningful use audits. All oversight areas of information governance affect the integrity of the data which has a direct impact on patient care and the effectiveness of the revenue cycle program.
The HIM professional has consistently demonstrated leadership in assuring that health information used for all purposes is accurate, complete and trustworthy. Healthcare industry executives should recognize and promote the HIM professionals' leadership in the revenue cycle and tap into HIM resources for strategic and transition planning to the new reimbursement models.
For decades, the American Health Information Management Association (AHIMA) and the HIM profession have led the call for uniform interoperable data and information including guidelines for best practices and clinical coding standards. Recent concerns that EHR implementation could lead to fraud further highlights the need to establish these standards. These standards will address data integrity, patient safety, quality measurement as well as traditional concerns regarding billing fraud.
It is the HIM professional who provides the oversight and drive for data integrity with an effective and meaningful information governance structure. It is because of information governance and the commitment of your data stewards to carry out the work of ethical clinical coding and compliance that you can feel confident that your revenue cycle program is well documented and sustainable, as reimbursement models change in our healthcare industry.
Bonnie S. Cassidy, MPA, RHIA, FAHIMA, FHIMSS, is senior director of HIM Innovation, Nuance Communications Inc.