The Inpatient Prospective Payment System rule's focus on quality creates a need for increased collaboration among risk management, revenue cycle, compliance, and health information technology professionals, says one expert.
A significant portion of updates in the Fiscal Year 2015 IPPS final rule pertain to the Hospital Value-Based Purchasing (VBP) Program, the Hospital Readmissions Reduction Program, and the Hospital-Acquired Condition (HAC) Reduction Program.
"The IPPS rule speaks strongly about quality and with the patient care quality initiatives that CMS is driving and supporting," says Gloryanne Bryant, RHIA, CDIP, CCS, CCDS, AHIMA Approved ICD-10-CM/PCS Trainer, past president of the California Health Information Association, and National Director of Coding Quality, Education, Systems and Support National Revenue Cycle- Kaiser Foundation Health Plan Inc. & Hospitals.
This quality focus creates a need for increased interdisciplinary collaboration across quality, HIM, risk management, revenue cycle, compliance, and technology.
"In addition, the use of data is ever increasing with these initiatives to guide quality and future decision making," Bryant says. Organizations will need to establish strong data governance in the near future.
"The 2015 IPPS rule emphasizes that hospitals, physicians, coders, and clinical documentation integrity staff must understand the risk-adjustment methodologies inherent to value-based purchasing, which are outlined on the web," says James S. Kennedy, MD, CCS, CDIP, president of CDIMD–Physician Champions in Smyrna, TN. "These complex documentation requirements must be woven into the hospital's EMR fabric so as to not impede the physician's natural work flow or burden him or her with numerous post-discharge queries."