Despite the fact that revenue from risk-based contracts continues to increase for medical groups of all sizes, motivating providers to fully participate in their organization's risk adjustment efforts remains a challenge for healthcare organization leaders. Because of this, many organization leaders have started looking for different ways to motivate their teams of providers to drive better engagement in HCC Coding & risk adjustment documentation. In our first blog post of this series, we discussed the importance of HCC coding and optimal documentation, its challenges, and the role of the individual provider. 

In February of this year, the ONC and CMS proposed a new interoperability rule that promises to be a game-changer for patients, providers, and software developers like us. Given that the federal government has spent tens of billions of dollars trying to get clinical providers on the electronic health record (EHR) bandwagon with, questionable results at best, it’s a case of better late than never. Here is my perspective as CEO of a clinical decision support startup that stands to benefit from the rule, once it is implemented.

Medicare Advantage plans use Risk Adjustment Factor (RAF) scores to determine patient care expenses. The RAF is therefore a benchmark that enables the Centers for Medicare & Medicaid Services (CMS) to estimate future spending. With higher RAF scores, the amount Medicare pays Medicare Advantage plans for patient care also increases. Ultimately the goal is to improve patient outcome with reduced costs. Risk adjustment can also affect physician income. More recently, Medicare is using the HCC model to allocate costs for patients in Medicare Accountable Care Organizations.

What should Athenahealth users know about Infera?

Down in the trenches of Medicare Advantage primary care, most providers in the business know the importance of HCC coding. However, for the busy practitioner who is taking care of the patient and dealing with an alphabet soup of mandates such as HEDIS, STAR, HCAHPS etc, it is quite a task to pay attention to HCC coding in real time. As a result, providers fall short and have to answer then queries from coders re HCC codes that may have been missed.

As CEO of a startup whose main product  provides advanced clinical decision support (CDS), I read with interest the draft guidelines for CDS software that The CDS Coalition came out with recently. I was also curious to see how our application, Infera, stacks up against the guidelines. I am happy to report that it stacks up really well. Read on for more details:

Inferscience is proud to announce the release of an innovative new technology for optimal HCC coding at the point of care in real time.  The HCC Assistant was designed to optimize accurate and real time documentation of the patient conditions critical to predicting the risk and future cost of Medicare Advantage patient populations.

In healthcare, we’re accustomed to things moving slowly. But every so often, trends accelerate and leaps are made, for better or sometimes worse. Recent news from two large EHR vendors about the adoption of open APIs signals an encouraging trend.