In this episode, HIM veteran and product manager at TruCode, Becky DeGrosky, discusses trends and challenges in HIM live from the 2016 AHIMA Convention.
Michael Passanante: Hi! This is Mike Passanante. Welcome back to the Hospital Finance Podcast. Very happy you could be with us.
Today, we are live from the second day of the AHIMA convention in Baltimore, Maryland. And I’m joined by Becky DeGrosky who is a product manager at TruCode. Welcome Becky.
Becky DeGrosky: Thank you Mike, nice to be here with you.
Michael: It’s great. It’s a great show and a lot of new things going on, so we’re happy to have a few minutes to talk to you about some of the challenges and changes that are going on in the HIM marketplace.
Becky just for our listeners, could you tell us a little bit about your background?
Becky: Sure! I’ve been credentialed HIM for longer than I care to say, but I’ll tell you, it’s been 40 years plus. I’ve seen ICD8, ICD9, ICD10, and we’ve survived them all. We survived them all.
Michael: And we will continue to in the future, right?
Becky: Exactly, exactly.
Michael: You just mentioned the ICD10, and now we’re a year into it. The grace period is over. Things seem to be going well. And we started off that process with something called Computer Assisted Coding. We were chatting on that just a minute ago.
Becky: Right! The CAC – Computer Assistant Coding – seems to be the answer for everyone as they’re approaching ICD10. This would save us production. We wouldn’t need all the coders that we were going to need in preparation for this crazy new coding system.
And it seems to have lost its glitter, its sparkle. People don’t seem to be as entranced with it. It’s not the system that’s the big deal here this year as it was in past years.
Michael: So, where do you see that moving to?
Becky: Believe it or not, I see more and more systems that are CDI which is Clinical Documentation Improvement. And what’s crazy to me about that is this is not a new idea. It’s been around for a long time. It’s just that now it has a new name. And now, we’re finally getting our arms wrapped around systems for it. And it’s a good thing. It’s a good thing for the hospitals.
In the 40 years, physicians have never documented well. So we’ve always been on the course of documentation improvement.
Michael: And we’re here in October. 2017 will be upon us before we know it. What are some of the challenges that you’ve seen the marketplace or maybe that you’re hearing here at AHIMA?
Becky: Well, the whole change in the MACRA Act where we’re going to start really enforcing the risk adjustment and the payment for the risk adjustment patients. And people are moving and really looking into it. I think it’s one of the hottest topics I’ve heard today in the convention.
The HCC codes from CMS—well, actually, they’re from the Health & Human Services. They’re at an even higher level. They are assigning hierarchal classification codes to the ICD codes, and then it assigns a risk assessment to it. That way, on the big data level, you can look at a patient’s cost, their continuum of care from the doctor’s office through the hospital through the pharmacy codes.
And we can say, “Hmmm Becky DeGrosky is a high risk. We don’t want her. We have to have her” because by law, they can’t turn me away. But we’re going to pay you more money to take care of her because we’ve already recognized that to be a risk. And “Hey Mike, he’s pretty healthy. He doesn’t have a whole high risk. We’re not going to pay you as much to take care of him.”
This is really where we’re moving both from the physician pricing models to, eventually, the facility models where they’ll start assigning them through the facility and paying everybody who’s in any kind of a risk pool.
Becky: You have to remember that with that payment methodology, you’re still getting paid. But now, you either get a bonus at the end of the year or you don’t get the bonus at the end of the year.
I think that, frankly, it’s a good way for us to move. This would be finally looking at everything that we’ve tried to do with risk over the years with the MSDRGs with the APRDRGs. This is much more refined.
Michael: So, let’s go back and touch on MACRA a little bit more because you see what’s out there in the marketplace right now. You see that a lot of doctors don’t even know what MACRA is. There’s been some congressional action trying to figure out how to time this, how to educate them, how do we roll this out in an intelligent way.
How is that affecting the implementation of systems that really track against that or can help the doctors do what they need do?
Becky: For one thing, physicians have never put a focus on the coding of their claims. They would code it to get it paid. This is a good code. Fatigue was always a good code. No matter what you gave the patient as far as testing, you’d get it paid.
Well, those days, fatigue isn’t something that—those days are gone. That isn’t something that’s going to get you big bucks. You have to really pay attention to your documentation even at the physician office.
And what I’ve seen through this conference so far, a lot of the consulting firms that we’re focused in improving coding and improving DRG assignment in a hospital setting are changing their focus on looking now in the physician office. So, they are providing that education for the physicians.
And in the long run, it will improve the hospital’s documentation because if you start at the very beginning and bring it up—
I’ve always said that one of the problems with the DRG system, the hospitals don’t employ the physicians. They employ the hospitals. But over the big course, they don’t. So they can’t really force them to do anything that impacts the hospital bottom line because it doesn’t impact the physician’s bottom line. He’s still getting paid whether the hospital is or not.
This is a way that that’s going to improve that documentation.
Michael: And it should improve compliance too.
Becky: Oh, absolutely, and quality of care. Again, it can’t always be about the money. We have to be coding thinking about quality of care, thinking about the statistics and the reporting that needs to be done with the things that we code.
A lot of people even in the hospital will code and get their CC, their MCC. “Hey I’m in a good DRG. I don’t need to worry about all the other things.” Well, interestingly, because HCC codes with the risk assignment do run the continuum of care, there are some of those codes (a good many of them) that are not CCs and MCCs for the hospital, and yet they’ll increase your risk assignment and you’ll get paid more of them.
So, in the long run, I think it’s a good thing. It’s a good thing.
I think that health care in America—see, I am sorry. I’m going to get on my little band box here. We know we have issues. We’re not providing the best care in the world anymore. We’re not the healthiest people. We should be and yet we’re the most expensive. That’s wrong. It’s a broken system. It’s been broken for a long time. But we need to go about fixing it in the right way.
And the sad truth is Medicare does drive everything because it’s the 80/20 theory. Who gets sick? Who’s in the hospital? Have you been in a hospital lately? It’s old people. It’s Medicare patients. So that’s what drives it.
I’m going to be a Medicare patient in a few years. I want to make sure that I’m getting quality and that somebody’s paying for me. This is all I think of, just improve, improve the whole system.
Michael: And beyond Medicare, it should improve the private payer’s side.
Becky: Correct, absolutely.
Michael: Yeah. I mean MACRA is just the start of how private payers will want to pay physicians, right?
Becky: Exactly! And Medicare managed care is really managed by those private payers. And that’s the biggest chunk, when you come down to it, of Medicare and Medicaid.
I’m from Pennsylvania. And in Pennsylvania, a 100% of our Medicaid is managed. And it has been for a long time. Those things are going to improve it for us.
And of course with the Medicaid population, you’re looking at different risk assignments because now you have a younger population. We don’t have a whole lot of pregnant Medicare patients. You’re dealing with younger people. You’re dealing with different risks, different criteria.
And when I was young, I didn’t complain that I had to pay for the old people. I just paid and knew that there are going to be young people that are going to come behind me. They’re going to pay for me. But it doesn’t seem now. People don’t want to do that. But you have to pay it forward.
And that’s what health care is all about. We have to take care of everybody.
Michael: Becky, that’s a great note to end on, some great information.
Could you just share for our audience a little about TruCode and what you do?
Becky: Sure! TruCode is a encoder. I always say we’re a one trick pony and we do that trick better than anybody else because we’re focused that way.
We provide encoding software, either in a client-server installed system or with our TruCode Encoder Essentials which is controls and services. Or right now, we’re working on the next generation of TruCode where we’ll either be hosting in the cloud or you can still load it on to your own server.
Michael: Good! Well, there’s our two-minute warning. Becky, have a great rest of the show. It was a delight meeting you and I appreciate your time.
Becky: Great! Thanks Mike.
Michael: Alright, thanks so much.
Becky: Bye bye.