Medaxiom Blog

After a long road of preparing for significant changes to Evaluation and Management (E/M) coding, revised policies on coding, documentation and payment of E/M services are now in effect. According to an American Medical Association (AMA) survey 100% of the major commercial payors said they would adopt new E/M guidelines, which means the changes that went into effect Jan. 1, 2021 have a significant impact on your program’s revenue cycle. It’s not too late to understand the evolution of E/M coding and documentation, and how to set your practice up for success in 2021 and beyond.

Like perennial flowers appearing in the spring, each and every year the thorny issue of physician slowdown breaks into the top five concerns for cardiovascular group and program leaders. Rarely does a cardiologist practice at full throttle and then simply retire on a chosen date. Typically, he or she will reduce day and/or evening responsibilities to extend the ability to continue practicing. While this may seem like a positive approach, given the backdrop of projected physician shortages (Figure 1), it presents significant challenges for program leadership.

The rapid impact of the COVID-19 pandemic has and continues to be at the forefront of our daily program operations. As we continue to be faced with several issues related to operating margins, revenue collection and reimbursement, safety has been our biggest priority. Thinking about accurate coding, clinical documentation improvement and ongoing education efforts are not top of mind… but should it be?

Authored by: John S. Rumsfeld, MD, PhD, FACC, American College of Cardiology’s Chief Innovation Officer & Rashmee U. Shah, MD MS, University of Utah Health, Division of Cardiovascular Medicine Cardiovascular medicine is inherently “high-tech”. The profession has a long history of adopting new technologies (i.e., transcatheter valvular therapeutics) to improve patient outcomes. However, healthcare delivery to improve efficiency and optimize prevention and health outcomes has not advanced in the same way. As a result, the U.S. still holds the title of most expensive, least effective healthcare system among developed countries. With CV disease a leading driver of healthcare costs in the U.S., we need solutions to improve care delivery.

Aligned? Not so Much The historical divide between CV physicians and hospitals/health systems is still alive and well in most programs despite contemporary trends in employment and contracted “alignment” models. We encounter it nearly every day and we often reside in one of two “camps” – the physician camp or the hospital/system camp. We can see how distrust, whether subtle or intense, can influence parallel decision-making processes and leadership structures. Differences are often years, or even decades old – management, infrastructure, compensation, call coverage or all of the above. Although it’s unintentional, this divided culture may cause our work to be more about our needs and managing margins and less about our patients.

MedAxiom’s recently released 2019 Cardiovascular Provider Compensation and Production Survey report unveiled heart failure insights for the first time. Heart failure physicians are still very rare in the cardiology workforce, making up just 2 percent of the total (Figure 1). For our survey, the designation of heart failure as the subspecialty type is made by the group responding. However, the Heart Failure Society of America corroborates how small this population of physicians still is, listing around 200 total fellows among its membership. Likewise, the American College of Cardiology includes 792 cardiologists who have received fellowships through its certification process, with another 105 currently in training.

Regardless of your role in your organization, you are likely intimately familiar with the administrative burden that accompanies documentation and coding and the crucial role it plays in a practice’s success. Because the process is complex and can be frustrating, mastering the art of documentation and coding requires “lifelong learning” and a team effort by all stakeholders.

What does “Patient Access” really mean in my Program? Patient access has become one of the hottest topics across the country in the majority of CV Programs. It seems so simple to “fix” however it remains a challenge. I have experienced that the definition of access has many meanings based on the individual’s interpretation in relation to their needs, schedule, organization, etc. Access has over time become synonymous with “value” care.

A common challenge in CV programs today is the cost/resource requirements of quality registry involvement such as NCDR-PCI and others. Due to several payer requirements for registry utilization, I’ve not yet been to a program that has not engaged with at least one registry in the CV program or service line. The challenge typically lies in the resource requirements for abstraction and registry data management. Although this is an important and real challenge, the bigger challenge I see is the utilization of the registry data in a meaningful way. Whether the registry is STS, NCDR-PCI, ICD, Action or others, there is a wealth of quality data that can provide feedback on patient outcomes, processes, clinical decision making and patient throughput. All of these can be tied to clinical outcomes, patient experience and the economics of your CV program. The key is using the data in a meaningful way to drive and support quality and process improvement within your organization. There are three areas that need to be managed in order to promote effective utilization of quality data - abstraction, data management, and program performance.

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