A Better Approach to Risk-Coding?

 

I’ve seen this in two different organizations who don’t financially risk-share with their physicians.

 

 

Their clinicians do no risk-coding.

 

 

 

None.

 

 

 

Zero.

 

 

 

Their back office coders extract risk-codes from the documentation of every office encounter and submit them in aggregate to their insurance partner through a spread sheet.

 

 

 

They know that even if their own internal staff misses a code, their insurance partner will diligently pick them up with their own systems.

 

 

 

Did the doctor forget to address a problem? A staffer calls the patient to get them to come back in. Or offers a home visit by an NP to fill the gap.

 

 

 

The physician is relieved of all “coding” and “data coordination” responsibilities.

 

 

 

In both cases, the physicians see more patients per day and, according to the administration at least, seem to be much happier (no change in turnover, though).

 

 

 

The economic law of comparative advantage confers a benefit to organizations with systems in which individuals are responsible for tasks for which they are best suited.

 

 

 

Let you clinicians be clinicians.

 

 

 

Leave the data management to your staff.

 

 

 

Everyone will do better.