Healthcare Technology Featured Article

July 10, 2017

Value-Based Purchasing Revisited



These days, I am often asked about the impact of Clinical Documentation Improvement (CDI) on Value-Based Purchasing (VBP). First, of course, I make sure that the person asking the question is inquiring about Clinical Documentation Improvement (and not Clostridia Difficile Infection, also referred to as “CDI,” sigh). In a previous blog entry, I reviewed the great opportunities for  impact of CDI on VBP. As I watch all of the recent political activity in Washington with regards to health insurance, I am reminded that VBP was enacted as part of the Affordable Care Act, and thankfully those provisions do not appear to be on anyone’s chopping block (at least not just yet), and they can still be affected by CDI.

So, given that the current estimates are that 60 percent of reimbursements in 2018 will be based on VBP methodology, let’s dig a little deeper into what contributes to the impact of the payment adjustments in the “2018 Domains:”

-Safety (25 percent), including:

-Clinical Care (25 percent) including:

-HCAPS: Hospital Consumer Assessment of Healthcare Providers and Systems (25 percent)

  • Communication with Nurses
  • Communication with Doctors
  • Responsiveness of Hospital Staff
  • Pain Management
  • Communication about Medications
  • Hospital Cleanliness and Quietness
  • Discharge Information
  • Three-Item Care Transition
  • Overall Rating of Hospital

-Efficiency & Cost Reduction, measured by Medicare Spending per Beneficiary (25 percent)

The measurements associated with Safety and with Clinical Care are ideal for review by the Clinical Documentation Improvement process, and CDI can have a significant impact. Try as I might, I have not figured out a way to link CDI with HCAPS scores, but of course I’ll keep working on that. And while a CDI program tightly tied with quality and core measures can improve Efficiency and Cost Reduction, I won’t try to claim credit for that.

Ramp up your CDI program to be on the lookout for the Patient Safety Indicators that will be part of VBS, and help ensure that your hospital is able to optimize their reimbursements in the new era. While I don’t want to venture into politics, I am reminded of what politicians and the major media outlets seem to have forgotten, namely that health care legislation involves much more than pre-existing conditions and Medicaid coverage. Value-Based Purchasing methodology appears to be here to stay – get familiar with it!

About the Author

Dr. Jonathan Elion, MD, FACC, is a practicing board-certified cardiologist in Providence, RI and an Associate Professor of Medicine at Brown University. With over 40 years of experience in computing and more than 25 years of experience in medical computing and information standards, Dr. Elion has committed his career to innovations in high value services and healthcare delivery to maximize efficiency and cost effectiveness.  Jon is the founder of ChartWise Medical Systems, Inc., a Rhode Island based company that recently introduced ChartWise 2.0.  It is the first-to-market interactive software system designed to improve precision in quality clinical documentation and to support revenue assurance through its web-based, comprehensive built-in expertise, electronic queries and robust on-demand reporting.

By Special Guest
Dr. Jon Elion, MD, FACC and Founder/President of ChartWise Medical Systems ,




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