Structure refers to hospital resources directly related to patient care. Process refers to delivery of care which encompasses diagnosis, treatment, prevention, and patient education. Outcomes are typically measured by risk-adjusted
mortality. Coding considerations include correct abstracting of a patient’s discharge disposition and accurate coding
of PSIs as defined by AHRQ.
A Different Perspective on HIM Audits
Despite the fact that healthcare ratings are an imperfect science,
they matter greatly to providers. Consumers’ perception is their
reality and if a healthcare organization’s rankings are unfavorable, consumers may take their business elsewhere—despite
the fact that the rankings may not reflect the true level of quality
provided by the organization. In order to ensure rankings accurately portray an organization’s quality mission, it is beneficial
to create a comprehensive audit plan that evaluates the data elements that factor into healthcare rankings.
A sample audit plan may include:
C-suite awareness of the advantages of HIM’s role in elevating or maintaining their organization’s rankings.
A designated HIM professional within the organization to
serve as the subject matter expert on the specific coding-related elements that factor into healthcare rankings. Since
each rating system uses slightly different elements for their
calculations, creating a database of the data elements
would be a valuable planning tool which would need to be
updated over time.
Incorporation of a designated HIM professional on the
Inclusion of quality scores in the executive and leadership
Dedicated health data analyst to abstract and report on
quality-related internal and external data.
A focused quarterly audit plan that assesses documentation quality and coding integrity through the lens of healthcare ratings.
A joint effort between clinical documentation improvement teams and HIM to objectively analyze audit findings
and craft education tailored to address gaps identified by
Follow-up audits to proactively identify documentation
gaps and coding errors that could lead to negative rankings
if not corrected.
Transparent communication with all team members on the
link between ratings and their organization’s fiscal health
and longevity, both of which are essential to job security.
HIM Should Use Skills for Ratings Improvement
HIM professionals bring the voice of data quality expertise to
the healthcare ratings conversation. According to AHIMA’s HIM
Reimagined (HIMR) white paper, “HIMR is, by design, future
focused and likely does not reflect what many are currently observing in their workplace settings. The recommendations in
this document are bold and ambitious and hold promise for future advancement for the HIM profession.” 3
In order to grow beyond the bounds of traditional HIM roles,
professionals must position themselves strategically to demonstrate their ability to positively influence healthcare organizations on a broad scale. Locking arms with their organization to achieve desired rankings is a perfect example of the
importance of continually scanning the healthcare landscape
for ways in which HIM professionals can use their skills in new
and different ways. HIM professionals’ unique training makes
them indispensable to many different areas of healthcare—a
fact that sometimes needs to be spotlighted with greater effectiveness. Work on improving healthcare quality ratings provides that spotlight. ¢
1. Lund, Kenneth. “ 10 Points for Negotiating Hospital Contracts.” American Health Tech. May 2013. www.healthtech.
2. Ducharme, Jamie. “Do Hospital Rankings Really Matter?” Boston. August 4, 2016. www.bostonmagazine.com/
3. AHIMA. “HIM Reimagined – Transformation Starts With
You.” White paper. 2017. www.ahima.org/about/him-rei-magined/himr?tabid=whitepaper.
Deloitte. “Understanding Medicare’s 5-star rating hospital
program.” Modern Healthcare. www.modernhealthcare.
Gruessner, Vera. “How Quality Metrics Affect Value-Based Care
Reimbursement.” HealthPayer Intelligence. June 29, 2016.
Medicare.gov. “Hospital Compare – Data sources.” www.
Seth, Sanjay. “The advantage of data analytics when negotiating
value-based contract terms with payers.” Becker’s Health IT
and CEO Report. June 20, 2018. www.beckershospitalreview.
Daniel Land ( email@example.com) is director of revenue integrity and
compliance review services at MedPartners.
Quiz ID: Q1828909 | EXPIRATION DATE: OCTOBER 1, 2019
HIM Domain Area: Management Development
Article—“HIM’s Vital Role in Healthcare Ratings”
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HIM’s Vital Role in