How PCPs can leverage better coding to succeed in value-based care

Over the last decade, as health care solutions have become more specialized and fragmented, primary care physicians (PCPs) have frequently been cut out of the loop, particularly in coding initiatives. Retrospective and in-home risk assessment solutions work around PCPs. This dynamic further complicates PCPs’ ability to thrive in value-based care, which hinges on primary care being underscored.

PCPs can take back control of care and accelerate their own transition to and success in value-based care through active participation in health plan-sponsored coding and documentation initiatives.

Why current approaches to coding and documentation don’t work

When I was a practicing cardiothoracic surgeon, I attended a health care conference at which I heard the CEO of a home assessment company tell an audience of health plans and providers that physicians could not complete the coding and documentation required for risk adjustment. With that assumption, he concluded that his organization and other home assessment companies were the best choice for Medicare Advantage organizations to hire to collect the codes, and the associated revenue.

I was angered at hearing this. How could an unqualified provider with very little knowledge of a patient’s medical history accurately diagnose and provide a treatment plan? I immediately went to research everything I could on Medicare risk adjustment and the Medicare Advantage industry. And, as it turns out, CMS had the same question I did. These approaches often focus on collecting codes and not providing comprehensive treatment—a major impediment to value-based care success.

I realized that to achieve better outcomes and succeed in value-based care, PCPs must be empowered to drive all aspects of care—the assessment, diagnosis, coding, and treatment.

How quality coding improves value-based care performance

Value-based care is about efficiently providing the highest quality of care to improve outcomes. Finances and quality of care are inextricably linked. Success in value-based care depends on accurately assessing your population’s needs so that your payments will be sufficient to deliver appropriate care. And for PCPs, succeeding in value-based care should be an urgent initiative since each year, alternative payment models shift more risk to providers.

As a PCP, why would you leave the fate of your reimbursement and value-based care transition to a home assessment company that doesn’t know your patient? Not to mention, any time an outside clinician sees a patient for coding, that may be a missed reimbursable visit, opportunity to deliver a preventive service or chance to close a care gap.

Removing burdens and barriers to improving care

While it’s true that PCPs should be at the center of care, the reality is that they don’t have time for yet another task to be added to their plates. I know the mounting challenges faced by physicians these days. I lived it. For PCP practices, particularly those who serve seniors, reimbursement models are changing. And the new models demand vigilant documentation, accurate coding, additional practice resources and subject matter expertise that most physicians don’t have. This dynamic was greatly compounded by COVID-19, which has caused a precipitous decline in provider visits and revenue.

Fortunately, there are PCP-centric solutions to help providers navigate these challenging times and thrive in value-based care. PCPs must be empowered with the right tools, resources, and technology to improve documentation and coding to focus on succeeding in the new value-based care environment. I encourage PCP-centric solutions that allow PCPs to improve clinical and financial performance, while not adding more administrative burden.

I’ve heard providers say for a long time, “When value-based care comes, then I’ll pay more attention to coding and risk adjustment.” But, with the way data lags in value-based outcomes, your coding and documentation today affects your performance down the line. The time to focus on improved coding is now.