Wiki Pay For Performance: What can we expect?

[Pam Warren]

Recently, my organization is taking steps to move towards becoming an ACO (Accountable Care Organization), to provide healthcare through the Intsitute for Healthcare Improvement's "Triple Aim":

• Improving the patient experience of care (including quality and satisfaction);
• Improving the health of populations; and
• Reducing the per capita cost of health care.

Since I've been practicing this billing/coding gig for the past 20+ years utilizing an RVU and productivity model, I'm left wondering what this change will mean for coders. Since we won't necessarily be instructing physicians to improve documentation for reimbursement, I'm thinking that our role will be to provide instruction on documentation improvement for medical necessity, to support disease management, to report patient non-compliance (which is typically left out of the equation these days), and to report appropriate surgical services. I'm wondering if I need to brush up on disease process and pathophysiology? It appears that we maybe moving back to a reimbursement model similar to capitation.

I'm curious....is anyone else moving towards this model? Have you thought about where coding fits into this scenario? What are you doing to prepare yourself or your staff?