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Common issues that put your practice at risk for financial ruin.
With the trend away from fee-for-service, and the increased shift to pay-for-performance and value-based care, risk adjustment scores play a pivotal role in the physician office’s balance sheet. Managing risk scores year in and year out, however, is a task that many organizations struggle with. Here are some of the most notable reasons why, and how you can overcome them to improve your practice’s risk scores.
Yearly Adjustments to Risk Score in Certain Chronic Conditions
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Assume congestive heart failure has a risk score of 0.455 this year, and you have 10 patients/members in the office with this condition. In the coming fiscal year, the score is adjusted to 0.420 — establishing a drop of 0.035 for each of those 10 members in the practice.
While it is difficult to predict how much a particular condition’s risk score will be dropped, the best way to prepare for the reduction is to familiarize yourself with the Centers for Medicare & Medicaid Services (CMS) call letter, published each year on or around April 1. The call letter has valuable information for all things related to risk adjustment and rate tables for each hierarchical condition category (HCC) for the upcoming fiscal year.
Membership Changes
When members leave or enter the membership panel, providers are likely to see negative drops to total risk scores. This usually happens when members transfer to another provider or pass away. New members tend to disrupt the score because their disease burden is mostly unknown to the practice.
Patient retention is key to risk scores. Here are a few customer service tips:
- Always treat patients as you would want to be treated — with compassion and kindness.
- When a member passes away, call the family or send a card to the closest family member.
- For new members, review the membership roster on a monthly basis, identify new members, and start your outreach via phone, letters, etc. If the office offers transportation, invite the patient to come in for a next-day appointment.
The goal is to get the members into the office to mitigate risk and document chronic ailments. If your electronic health record (EHR) has a patient portal, consider uploading a medical history questionnaire to get this process rolling.
Poor Documentation and Coding
Jotting down a laundry list of chronic illnesses for the patients is not enough; physicians must include supporting documentation that includes the status, treatment, and results of the conditions being treated. Generally, physicians are not trained as medical coders, and that is a recipe for potential coding errors, especially when conditions require combination codes.
Example: Diabetes with chronic kidney disease, stage four – ICD-10-CM E11.22 Type 2 diabetes mellitus with diabetic chronic kidney disease, and ICD-10-CM N18.4 Chronic kidney disease, stage 4 (severe).
As medical coders, we need to help physicians make the connection between their clinical documentation and the medical codes. If a patient has diabetes, for example, and the most recent laboratory value indicates evidence of chronic kidney disease, a well-trained coder may write a query asking the provider for clarification regarding the clinical significance between diabetes and the abnormal lab result. Generally, the physician will understand and quickly learn that the cause-and-effect relationship between diabetes and its comorbidities must be documented before it can be coded.
The Absent Patient
Patients who do not come for regular office visits, cancel appointments, or don’t show up hinder the practice’s ability to generate accurate risk scores. Those same patients often end up requiring an extravagant amount in funding to care for a catastrophic ailment.
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Tips for increasing office availability and reducing no-shows and cancel rates include:
- Offering walk-in visits
- Having multiple open slots in the schedule to accommodate late visits
- Opening the practice half a day, two Saturdays per month
- Offering telehealth services if your locality allows
The Big Picture
These are just some of what practices can do to improve their risk scores. Incorporate one or more in your office to protect your organization’s financial viability.
For more information about risk adjustment, read these Healthcare Business Monthly articles:
- 4 Tips for Managing Risk Adjustment Scores - March 1, 2020
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20:40 Thissmytime
This is a pretty winnable race given it’s a Grade 2 and has $200k in the kitty. It revolves around Cinnabunny and Thisismytime. You can never say never with Brad Cox, but his Cinnabunny has done all her best work at 6 furlongs and the 7 furlong trip poses a big question tonight.
This is no issue for Thissmytime who has won at 6f, 7f and a mile including three wins and two places at Gulfstream Park. I’d expect her to stalk Cinabunny and take it up in the straight.
21:13 Doswell
Sadler’s Joy backers may face the all too familiar feeling of backing the best horse in the race while throwing their dockets in the bin! He’s an extremely tricky ride and doesn’t win half the races he should. they are likely to go no pace in this 12 furlong turf race and Doswell in stall one, makes plenty of appeal. While the trip is a question mark, he should be allowed set a sedate gallop on the front end and use his speed to try and outsprint the field at the finish.
4 To Score Tips For Beginners
His second last time out reads well, given the horse that beat him is one of the market leaders for the Pegasus Turf later on the card.
Best Score Tips
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21:59 Cross Border
The third edition of the Pegasus Turf is a pretty poor affair and lacks a standout horse – or anything close to one. I’m staying well clear of the front of the market and will play Cross Border at hopefully a double-figure price in a race we are paying 4 places.
With nine wins and nine places in 30 career starts, he is very consistent. He doesn’t quite get home over 1m 4f and is just too slow for 1m, today’s 1m 3f trip should be perfect. Trainer Mike Maker and jockey Tyler Gaffalione both had north of 250 winners in 2020 and a combined strike rate of 23 per cent. I’d expect Cross Border to be placed just behind the leaders in a race where there shouldn’t be much pace on up front.
22:44 Code of Honor
We are running our online MBS here with money back on horses than finish 2nd, 3rd and 4th(usual T&C’s apply) as 12 go to post for this year’s Pegasus World Cup. The race lost its likely favourite in Charlatan, but still has a superstar in Breeders Cup Dirt Mile winner, Knicks Go.
He has looked a changed animal since moving to Brad Cox but races at Gulfstream for the first time, without race-day medication for the first time and faces a trip that’s he’s never won over.
The play is to look to get him beaten and I’ll do that with Code Of Honor. The draw in 10 could be better, but he’s tactically versatile and has ran some excellent races this year. He’s won at the track and gets his perfect trip too. What’s not to like?
Sean O’Sullivan’s Saturday selections at Gulfstream
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20:40Thissmytime
21:13Doswell
21:59Cross Border
22:44Code of Honor