Put GI Data to Work: How to Leverage Data to Improve Reimbursement Rates
Ask a Gastroenterologist is a weekly series of questions posed to GI physicians around the country on business and clinical issues affecting the field of gastroenterology. We invite all gastroenterologists to submit responses. Next week's question: How can gastroenterologists get involved in population health initiatives?
Question: How can gastroenterologists use data to leverage improved reimbursement rates?
Patrick Takahashi, MD, CMIO and Chief of Gastroenterology Section of St. Vincent Medical Center (Los Angeles): Gastroenterologists can leverage data to improve payer contracting in a multitude of ways.
Physicians should be aligned with both the payer as well as the surgery center in order to guarantee payment to both entities. Physicians not aligned often times may perform procedures without prior authorization, which is a recipe for reimbursement denial.
Being aware of national benchmarks as it relates to complication rates regarding infections, other post procedure complications, or post procedure ED visits can prove invaluable to a surgery center and its physicians to prove quality-based care as well as value.
Clinical quality measures will continue to become more stringent as regulatory agencies continue to put their footprint on healthcare. By asking physicians to review data on their patients on a monthly basis, this information can be properly accrued and sent off to payers to help strengthen the process of payer contracting. Payers are looking for positive numbers to justify alignment with centers and physicians. If physicians can demonstrate high quality healthcare in the setting of efficient resource utilization, they will position themselves and the center for a win-win. Hospitals have a much more difficult time with resource utilization, and this is where a surgery center can truly shine — by demonstrating efficiency with disposable equipment, personnel and the like.
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