HIM plays a vital role in healthcare ratings

Oct. 18, 2018

To ensure healthcare ratings accurately reflect the quality of care given, health information management (HIM) professionals should lead their organizations in developing a comprehensive audit plan that evaluates the coded data—the health information in a patient’s medical record—that is the foundation of healthcare ratings.

In the article “HIM’s Vital Role in Healthcare Ratings” in the October issue of the Journal of AHIMA, the monthly journal of the American Health Information Management Association (AHIMA), the author outlines strategies organizations must take to protect the integrity of their data, including an audit plan. This analytical process involves stakeholders from all areas of patient care and should provide an objective assessment of institutional data quality. The findings can be used to correct deficiencies, identify opportunities for improvement, and proactively monitor data quality over time, which ultimately should improve an organization’s rating.

In addition to the consumer perspective, accurate clinical outcomes data is important to the process of contract negotiations between hospitals and payers. The accuracy of this data helps organizations quantify their commitment to value-based and high-quality care.

Sample components of an audit plan 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.
  • A dedicated health data analyst to abstract and report on quality-related internal and external data.
  • 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.

The article also includes a summary of selected healthcare ratings systems such as Hospital Compare and Healthgrades. In addition, the author provides specific examples of how coding can negatively impact healthcare ratings.

AHIMA has more information