The 2017 calendar year marks the beginning of a new approach to physician payment through the Quality Payment Program (QPP), an initiative created by the Medicare Access and CHIP Reauthorization Act to revise the physician payment system previously updated through the Sustainable Growth Rate.
Sally, a case manager assigned to surgical cases, has noticed a recent increase in challenging insurance cases since her hospital brought on a new trauma surgeon. One such challenging case began Christmas Eve, when an 80-year-old female patient with several fractures was admitted to Sally’s unit. The patient shared with Sally that her injury occurred when she tripped while exiting a major super store. She fell face first on an icy sidewalk. She had just finished her holiday shopping and all her presents were scattered in front of her. The ambulance drivers had been so accommodating. Before transporting the patient, they collected all the gifts and delivered them to the nearest hospital with the patient.
How we define, diagnose, and document diagnoses that predict morbidity and mortality is essential if we want our patient’s risk to be accurately portrayed.
