How hospitals are using AI software to improve outcomes in value-based care

Physicians today face increased pressure to produce more accurate, complete and compliant clinical documentation while simultaneously maintaining their focus on patient care and satisfaction. However, without better clinical documentation processes and technology in place, physicians and hospitals risk receiving inaccurate quality scores and lower reimbursement rates. CMS continues to advance the level of reimbursement it ties to clinical performance. By 2018, CMS expects to base payment criteria for Medicare value-based purchasing programs wholly on clinical performance according to efficiency of care (25 percent), patient outcomes (25 percent), patient experience (25 percent) and safety (25 percent). To achieve full reimbursement from payers in value-based care, "clinical coding should capture the complexity of the patient's condition -- the number and severity of comorbidities, the relationships between conditions and the results of treatments and interventions," Anthony Oliva, MD, vice president and CMO at Nuance, said during a webinar sponsored by Becker's Hospital Review Jan. 24.