Accurate coding is crucial to accountable care because it is strongly associated with the kind of care patients receive.
That’s the takeaway from new research by Humedica, which shows that patients with major chronic conditions who are uncoded use far less primary care, but much more acute care. Diabetes patients without a coded diagnosis, for example, saw primary care physicians 73 percent less often than coded patients, but had 45 percent more inpatient visits and 30 percent more emergency department visits.
What’s more, once uncoded patients with chronic conditions were coded, their use of outpatient services increased nearly threefold, and their clinical outcomes improved.
Clearly, uncoded patients represent a significant opportunity to improve care and lower costs. But Humedica’s research team wanted to better understand the connection between coding, utilization of care and clinical outcomes. The team dug deeper into its data to find out why uncoded patients use more acute care, whether they’re sicker than patients with a coded diagnosis, and after being coded, who improves the most.
Focusing on conditions like diabetes and hypertension—which are responsive to ambulatory care interventions—Humedica found that at baseline, uncoded patients were sicker than coded patients. Almost half had evidence of two or more conditions, and many were poorly controlled.
Using a scoring system that was developed to estimate each patient’s risk at baseline, Humedica discovered that 11 percent of uncoded patients fell into the highest risk category versus only 6 percent of coded patients. The data also revealed that a significant number of uncoded patients are relatively complex, and have a high risk of future problems requiring higher levels of care.
But being sicker only represents half of the problem for uncoded patients. The other half is seeking the wrong kind of care.
Uncoded patients use 42 percent less primary care than coded patients, while their rate of ED and inpatient utilization is 14 percent and 19 percent higher respectively.
Identifying uncoded patients and more proactively engaging them in ambulatory care to curb their use of the hospital and ED makes sense. The question is, once they’re coded, will this scenario play out? I’ll address that subject in my next post.
For more on this topic, please download: “Uncover the link between coding and better patient care”
–Jeremy Orr, MD, MPH, Chief Medical Officer, Optum Analytics