An often-repeated statistic warns that 8 million Americans have diabetes and don’t know it. There are similar claims about other chronic illnesses, like hypertension and chronic heart failure.
If a patient doesn’t know they are missing a diagnosis, their health care provider may not either.
The white paper Accurate coding: The foundation of accountable care explains that a team at Optum One found 37 percent of patients with major chronic conditions go uncoded.
It might sound daunting to identify all patients with a chronic condition, but research shows that assigning accurate and complete codes to patients can provide a huge opportunity.
Research conducted with the Anceta Collaborative, a partnership between Optum and the American Medical Group Association (AMGA), found newly coded patients show significantly higher rates of clinical improvement.
- Read more in the topic spotlight: The impact of coding on quality of care
Dr. John Cuddeback, chief medical informatics officer for Ancenta, explains what happened in the 12 months after diabetes patients received the correct codes.
“The changes were remarkable. Their use of outpatient services increased nearly threefold and their clinical outcomes significantly improved,” said Cuddeback.
“Forty-seven percent of diabetes patients with a newly coded diagnosis improved on at least one clinical measure versus 24 percent of those uncoded.”
Finding these patients can save money and protect revenue.
Analysis indicates that uncoded patients’ conditions are poorly controlled. They tend to use more acute care and less ambulatory care, and their inpatient visits are longer.
Providing complete codes can help identify patients who qualify for care coordination and other assistance. Matching care to their needs — or right-sizing the care — should help reduce costs, especially under risk-based contracts.
Research showed a group practice with 500,000 patients stands to lose as much as $17 million each year due to uncoded patients.
Learn more from Dr. Cuddeback in a #5in5 interview Improve care quality through complete medical coding.
In five minutes, you can find out what he finds most surprising about the current state of patient coding and how problem lists have changed due to electronic health records.
Dr. Cuddeback also starts the conversation on how health systems can go about identifying uncoded patients. You can dig deeper into that topic in the white paper Accurate coding: The foundation of accountable care.
About the author
Karen Thomas-Smith is vice president of Provider Marketing & Reference Management at Optum. She brings to the role more than 15 years of global experience in the software industry. Karen has shared her unique ideas on corporate culture and leadership in a number of television appearances on Oprah, 60 Minutes and Canada Public Television. Prior to her position at Optum, Karen spent time at Allscripts and SAS.
She holds a bachelor of science degree in business administration from North Carolina Wesleyan College, graduating Magna Cum Laude.