- by Ron Savelo
Value-Based Care - Who Says What is Valuable and What is Not?
I started hearing from some of my Report Master clients beginning around 1998 about Outcome-Based Reimbursements. And at the time I remember thinking "That's how doctors should be paid, based on results!" Of course on the flip side of the coin is the fact that insurance companies were likely hoping outcome based care would give them more opportunities to not pay. But the fact is that any doctor who isn't getting real results, is likely either misdiagnosing or is treating only symptoms rather than causes, or doesn't really know what's wrong with the patient, but doesn't want to admit it.
But, be that as it may, Value-Based Care (the new buzz-phrase) is definitely here and hopefully here to stay. I just hope that all doctors are forced to play by the same rules. Of course it will probably put the psychiatric industry out of business, but you won't see me shed any tears if that were to happen.
So the real question becomes "What's valuable and what's not, and according to whom? For me, the obvious answer is that the Patient should be the one to decide if they're getting better or not. In chiropractic, the two most obvious measures are Pain and Activities of Daily Living. Fortunately, with chiropractic (since prescribing pain meds is off the table), Pain Reduction is normally actual Pain Reduction, not the usual Medical Model's "solution" of Pain Meds and/or Surgery.
So, lowered levels of pain is a valid measure of Value in chiropractic documentation. The other key measure is how the patient is getting along in their Activities of Daily Living, which is hard to fake, even for an MD, particularly if the list of Activities that the patients is given to check off or rate during their visits is a comprehensive list. The patient is either getting better with regard to their numerous Daily Activities or they are not. There will always be some degree of subjectiveness, but the bottom line is if the patient can now bend over far enough to tie their own shoes, then a valuable result has occurred. Then it simply becomes a matter of fully documenting it, which will also go a long way in demonstrating medical necessity.
In the short video below, we show how easy it is to document the patient's Activity of Daily Living with the Report Master software. We also provide editable forms that match up with the screens.