Dr. Ronnie Smith

Risk Adjusted Patient Care

Dr. Ronnie Smith is an internist with Vidalia Medical Associates. He has practiced medicine for

nearly 40 years. He has a medical degree from the Medical College of Georgia. Dr. Smith

graduated from the Executive Medical Management Program at the Wharton School at the

University of Pennsylvania. He is an expert in outpatient and inpatient risk adjustment documentation and coding and reimbursement, and he is passionate about educating his fellow

physicians and their practice staff on how to master risk adjustment and simplify the transition to

the new value-based care model.

Dr. Smith has developed innovative, point-of- care reference tools to assist physicians and medical practices that streamline the workflow process.

Risk-Adjusted Reimbursement

Physicians in the United States find themselves in a seismic paradigm shift from volume-based

reimbursement to value-based reimbursement. This is being driven by escalating health care

costs and an increasingly-sicker population. Pay-for- performance is consequently based on

patient risk scoring, and quality measures are being used at every level of our health care system.

These changes are meant to stimulate quality improvement and cost-efficiency within the health

care system.

Physician reimbursement that is tied to patient risk scoring is here to stay, so it is imperative for

physicians to understand how patient risk scoring works because it will affect their income in

significant ways.  Risk adjustment uses a patient’s health status in a base year to predict or estimate what utilization costs should be the following year. If a physician fails to recognize risk-adjusting diagnoses and under code them, they will likely fail under today’s value-based reimbursement system. The clinical management of the utilization-based spending that will be required to qualify for any shared savings incentives will be challenging.

If a physician can accurately and thoroughly document how sick their patients are, they stand a far

better chance of achieving their budget objectives. This, then, gives them the best opportunity to

receive the shared savings incentives and to minimize their risk for shared losses.  Dr. Smith’s key steps to succeed under the new value-based, pay-for- performance reimbursement models include…

* Verifying that your EHR is capable of submitting at least 12 diagnosis codes per clinical

encounter.

* Retrieving, analyzing and understanding your Quality and Resource Use Reports (QRURs) for

Medicare Part B.

* Getting informed and trained on risk adjustment methodology.

* Scheduling all of your attributed patients in your managed care plans, including Medicare Part

B and Medicare Advantage plans, for an office visit at least once, and preferably twice, during

each calendar year.

Dr. Ronnie Smith is an internist with Vidalia Medical Associates. He has practiced medicine for

nearly 40 years. He has a medical degree from the Medical College of Georgia. Dr. Smith

graduated from the Executive Medical Management Program at the Wharton School at the

University of Pennsylvania. He is an expert in outpatient and inpatient risk adjustment documentation and coding and reimbursement, and he is passionate about educating his fellow

physicians and their practice staff on how to master risk adjustment and simplify the transition to

the new value-based care model.

Dr. Smith has developed innovative, point-of- care reference tools to assist physicians and medical practices tha...