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Patient-Centered Oncology Care

Documenting When a Patient Falls Outside a Recommended Pathway

Documenting when a patient falls outside of a recommended pathway has the dual benefits of improving the algorithm and helping a provider get reimbursed faster, explained Torrie K. Shields, MPH, senior program manager of Palliative Care Program Design & Implementation for Blue Shield of California. 


Documenting when a patient falls outside of a recommended pathway has the dual benefits of improving the algorithm and helping a provider get reimbursed faster, explained Torrie K. Shields, MPH, senior program manager of Palliative Care Program Design & Implementation for Blue Shield of California. 

Transcript

How does digital data help when a patient falls outside of a recommended pathway?

When a patient falls outside of that pathway, the first thing is making sure it's actually documented, why you made a difference choice. That, actually, can feed back into the algorithm that helps people better understand what types of patients respond to what types of treatment, and it could essentially create a new pathway, and a more nuanced focus on personalized medicine. So we're able to feed data back in when we are able to document somebody falling outside that.

It helps a provider in terms of audit, or in explaining to a payer, a financer, about why they went outside of that pathway, and that creates a dialogue that really focuses on change or quality improvement, rather than on incentives and mandates. So, when a payer, especially when we're moving to value-based payment, knows why somebody went outside of a pathway, they're able to look at it differently and assess and respond and pay/reimburse faster.

 
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