Executive Roundtable

Risk-Adjusted ReimbursementPhysicians in the United States find themselves in a seismic paradigm shift from volume-basedreimbursement to value-based reimbursement. This is being driven by escalating health carecosts and an increasingly-sicker population. Pay-for- performance is consequently based onpatient 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 healthcare system.Physician reimbursement that is tied to patient risk scoring is here to stay, so it is imperative forphysicians to understand how patient risk scoring works because it will affect their income insignificant 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 mana