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With more than one-third of Americans reporting that an unexpected medical bill greater than $100 would push them into debt, healthcare organizations are grappling with increasing payment collection difficulties, major margin reductions, and a significant loss of revenue. In 2018, $12 million was the average amount of uncompensated care reported by hospitals, and this figure is expected to grow.
Every year, approximately 25% of the U.S. population gains, loses, or changes their source of health insurance coverage. This “churn” not only increases member acquisition and administrative costs, it can also destabilize care continuity and contribute to worse health outcomes. High levels of churn also disincentivize long-term investments in health promotion, particularly for SDoH efforts.
Being discharged from the hospital can be bad for your health. Nearly one in five adult patients experience an adverse event within three weeks of leaving the hospital, and roughly 20% of Medicare patients discharged from a hospital—approximately 2.6 million older adults—are rehospitalized within 30 days, at a cost of over $26 billion every year.
Risk adjustment is quietly becoming an economic cornerstone in healthcare, and the Hierarchical Condition Category (HCC) is at its core. Because HCCs determine payments, they influence an organization’s economic viability, available resources, and care delivery capacity, which means accurate and complete diagnosis coding is becoming an economic and clinical imperative.
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