As Head of Medical Systems at the Hirslanden clinics in Geneva, Dr Thierry Fumeaux ensures efficient care management and fosters strong communication between the medical and financial departments. With the support of Swisscoding’s Medizincontrolling services, he works to raise doctors’ awareness of the financial impact of their decisions, without compromising their professional autonomy.
You’re a physician who became interested in medical coding and hospital management. How did that happen?
During my time as Head of Internal Medicine and Intensive Care at a regional hospital, I became interested in coding upon introduction of the DRG system in 2012. I was struck by the lack of communication between physicians, who often didn’t see the relevance of coding, and the coding teams, which were sometimes out of touch with clinical realities. It was through working with a physician-coder that I realised proper reimbursement could be achieved simply by optimising the coding process, through direct collaboration between these two groups of professionals.
After completing an Executive MBA at IMD, you joined the Hirslanden Group as Head of Medical Systems for Clinique des Grangettes and Clinique La Colline. Why did you step away from clinical practice?
I wanted to act in line with my convictions. For years, I had regretted that physicians weren’t more involved in the administrative and financial aspects of healthcare management. I chose to study administration and finance so that I could contribute directly to improving the system. My aim is to reconcile the medical value created for patients with its appropriate economic reflection.
Do physicians always understand these issues?
Not necessarily. It often depends on how directly they are affected. In public hospitals, it’s generally easier to make salaried physicians aware of their essential role, through the documentation of diagnoses and procedures, in securing funding for the hospital. In private clinics, however, doctors are self-employed, and their fees are not directly tied to documentation, unlike the clinic’s own invoicing, which is largely based on DRG rates and therefore directly dependent on medical documentation.
From 2025, doctors will need to adapt their invoicing for inpatients with supplementary insurance based on new pricing models. What impact will this have?
Under FINMA’s recommendations, fees reimbursed by supplementary insurance (under LCA/VVG) must be clearly itemised and deducted from services covered by basic insurance (under LaMal/KVG). The reimbursement from basic insurance is determined by the quality of coding, and thus by the quality of medical documentation.
How can you best support them through this transition?
The first step is to provide clear and thorough information about the upcoming changes, and to foster an understanding that we are partners in creating value for patients, with each party playing a key role. But this also implies mutual dependency when it comes to financial constraints. We must be able to respond clearly and precisely to their questions about how documentation affects coding and, ultimately, reimbursement. Granting access to controlling data helps them better understand the importance of their role in maintaining the institution’s financial health.
How do Swisscoding’s Medizincontrolling services support you in this mission?
They are at the intersection of clinical, coding, and financial operations. Swisscoding’s Medizincontrolling services play a vital role in providing the information needed to strengthen this coordination, ensuring proper reimbursement for services and, in turn, contributing to the quality of care, which depends on financial balance.
«We need to evolve towards a model where doctors are true partners of the clinic, not just users of its infrastructure. A physician who documents and structures their activity properly not only determines their own remuneration but also contributes to the clinic’s financial stability. »
Dr Thierry Fumeaux, Head of Medical Systems at the Hirslanden Clinics Geneva.
What’s your view on outsourced coding, as practised at Les Grangettes?
Working with a specialised partner offers clear advantages, not only in terms of cost efficiency, but also in terms of expertise and effectiveness. Swisscoding works with multiple institutions, which gives them access to a much broader dataset than an in-house team would have. This allows them to identify trends, provide in-depth analyses, and develop advanced tools, including AI solutions. It also means we can set a high bar: an expert partner should deliver ongoing feedback, assist in data analysis, and support continuous improvement of our coding processes.
What specific services do you benefit from, and how do they help?
We benefit from Swisscoding’s analyses and feedback, which help us monitor changes in our average cost weight and identify potential coding anomalies. They also support pre-coding, enabling doctors to access a DRG proposal, and an expected average length of stay, at the planning stage of an intervention. Early coding, within the first 24 to 48 hours after admission or surgery, also helps refine the data and anticipate necessary adjustments. Swisscoding assists in identifying opportunities for improvement, such as flagging under-documented clinical information – like certain comorbidities – that may affect invoicing. Their expertise allows us to cross-analyse clinical and financial data to better understand trends and continuously optimise our practices.
What tools can help doctors better understand how their decisions impact clinic operations and improve their own practice?
The best tools provide clear insights and enable actionable steps. A useful dashboard should focus on meaningful indicators doctors can influence, such as the average length of stay linked to a specific DRG, or how changes in documentation affect DRG coding and reimbursement. The goal is to give them accessible, practical information that supports clinical and administrative decision-making.
In your opinion, how can doctors play a more active role in the medical and financial management of clinics, while maintaining their independence and clinical freedom?
We need to evolve towards a model where doctors are true partners of the clinic, not just users of its infrastructure. A physician who documents and structures their activity properly not only determines their own remuneration but also contributes to the clinic’s financial stability. The idea is not to increase their workload, but to make things easier by providing them with clear benchmarks to understand how their actions affect both their own and the clinic’s reimbursement.
What’s your vision for the future of the healthcare system and private clinics?
Today, we have a system focused on care delivery, but not yet a fully integrated healthcare system. The real challenge is to strike a balance between the overall value of health generated for patients, which is still difficult to quantify, and its proper economic valuation. In the private sector, it is crucial to preserve liberal medicine and patients’ freedom to choose their doctor and institution, while making healthcare structures more efficient, cost-effective, and sustainable. The goal is to rationalise care without rationing, by optimising management without ever compromising the quality of care. In this dynamic, partners like Swisscoding play a vital role by offering expertise and tools to structure documentation, enhance coding, and reinforce medical-financial governance.
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