With the ICD-10 transition now behind them, leaders at Mission Health System in Asheville, NC, have their sights set on the future of clinical documentation.
Western North Carolina's only not-for-profit community hospital prepared for ICD-10 by implementing the Optum® Enterprise Computer-Assisted Coding (CAC) Platform, training staff and updating processes to mitigate anticipated productivity and revenue losses.
At the same time, the system also had a vision for the bigger picture: improving the overall quality and accuracy of its clinical documentation.
"We needed a solution that would power concurrent coding, identify opportunities for clinical documentation improvement within records, and increase overall efficiency among our teams," explains Eliana Owens, executive director for coding, CDI and revenue integrity.
Owens and her team wanted a solution that could:
· Power concurrent coding and querying
· Leverage a natural language processing engine to recognize and understand context and sentence structure in clinical documentation
· Improve communication and efficiency between coding and CDI (clinical documentation integrity) teams, while supporting their documentation improvement program
Solutions and results
Laying the foundation for the future
Mission Health sought to take both its coding and CDI initiatives to the next level, to not only meet the challenges of today, but also be well prepared for the future. System coding manager Susan Hoyle explains, "When looking for a CAC solution, we wanted a tool that would help us boost productivity and efficiency, increase code capture, and mitigate forecasted productivity and revenue losses from the ICD-10 transition." The Optum patented LifeCode® natural language processing (NLP) technology was a key differentiator when it came to choosing a solution. "We were really impressed with the ability of the LifeCode NLP engine to suggest codes based not only on the key terms and text in physician documentation, but also the context," says Hoyle. The result is more intelligent code suggestions, which translates to both increased accuracy and specificity in the documentation, as well as higher productivity for the coding team.
When the ICD-10 transition deadline came, Enterprise CAC helped Mission Health meet its timelines and make a smooth transition. "After ICD-10, we didn't see the hits to productivity and revenue we were originally forecasting," Hoyle explains.
Mission Health now uses Enterprise CAC in all areas of its flagship hospital, including inpatient, outpatient, surgery and emergency departments. The consistent approach to coding across the institution is significantly unifying workflows and enabling concurrent coding.
With CAC up and running, Mission Health leaders next turned their attention to bolstering their documentation improvement efforts -- and streamlining communication and interaction between the coding and CDI teams, as well as the health system's physicians.
"Following the Enterprise CAC implementation, we added the Optum CAC Workflow Module and Optum CDI 3D," says Owens. "The way these tools work together is definitely supporting our goals for accurate, high-quality clinical documentation at Mission Health."
Together, the Optum360 solutions have helped Mission Health achieve:
· $4.8 million increase in total reimbursement in the first fiscal year
· 2.4 percent initial CMI increase due to CAC and concurrent coding
· 0.4 percent additional CMI increase due to CDI
· $297,000 average monthly increase in DRG reimbursement
· A 30 percent decrease in discharged not final coded (DNFC) inpatient and observation cases greater than five days (which has held steady under ICD-10), going from $6.9 million to $4.3 million
· 115 percent increase in query volume and a 26 percent increase in CDI team productivity thanks to automated case-finding technology
· 43 percent increase in case review by CDI specialists
Unified platform improves CDI productivity, communication between coding and CDI teams
"It's important that we serve our community efficiently, effectively and with the highest quality of care possible," says Krystal Haynes, system manager of CDI, and CDI and coding education. "A large part of that depends on optimizing our coding and CDI practices and making them as integrated as possible."
The unified platform powering Enterprise CAC and CDI 3D was the ideal solution for Mission Health's teams. Together, the LifeCode NLP engine, automated workflow tools and automated case-finding technology made a significant impact on both coding and CDI results.
"We ultimately chose Optum360 solutions for the NLP engine and the clinical algorithms used to identify specific cases with opportunities for clinical documentation improvement," Haynes says. "Together with the automated case-finding technology and 100 percent record review, we were able to increase our productivity by 26 percent -- and increase our volume of queries by 115 percent."
Physicians at Mission Health have been very supportive of CDI 3D and its positive impact. "Physicians care about both quality data and accurate reimbursement," says Dr. Brett Senor, physician advisor to the clinical documentation integrity team at Mission Health. "The queries that come through our regular workflow demonstrate where we have opportunities for additional clarity or specificity, to truly support both reimbursement and quality goals."
Haynes shares that the quality of the queries generated by CDI 3D has helped build a foundation of trust between the CDI team and physicians, resulting in an 86 percent query agreement rate, which is higher than the national average. "With a large base of more than 1,000 physicians, having their buy-in was very important," says Haynes. Dr. Senor agrees. "From a provider perspective, the Optum360 solutions have allowed physicians and advanced practitioners to accurately depict the quality of care we're providing -- and ensure we're being reimbursed for it appropriately," he explains. In the end, the beneficiaries are our patients and our community."
In addition to the power of the underlying technology, the Optum360 solutions helped Mission Health achieve its goal of bridging the gap between coding and CDI to facilitate the flow of communication. Both teams can now work and communicate through the same platform without opening multiple tools simultaneously.
The integrated platform also provides great flexibility. "The Optum360 solutions have freed us to allow our teams to work remotely -- which has certainly made it easier to recruit staff as well as boost employee satisfaction," says Haynes.
Outstanding support and partnership
All of the gains in productivity, reimbursement and efficiency wouldn't be possible without a strong sense of partnership between the Mission Health System and Optum360 teams. "Working with Optum360 has been a wonderful choice for Mission Health," says Hoyle. "It has been beneficial to our coding and CDI teams, as well as our physicians -- and that comes through in the improvements and results we're seeing."
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