CAC: Understanding the Technology and Lessons Learned from Early Adopters and The Next Big Thing : Core Measures and Quality Reporting

Transcription

1 CAC: Understanding the Technology and Lessons Learned from Early Adopters and The Next Big Thing : Core Measures and Quality Reporting Matt Turner, Regional Manager, Dolbey mturner@dolbey.com

2 What is Computer-Assisted Coding? As defined by The American Health Information Management Association (AHIMA), Computer- Assisted Coding is The use of computer software that automatically generates a set of medical codes for review, validation, and use based upon clinical documentation. ** There are CAC solutions in the market today that do not meet this basic definition and do not suggest codes. Remember, just because a solution is marketed as CAC, does not mean it meets the criteria that AHIMA has defined. **Delving into Computer-Assisted Coding, American Health Information Management Association (AHIMA)

3 Universal Truths About CAC CAC: Is a coder productivity tool Will not eliminate coders** Will not eliminate the encoder, but it will change how you work with it! Not all CAC solutions are created equally

4 How Can CAC Help HIM/CDI? Streamlined workflow Increased coder productivity/automation Reduced need for outsourcing Increased query efficiency/response rate Detailed reporting and audit trails AutoClose *** Caution Codes, searchable text, electronic worksheets

5 How Does CAC Work? CAC utilizes Natural Language Processing* All text based documentation in the medical record is considered Potential diagnoses and procedures are identified Diagnoses and procedures are converted into ICD- 10 and/or CPT codes HIM coder reviews and validates the suggested codes Reporting and Analytics allows for fine tuning of NLP engine * Not all CAC solutions utilize NLP

6 What is AutoClose? AutoClose is the ability to have a very specific type of chart bypass coders and go straight to billing. When is this an option: High volume Ancillary charts such as single code Labs and Radiology Relevant documentation is consistent and electronic The site is comfortable with the technology and concept

7 AutoClose Site Overview Site was under-staffed in Coding Department Hospital was acquiring several area imaging and laboratory practices and the in-house support services were to absorb the volume AutoClose 84% of LAB accounts weekly (5k+) Over a 19% decrease in AR days, directly attributable to CAC

8 Additional AutoClose sites 79% LAB accounts weekly 96% of total CARDIAC REHAB accounts Additional AutoClose options Screening Mammograms Radiology Sleep Lab

9 CAC Benefits Beyond HIM Revenue Cycle Reduced AR days and DNFB Improved reporting/gap analysis Automated Recovery Resubmission, not part of all CAC solutions CDI Concurrent DRG Automated workflow Pre-discharge query capabilities/caution codes Core Measures Reporting Auto case identification Electronic data submission Skip logic

10 Lessons Learned from Early Adopters Interfaces Coding Partner Testing, training, short term post go-live productivity drop Testing Resources Need knowledge of coding and downstream systems Document existing workflows and productivity Project Management IT Resources Workstation set-up, interfaces, setting up training PC s Executive level support/buy-in

11 Covenant Health Case Study

12 ABOUT COVENANT HEALTH Not-for-Profit Health System Headquartered in East Tennessee Bed Size: 1, Acute Care Hospitals, Home Health, Cancer Center, Behavioral Health, Physician Office Practice Management, Rehab, SNF Facilities

13 ABOUT COVENANT HEALTH, CONT D. Facility Volume: 80K IP Discharges 750K OP Visits 450K ED Visits 600K Physician Office Visits Dolbey Products: Fusion Voice, Text, Speech, Expert (since 2006) Fusion CAC (since January, 2014) Fusion CQM (Core Measures, since November 2014)

14 CODING TEAM, 2012 Centralized Coding in coders, almost all work remotely Outsourcing the equivalent of 7 FTE s 2 job titles: Coder Analyst and Coding Specialist Incentive Plan Productivity: 20 IP Charts 100 ED Charts 200 OP Charts 70 series/invasive charts

15 CURRENT CODING TEAM 60 FTE s Added 2 additional hospitals, added behavioral hospital (IP/OP), Home Health, Cancer Center, Physician Offices, CDI Some days they are completely current for some patient types CMI is up.35 in some service areas Using CAC for quality reporting (Fusion CQM)

16 OUTCOMES OF CAC Unbilled Before CAC $27M After CAC $8.4M CMI Up in Surgery Service Line by as much as.4 CDI Post Discharge Queries Down across the board Audits 1 st and 2 nd quarter best ever: 99% overall Standard process and workflow for coding

17 CAC SAVINGS Productivity Before CAC 65.6% YTD 105.4% Cost per coded point Before CAC $1.97 YTD $1.80 Unbilled due to uncoded Before CAC 2 AR Days YTD.6 AR Days YTD Coded Chart Volume up 18.5%

18 PRODUCTIVITY STATS Charts per 8hr Day

19 Core Measures Reporting and the Financial Impact to Hospitals

20 What are Clinical Quality Measures (CQM)? CQMs measure health care: Processes Observations Treatments Outcomes CQMs are designed to quantify quality

21 CQM/Quality Reporting IQR/OQR ecqm PQRS Patient Safety Indicators (PSI) Infection Control ** Antibiotic Stewardship ** **2017

22 IQR/OQR Core Measure Sets Stroke Venous Thromboembolism (VTE) Perinatal Care (MANDATORY) Substance Abuse Tobacco Treatment Hospital Outpatient Department AMI Children s Asthma Care Immunization ED HBIPS Sepsis

23 IQR/OQR Reporting Patient ADT/BAR data is collected Patient population is randomly sampled Chart abstraction for sample population Questionnaire completed per patient and submitted for review Patient accepted, fail or exempt Additional abstraction/questionnaire as needed TJC submission via Oryx vendor or CART tool to CMS

24 ecqm ecqm refers to a clinical quality measure that requires vendors to certify their products based upon the testing specifications listed in the Certified Health IT Product List (CHPL)

25 Types of ecqm Professional vs Eligible Hospital Classified based on unit of scoring Patients vs Episodes Based on how the score is computed Proportion vs Continuous Variable

26 Why ecqm Reporting Matters? Sores and reporting have a direct impact on Meaningful Use success No reporting ecqm s, your hospital will face penalties in the future for Meaninful Use and all other Quality Reporting Programs

27 What Do Sites Report? TJC facilities are required to report on a minimum of 6 measure sets 3 Options for TJC facilities Option 1: Vendor submission of quarterly data on six of nine sets of chart-abstracted measures. Option 2: Vendor submission of data on six of eight sets of electronic clinical quality measures (ecqms). Option 3: Vendor submission of data on six measure sets using a combination of chartabstracted measures and ecqms

28 Hospital Value Based Purchasing (VBP)

29 VBP Overview Links Medicare s payment system to a value-based system to improve healthcare quality Affects inpatient stays in 3,500 hospitals Designed so that participating hospitals are paid based quality, bit just quantity

30 How is VBP Funded? Funded by a 1.75% reduction from participating hospitals base operating Medicare DRG payments for FY2016 Funds are redistributed to the hospitals based on TPS- Total Performance Scores Amount depends on range/distribution of all participating facilities Facility may earn percentage back that is less than, equal to or more than the initial reduction

31 VBP Domains and Weights 2016 Clinical Process of Care (10%) AMI-7a Fibrinolytic Therapy w/in 30 min of hospital arrival Patient Experience of Care (25%) HCAHPS- communication w/ nurses/doctors Overall hospital rating Outcome (40%) CAUTI- Cath Associated UTI Efficiency (25%) Medicare Spending per beneficiary (MSPB)

32 VBP Domains and Weights 2017 Patient and Caregiver-Centered Experience of Care/Care Coordination (25%) Safety (20%) Clinical Care (30%) Clinical Care Outcomes (25%) Clinical Care Process (5%) Efficiency and Cost Reduction (25%)

33 VBP Domains and Weights 2018 Patient and Caregiver-Centered Experience of Care/Care Coordination (25%) Safety (25%) Clinical Care (25%) Efficiency and Cost Reduction (25%)

34 CLIENT CQM SUCCESS STORY

35 Before Fusion CQM 35 full and part-time RN abstractors Sent patient population to 3 rd party and waited for random sample population Abstracted and completed questionnaires and waited for 3 rd party to provide pass/fail results Abstracted additional charts for any exempt Working 6-8 weeks post discharge

36 With Fusion CQM 3 Full-time HIM employees handle all Fusion CQM randomly samples and provides and automated worklist Electronic questionnaires with skip logic Working this week on last weeks discharges- nearly concurrent Able to see quality scores and make adjustments prior to end of quarter and submission

37 About Dolbey Privately Held Since 1914 Offices &. Affiliates Throughout North America

38 Proven Leader Dolbey is a proven leader in Transcription Dictation Speech Recognition CAC and Core Measures Reporting We offer an enterprise wide single platform solution that was awarded Best in KLAS for speech recognition in 2012, 2013, 2014, 2015/2016