Coder productivity is overwhelmingly the top goal and measure of success for hospitals’ implementing computer-assisted-coding (CAC), according to the recent KLAS report: Hospital-Based CAC 2014. While productivity is an important benefit, it is not the only one. If you work in healthcare, you know it’s not enough to be more productive, you also need to deliver better quality results in the process. That’s where CAC can help by bolstering health information management (HIM) teams’ knowledge, coder productivity and coding quality.
ICD-10: limited coders and limited time
Like all healthcare organizations, Summit Health, a multi-facility health system in Pennsylvania, wrestled with tight resources and a shifting ICD-10 transition deadline. In order to proactively address the potential impact this might have on revenue, they conducted a data analysis on coder productivity and the associated monetary ramifications.
“We discovered Summit Health was at risk for $400,000 from diagnosis-related group (DRG) shifts,” explains John Lucabaugh, vice president of HIM. “Given the magnitude of the ICD-10 transition, every organization should do a data analysis to determine just what’s at risk in terms of lost productivity and the costs associated with that loss.”
To build a solid foundation for clinical accuracy across both inpatient and outpatient settings, Summit Health implemented a CAC solution to improve the accuracy of codes, and simplify the coding process by putting relevant documentation at coders’ fingertips. Almost immediately the team began to see better results, notably fewer missed codes. “With all the reference tools right there, online, at our coders fingertips, we’re seeing fewer missed codes for conditions such as diabetes and hypertension, and we’re seeing a more standard approach to coding,” says Ellen Shatzer, Summit’s health data quality manager.
This comes as no surprise, as I’ve seen organizations such as Summit capture up to 68 percent more inpatient codes per case. With such a drastic bump in captured codes, CAC can provide greater specificity and accuracy in reporting. For instance, in standardized coding, and, when coupled with clinical documentation improvement, it can improve compliance and generate significant case mix corrections by more accurately reflecting Severity of Illness (SOI) and Risk of Mortality (ROM) assignments that impact reimbursement, and quality scores.
Old dog, new tricks?
Initially, Summit Health noticed variations in coder productivity. It seemed as though their more experienced coders (who had been coding for 10+ years) were taking longer to review charts, than a newer coder who flew through charts using the new CAC tool, expediting coding tremendously. This faster pace, however, did not necessarily equate to accuracy. Time, audits, and ongoing education were needed in order to fine-tune decision making and deliver the results they anticipated. This due diligence led to an inpatient coder productivity increase of as much as 35 percent. And it didn’t stop there: “Speed is picking up,” notes Shatzer. “We’ve seen a 17 percent increase in speed on the inpatient side, and equally important is the improvement in the quality of our coding.”
With the coder shortage threatening to compound the ICD-10 impact, coupling educational programs with tools such as CAC can help organizations pinpoint opportunities for improvement. If your organization is looking to implement a tool, it is important to remember that all solutions are not the same. Researching which tool will work best for your organization will help ensure easier and streamlined workflows as well as accuracy—both of which are critical for doing what’s right for the patient and ensuring financial integrity.