Cognitive Emulation Archives - Page 2 of 2

Reducing Revenue Cycle Leakage with Cognitive Emulation

Today, most healthcare technology solutions that support revenue cycle billing, coding and documentation teams use systems and workflows that “think” like computers – not clinicians.

They leverage rules and check-lists, which only consider narrative documentation and can lead to unforeseen errors given the many nuances of the healthcare revenue cycle.

Iodine Software takes a different approach. The company has pioneered a new application of artificial intelligence and machine learning called Cognitive Emulation. This approach uses proprietary AI technology and machine learning algorithms which allow a machine to interpret clinical data in the same way a clinician thinks, and emulate clinical judgement in a manner very similar to how providers of care assess and treat their patients.

Augmenting the work of health system professionals with software that can actually “think“ enables Iodine to solve numerous healthcare problems in new ways with proven results. Iodine analyzes the full clinical record for each patient much the way a clinician would, but at a massive scale.

Iodine’s first application of Cognitive Emulation? Examining new ways to fix mid-revenue cycle leakage.

Applying Cognitive Emulation to the healthcare revenue cycle

Today, each stage of the CDI or documentation process represents an opportunity for leakage via incorrect or incomplete coding and documentation. Legacy software solutions focus on natural language processing – which means they are only looking at documentation in the patient record and not taking into account lab results, vital signs, cardiology and radiology results, and patient history (for example). Even health systems with mature CDI programs supported by legacy software solutions can see significant documentation improvement opportunities not making it into the final code – leaving millions of dollars on the table.

For clinical documentation to be accurate and support reimbursement objectives, a CDI team would ideally review every record, every day throughout the stay and ensure all conditions are documented appropriately. In the current staffing environment, with typical case volumes, that is essentially impossible without the right type of technology.

Similar to how physicians base decisions on their knowledge of medical concepts, experience in the field, and clinical judgment, Iodine leverages its Cognitive Emulation approach (via its CognitiveML™ Engine) to consider and analyze the entire patient record. For example, rather than drawing conclusions simply from documentation, Iodine considers:

Lab results
Vital signs
Orders
Medications
Demographic information
Patient history
Radiology results
Cardiology results
Working, target, and final codes
and Documentation

By matching this evidence against patterns observed across the billions of data points in Iodine’s database, the CognitiveML™ Engine determines the statistical likelihood a meaningful difference exists between a patient’s clinical state and what has been documented. Not only does Iodine identify instances of highly-likely but undocumented conditions, it also can identify where the clinical data contradicts what is documented to help avoid denials. As new data is reviewed, Iodine expands its knowledge base, becoming increasingly more intelligent and effective over time.

Proven results using Cognitive Emulation

Iodine applied its Cognitive Emulation approach to clinical judgement with the AwareCDI Suite™ to reliably identify areas of potential opportunity to accelerate productivity, data accuracy, and financial return.

Cognitive Emulation drives smarter prioritization through the Iodine Concurrent™ module, which considers the entirety of the clinical record and patient experience to predict likely conditions, identify gaps between evidence and documentation, and help CDI teams query more effectively and efficiently.

Cognitive Emulation is also the foundation of the Iodine Forecast™ module, which predicts final DRGs early in the patient’s stay–well ahead of the availability of final coded diagnoses which are typically only available days to weeks after discharge. Forecast™ increases the accuracy and efficiency of assigning working DRGs, supporting CDI workflow and enabling teams across the health system to make real-time, evidence-based predictions – without needing to wait for final coded data.

Iodine clients consistently achieve substantial results utilizing Cognitive Emulation and the AwareCDI Suite™ to improve documentation integrity. Irrespective of any preexisting legacy tools, Iodine clients have seen:

A median 75% increase in query volume
A mean 4.3%, or 0.0633 point average, increase in CMI per facility
An increase in MCC capture at 94% of facilities after using Iodine
$1.5 billion in additional appropriate reimbursement recognized annually

To learn more about Iodine’s Cognitive Emulation approach to solving mid-revenue cycle leakage, contact info@iodinesoftware.com.

Figures are based on a $6000 modeled base rate and actual measured MCC capture performance from the 2019 Iodine Performance Cohort Analysis of 339 facilities that compared measured MCC capture and CMI impact for the Iodine usage period 9/1/2018-8/31/2019 against pre-Iodine baseline performance.

Best in Class Documentation: A Critical Way out of COVID-19 Financial Distress

Prior to COVID-19, health systems were already operating on generally thin margins, with many finance leaders acknowledging that a significant root cause was leakage from their mid-revenue cycle and that “average performance” was still well below optimal results. Today due to COVID-19, there are several additional factors impacting hospital revenues, with health systems now facing inpatient reimbursement declines of up to 30% year-over-year:

Patient volumes: On April 7, 2020, CMS recommended that all elective surgeries and procedures be limited to free up capacity for COVID-19 patients. Even as this restriction is removed in some states, limitations remain in effect across much of the country. Patient populations may also choose to defer elective surgeries out of fear. Given these challenges, the CARES Act’s aid to hospitals will not by itself keep hospitals and health systems afloat.
Rising unemployment: The payer mix will further shift away from commercial coverage due to rising unemployment.

Recent analysis by the Iodine data science team found that as health systems exit the pandemic and COVID-19 admissions decrease, medical reimbursement is expected to decline. If surgical volumes do not recover, health systems could experience a second wave of financial distress.

To overcome the financial distress related to COVID-19, health systems need to explore revenue accretive solutions. The mid-revenue cycle contains significant untapped potential, with the average 250-bed hospital losing $4.7 million in mid-cycle revenue each year¹. One survey of healthcare leaders found that 84% believe clinical documentation and coding are at medium or high risk for errors leading to a negative impact on revenue². Accurate documentation results in revenue integrity, but even established CDI programs struggle to consistently capture all documentation opportunities. To realize the full potential of documentation integrity to decrease mid-cycle leakage and improve margins, CDI teams would need to review every single record continuously throughout the entire stay.

Iodine’s CognitiveML™ engine leverages proprietary artificial intelligence technology and machine learning algorithms to automatically analyze the full clinical record for each patient. Combined with a growing database, Iodine’s technology is able to identify more statistically relevant predictors of disease, helping teams quickly and accurately identify areas of potential opportunity to accelerate productivity, data accuracy, and financial return. This approach has helped hospitals realize a 75% increase in query volume.

As healthcare finance leaders seek creative solutions to slow mid-revenue cycle leakage, they should consider whether their CDI teams are armed with the right technology to be able to capture more revenue.

¹Advisory board study from 2016

²https://info.besler.com/hubfs/HIMSS%20Revenue%20Cycle%20Management%20Research%20FINAL%20SECURE.pdf?hsCtaTracking=b4b7691a-4990-48fd-ad6a-7585504a25d1%7C52d35be5-671a-4a59-ab80-123faf69c1c4

Supporting the Front Lines during COVID-19 with Machine Learning Models

In light of COVID-19, hospitals and health systems across the country are adapting to meet the needs of their communities. At Iodine Software, we also feel a responsibility to support our clients and their patients during this crisis.

After learning major pain points of our partner hospitals, our Iodine Data Science team applied their machine learning and artificial intelligence expertise to our 20 million inpatient admission database to create a predictive tool that allows for early identification of patients at risk for respiratory compromise. Early identification allows healthcare providers to plan care, intervene sooner and support positive patient care outcomes.

Iodine’s Patient Triage and Escalation Support Tool (PTEST) is an extension of our existing technology that has the ability to predict patient conditions and comorbidities. This tool is designed to assist with identifying patients at risk for pulmonary challenges, need for ventilators, and critical care support. This capability helps patient care teams to intervene early and potentially reduce the demand for scarce resources. In addition to supporting the quality of patient care, PTEST has the potential to aid healthcare leaders in more accurately forecasting their resource needs amidst equipment shortages and overwhelmed ICUs.

Help your organization to stay resilient during this healthcare crisis by learning more about PTEST and Iodine’s machine learning approach — cognitive emulation — to support accurate reporting of care provided. Please contact: info@iodinesoftware.com.

Iodine participates at the annual CDI Leadership Exchange

The Association of Clinical Documentation Improvement Specialists held the 2nd Annual CDI Leadership Exchange September 17th-19th in Chicago at the Oakbrook Hilton. Iodine Software co-sponsored the event and led two roundtable sessions discussing the use of technology in the CDI industry. The event hosted over 30 industry leaders in the clinical documentation field and focused on use of technology, staff management and physician engagement.

The Leadership Exchange was an opportunity for executive leaders of CDI programs nationwide to share their thoughts regarding the current state of the CDI industry and forecast future growth. The event was organized as informal roundtables, with Iodine spearheading a discussion on the use of technologies that support CDI workflow.

As the leader in CDI innovation, Iodine believes it is important to learn from CDI leaders about the issues they are facing and discuss how technology can be utilized to create solutions that improve program process and ultimately program outcomes.

Iodine provided a high-level description of artificial intelligence and machine learning and explained how this technology is different from natural language processing models. Machine learning models create efficiencies that allow CDI staff to focus their reviews on the right records at the right time. This is accomplished through identification of medical records with clinical evidence of conditions that are being monitored and treated without the associated specificity in the providers documentation.

Feedback from participants reinforced that Iodine’s AI/ML technology is a necessary tool for efficient daily workflow of CDI Specialists. Being able to focus CDI attention to records with the greatest documentation opportunity removes the frustration that CDI teams face regarding wasted time on records without documentation opportunity.

Additionally, increasing scope has placed greater demand on depth of record review for quality metrics accentuating the need to leverage technology for assistance in identifying key records for review. Attendees were able to walk away from the session with a greater understanding AI technology and plan for methods to better leverage the technology for their programs.

Iodine Software

Insights Category: Cognitive Emulation