- Despite costly investments in the mid-revenue cycle, leakage continues to occur and opportunities continue to be missed
- Healthcare providers interested in keeping their cost to collect down must leverage technology to scale their workforce and introduce new efficiencies
- Implementing Concurrent allowed Integris Health to more than double their query rate, capturing more opportunity
Iodine Intelligence tackles a new challenge in healthcare’s mid-revenue cycle every month, shedding light on problems and solutions and sharing valuable insights from industry experts. Listen to Episode 7: Iodine Toolkit in the Mid-Revenue Cycle to learn more.
Clinical Documentation Improvement and stemming leakage have long been priorities for health systems, but studies have shown that despite investment in this area, leakage continues to occur and opportunity continues to remain un-captured. One such study from 2016 by the Advisory Board found that the average 250 bed hospital continues to lose around $4.7 million in the mid-revenue cycle each year, even after costly investments into halting leakage. Part of the problem is the mid-revenue cycle is a multi-step process with each step presenting its own unique problems and opportunities for leakage.
The impacts of revenue leakage can be many and far reaching. As hospitals margins continue to shrink, they can’t afford to leave dollars on the table, especially if they hope to continue to re-invest in their facilities, physicians and nurses, and clinical technology. Inaccurate documentation can also lead to inaccurate quality scores and rankings. In a time of workforce shortages, healthcare providers need to be able to attract applicants, and the top talent wants to work for the top organizations. Additionally, healthcare consumers have never had more freedom of choice and are selecting their providers based off publicly available rankings and ratings.
Kati Beisel, Director of Health Information at Integris Health, implemented Iodine Software’s artificial-intelligence powered tools at three key stages of the mid-revenue cycle to tackle documentation leakage.
Review and Query Concurrently to Capture Documentation Leakage
From a patient’s perspective, things are changing every day. So in a manual environment you need to review every medical record every day to ensure accuracy, which is impossible with the current staffing levels and admission volumes. Healthcare providers interested in keeping their cost to collect down must leverage technology to scale their workforce and serve patients efficiently and effectively.
Concurrent leverages Iodine’s proprietary machine-learning engine, CognitiveML, to perform live gap analysis between the clinical evidence and existing documentation, simultaneously de-prioritizing cases with no apparent opportunity and prioritizing for review cases with errors, inaccuracies, or omissions in real time.
“Our query rate before we had a prioritization tool, and then after, our query rates more than doubled. So we know that we started getting to the right cases at the right time, because we just weren’t seeing that kind of opportunity before” says Kati Beisel.
“One of the biggest things that we’ve done is implemented prioritization software through Iodine Concurrent. That was a game changer for us because it uses artificial intelligence to help prioritize cases that we need to see…it surfaces those cases to us when we need to see them, and that helps take some of the pressure off”
– Kati Beisel, Director of Health Information at Integris Health
To combat the physician pushback that can accompany increased query volumes, Kati and her team took a proactive approach: educating physicians on why they were implementing Concurrent, what to expect, what the top query reasons were, and what questions they would be asking. As a result, physicians know the goal of the program and the entire organization, and in Kati’s words, their participation has been “outstanding.”
Retrospective Reviews as the Last Line of Defense
The more accurate documentation has flowed downstream and positively impacted coding as well. Kati explained that prior to Concurrent, they were doing a lot of retrospective queries, which is time consuming for the coder. Coding is now able to pick up all the diagnoses appropriate for the patient stay, which cuts down on discrepancies between the clinical perspective and the coding guidelines.
Her team is also using Iodine’s Retrospect to comb through patient records and identify cases at risk of denial.
Focus CDI on documentation by removing final DRG prediction from their plate
The COVID-19 pandemic has given Integris Health, and many hospitals, the additional strain of needing patient beds. It’s more important than ever to get the patients in, get them treated at the right level of care, and then get them discharged.
Forecast is key to helping Integris Health’s multi-disciplinary teams including physicians, case management, nurses, and nurse managers anticipate what a patient’s length of stay may be, and what needs to be done to get a patient ready for discharge and the next level of care. As Kati explained, “Instead of my team being responsible for making sure every single case has a working DRG every single day – and we’re not going to get yelled at by case management and UM – we have Forecast for that and then my team gets to focus on where are the biggest opportunities in documentation and how can we affect the outcomes of what is reported.”