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

What is Computer-Assisted Coding?

**Delving into Computer-Assisted Coding, American Health Information Management Association (AHIMA)

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.

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

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

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

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

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

Additional AutoClose sites

• 79% LAB accounts weekly

• 96% of total CARDIAC REHAB accounts

• Additional AutoClose options

– Screening Mammograms

– Radiology

– Sleep Lab

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

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

Covenant Health Case Study

ABOUT COVENANT HEALTH

• Not-for-Profit Health System Headquartered in East Tennessee

• Bed Size: 1,950

• 10 Acute Care Hospitals, Home Health, Cancer Center, Behavioral Health, Physician Office Practice Management, Rehab, SNF Facilities

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)

CODING TEAM, 2012 • Centralized Coding in 2012

– 80 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

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)

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 1st and 2nd quarter best ever: 99% overall

• Standard process and workflow for coding

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%

PRODUCTIVITY STATS

20

100

175

200

260

40

70

Charts per 8hr Day

Core Measures Reporting and the Financial Impact to

Hospitals

What are Clinical Quality Measures (CQM)?

• CQMs measure health care:

– Processes

– Observations

– Treatments

– Outcomes

CQMs are designed to quantify quality

CQM/Quality Reporting

• IQR/OQR

• eCQM

• PQRS

• Patient Safety Indicators (PSI)

• Infection Control **

• Antibiotic Stewardship **

**2017

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

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

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)

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

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

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 chart-abstracted measures and eCQMs

Hospital Value Based Purchasing (VBP)

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

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

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)

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%)

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%)

CLIENT CQM SUCCESS STORY

Before Fusion CQM

• 35 full and part-time RN abstractors

• Sent patient population to 3rd party and waited for random sample population

• Abstracted and completed questionnaires and waited for 3rd party to provide pass/fail results

• Abstracted additional charts for any exempt

• Working 6-8 weeks post discharge

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

About Dolbey

• Privately Held Since 1914

• Offices &. Affiliates Throughout North America

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

Proven Leader