- Healthcare organizations looking to improve the quality of their data assets are actively seeking ways to leverage data for clinical analytics and population health management, according to a new poll from Black Book.
Ninety-three percent of hospital and physician financial executives believe it is critical to explore new ways to use data analytics to support value-based reimbursement and meet the demands of consumerism.
Clinical documentation improvement (CDI) programs, increasingly outsourced to expert vendors, are playing a key role in this quest to develop actionable data assets with a high degree of integrity and quality.
“The need for proper clinical documentation improvement driving quality outcome scores has never been more essential,” says Doug Brown, managing partner of Black Book. “At the same time, the shift in care settings challenges financial leaders who are managing a far more complex enigma centered on optimizing the revenue cycle and reimbursements.”
“CDI is a key step in dramatically improving operational efficiency in healthcare organizations. Failing to address flaws in documentation processes has resulted in higher incidences of errors, financial losses and diminished patient care, and struggling hospitals will not survive on that old path.”
Providers that focus on CDI efforts are seeing speedy and measurable results, the survey showed.
Eighty-nine percent of hospital CFOs believe that CDI can improve case mix, reduce revenue leakage, and optimize the use of expensive specialty providers.
Their theories are being borne out in practice: eighty-eight percent of hospitals have documented quality improvements and increases in case mix index within six months of beginning a clinical documentation improvement initiative.
“CDI solutions are the critical link in ensuring full and timelier reimbursements from insurers and payers, as well as avoiding costly penalties for non-compliance,” Brown says. “This is why hospital chief financial officers have become the greatest advocates for outsourced end-to-end coding.”
More than 90 percent of hospitals with 150+ beds have seen increases of more than $2.1 million in appropriate revenue and reimbursements. These hospitals have all contracted with an external CDI company to oversee documentation quality improvement.
Outsourcing is becoming a very popular strategy for organizations that would rather focus on analyzing data than conducting quality assurance processes.
Nearly a quarter of hospitals in the United States now outsource at least some of their medical coding and clinical documentation improvement (CDI) activities in an effort to improve accuracy and reduce costs.
Among hospitals with more than 200 beds, just under two-thirds now outsource CDI auditing and review programs. This represents a swift and significant increase from 2015, when just 24 percent of these organizations contracted with CDI specialists.
Better quality data may be directly contributing to more actionable analytics insights – as are general improvements in the design and flexibility of health IT tools.
Organizations are exploring new options for coding and CDI platforms, the survey says, even if they do outsource many of their CDI functions.
Thirty-five percent of participants in the poll are considering replacing their legacy systems with CDI and coding tools that can rise to the analytics challenges of a post-ICD-10 world. These tools must be able to ingest and manage data from electronic health records and other systems in order to support team-based care.
“EHRs are certainly playing a role in the industry-wide movement to increase clinician collaboration and communications,” observed Brown.
“Half of acute-care respondents in the 2016 Black Book survey were not confident that their EHRs effectively captured the patient data to meet developing clinical documentation needs for population health and big data initiatives, which has improved to a current confidence level of 70 percent.”
This lift in confidence, coupled with impressive financial results from investing in data integrity and quality, paints an optimistic picture for organizations that are angling for a competitive edge in a challenging environment.
Updated health IT tools and processes will be vital for success in an industry increasingly driven by data analytics and operating on razor-thin financial margins. Maximizing revenue, improving case mix, and reducing errors due to incomplete or inaccurate documentation will depend on strong CDI processes supported by modernized health IT solutions.