ICD-10 Transition Made Easier with Natural Language Comprehension -Driven Coding Tools

Transcription

1 ICD-10 Transition Made Easier with Natural Language Comprehension -Driven Coding Tools Author: Dee Lang, RHIT, Vice President, Product Management and Strategy, Precyse Advanced Technologies

2 THE ICD-10 CHALLENGE We are in the midst of one of the most challenging and exciting times in the history of healthcare. At every turn there are words and phrases striking fear and tribulation among healthcare providers: healthcare reform, meaningful use, RAC, ICD-10, accountable care, CDI, pay for performance, compliance the list goes on and on. While the pros and cons of all of these issues are hotly debated, one thing is for certain: Change is coming. Many are comparing ICD-10 to Y2K, but the challenges of ICD-10 are even more cumbersome. While Y2K only impacted technology, ICD-10 will have an impact on people, processes and technology. The impact will stretch across a wide breadth of interests, including: patient access services such as scheduling, pre-registration, financial counseling as well as registration; and charge capture, utilization, abstracting claims processing, account resolution and payment posting. CDI and coding are expected to experience one of the most significant impacts. This paper will focus on ICD- 10 and how technology can support the CDI and coding processes. The transition to ICD-10 alone will involve going from 17,000 to 155,000 codes and an anticipated percent decrease in productivity for most coders during the projected six-month learning curve. Some Canadian coding experts will tell you that productivity in Canada, which adopted ICD-10 in 2008, never recovered from the drop in production as a result of the transition. In addition to diminishing productivity, error rates are expected to rise. According to the Department of Health and Human Services, During the first six months or so after implementation, error rates may rise to 6-10% compared with the typical 3% error rate that occurs for a few months each year with the annual ICD-9 updates. 1 Furthermore, according to the Advisory Board Research and Analysis: denial rates are expected to increase 10-25%; 10%+ charts will not have documentation specific enough for accurate coding; over-coding due to coder inexperience will lead to a potential increase of 10-25% in RAC/MIC takebacks A successful ICD-10 transition will require an integrated, enterprise-wide technology solution that will enable healthcare providers to educate their staffs, to assess and improve clinical documentation and to automate workflow processes for clinical documentation improvement, coding and auditing, while automating the code assignments as much as possible. This technology must help people do their work more quickly and more accurately. It will require an integrated learning platform and at-yourfingertips tools that will streamline workflows and provide management with dashboards and tracking tools to ensure critical metrics are managed and outcomes are achieved. Copyright 2011 Precyse Solutions, LLC. All Rights Reserved page 2

3 For processes, it will take automation of workflow to successfully manage the impact of productivity and quality that is destined to affect coding. This automation must minimize hands-on time for the mundane, easy-to-do steps that can be handled by technology. TECHNOLOGY AS A STRATEGY What kind of ICD-10 technology will help healthcare providers gain productivity, improve efficiencies, reduce costs and find new sources of revenue? The answer is an integrated, enterprise-wide technology solution that provides online education, supports clinical documentation improvement, includes a computer-assisted coding application, provides a streamlined approach to auditing and supports automated workflow. This is undoubtedly the quickest way to a successful ICD-10 transition. Most experts agree that without computer-assisted coding, the task will be virtually impossible. To achieve the added benefits of more clinically relevant data for research, the coding workforce of 2013 and beyond will need to be supported with powerful technology to improve the quality of their coding in addition to the efficiency of their workflow. However, not just any computer-assisted coding solution will suffice. While the coding function is at the heart of a computer-assisted coding solution, the kind of solution that is needed to meet the challenges that lie ahead will go beyond coding and unify and optimize the entire workflow process, from clinical care through the traditional revenue cycle. Many computer-assisted coding applications today are enabled by one of several types of natural language processing (NLP). What differentiates these various types of NLP is their approach (rulesbased, statistical-based and often a combination of both). Variations of NLP are able to process textual data and find semantic meaning that can be provided as suggestions back to the coder. In many cases, NLP solutions are not able to strike the right balance between semantic recall and precision, and the result is an inappropriate amount of feedback. Natural Language Comprehension (NLC) is the ultimate form of NLP because it establishes the clinical relevance of the patient story by breaking down data into its SNOMED concepts combined with other attributes that collectively drive a contextual representation back to the coder in the form of ICD-9 and ICD-10 diagnostic and procedure codes. Thus NLC-enabled computer-assisted coding provides a distinct advantage to healthcare providers and has already been shown to significantly improve coding workflow and production. The combination of computer-assisted coding engines with NLC-driven intelligent workflow solutions provides a single, comprehensive platform to optimize coding processes and unify the entire clinical documentation workflow process. This is the single best solution for providers as they face the imminent challenges on the horizon for the healthcare industry. Copyright 2011 Precyse Solutions, LLC. All Rights Reserved page 3

4 In addition to the NLC-driven computer-assisted coding application, it is paramount to make sure the integrated coding solution can improve coder efficiency by automating workflow and offering management tools. One way to improve coder productivity is to centralize the hybrid record and provide representation with color-coded tabs and re-sequencing capabilities in a single view for fast and easy record review. This approach eliminates the need for a coder to access multiple systems to do his or her job. The ideal automated coding platform should provide workflow automation to minimize the hands-on time to manage the coding process. Monitoring the work that needs to be done and the resources available to do the work is an ongoing task for management and, in some cases, requires monitoring 24x7. A computer assisted coding platform with workflow automation will allow management to establish work pools based on coder skill set. The system will know when a particular coder is available to work (when that coder logs in). Based on the work pools assigned to a particular coder and the prioritization of the work pools (high-dollar cases, high-risk Recovery Audit Contractor (RAC) targets) and the work available to do, the system will make sure the right charts get to the right coder when that coder logs into the system. No management time will be wasted with the daunting task of work assignments. An integrated solution that supports clinical documentation improvement and auditing programs should have this same workload distribution logic, so whether it is cases for CDI review, coding or auditing, the system does all the work! An integrated physician query tool with automated workflow for the query process will address the expected rise of 10-20% in physician queries. A coder or CDI reviewer can generate a physician query from either the CDI or coding application. Because of the underlying NLC and continuous understanding, certain queries can automatically be generated. Once a query has been delivered to the clinician who responds, the coder or CDI reviewer is notified and the case is automatically returned for completion. Healthcare providers should expect to have a way to track, measure and report real-time production based on actual coding time while differentiating record type and even complexity of cases (such as long length of stay and total charges) with their automated coding platform choice. An automated coding platform that incorporates alerts and notifications means management doesn t have to monitor the system to look for potential problems. Instead they can manage by exception so attention is focused on other critical areas. For example, based on staff schedule, let s say at least five coders are expected to be online starting at 8 a.m., but only three have logged in. An alert appears in the manager s inbox. Imagine how such alerts can help drive down Discharged Not Final Billed (DNFB). For example, the system can alert a coder when a high-dollar case has been assigned or when a query that he/she initiated has been completed by the physician. Copyright 2011 Precyse Solutions, LLC. All Rights Reserved page 4

5 Tracking and monitoring key metrics for the clinical documentation improvement, coding and auditing processes will be more important than ever, especially in light of the impact ICD-10 will have on all three. A dashboard with real-time, at-a-glance data will be a must-have for any healthcare organization. There are a number of other applications that an integrated coding solution can be used for to help an organization be successful under ICD-10: Education and training for ICD-10 will be ongoing. The coding technology solution should provide direct access to an integrated online learning platform that addresses all learning styles. Understanding that individuals learn differently, the integrated learning platform would have traditional self-directed lessons or modules as well as webinars, MP3 recordings and, for those of us who are Wii, Xbox and PlayStation junkies, a game arcade. Because this learning platform is part of an integrated coding platform, it becomes easy to link it directly to coding quality performance. Here s how it would work. The coding platform supports pre-bill quality assurance (QA) workflow. This means that certain cases can be flagged and automatically routed for QA review before they are sent to billing. This is the notion of getting it right the first time. Let s suppose for a moment that coding septicemia is problematic for a specific coder. A pre-bill QA rule is established so the system knows that when this coder finishes any case that has a code for septicemia, it is routed automatically to the QA auditor. The QA auditor reviews the record and finds <95% accuracy for this case. The QA findings are entered into the coder s profile (another feature of this integrated coding platform). Now the coder is placed on 100% pre-bill QA review. The elearning module on how to code for septicemia is automatically assigned to the coder for completion. Once the coder successfully completes the module, a notification is delivered to the coder and QA manager s dashboard. A certificate of completion is maintained in the coder s profile and the coder is removed from the 100% review list. The following workflow diagram provides a visual of the scenario just described. Following the diagram is an excerpt from an online educational learning application that is linked directly to the system so the coder is presented with information targeting the specific coding problem. Copyright 2011 Precyse Solutions, LLC. All Rights Reserved page 5

6 This chart shows a system that tracks coder quality, identifies an area for improvement, alerts the manager and the coder, recommends a module from the learning platform, tracks the coder s completion of the module and reports back to the coder and manager when the module is successfully completed. Copyright 2011 Precyse Solutions, LLC. All Rights Reserved page 6

7 Because the integrated coding platform provides functionality for clinical documentation improvement, this same learning platform is available to the CDI reviewer. It is evident how the shared learning platform can directly affect not only the coding quality performance but the CDI performance as well. Example: NLC-Enhanced CDI Workflow with Linkage to elearning for ICD-10 Copyright 2011 Precyse Solutions, LLC. All Rights Reserved page 7

8 RAC and other auditing activities are applications that an integrated coding solution should support. Let s suppose a provider wants an auditor to look at certain targeted RAC cases after the record has been coded, but before the codes are sent to billing. If he or she wants to make sure the necessary documentation is present and the code assignments are correct, he or she will need to route these completed cases to this auditor quickly to avoid creating a negative impact on DNFB. A manager would create a work pool in the system called RAC Review. The auditor s profile lets the system know who is eligible to review the cases. The system would automatically route the targeted cases when the auditor logs into the system. Because of the underlying NLC capabilities, highlighted text associated with the codes assigned to the case would be easily identified by the auditor. Additional comments added by the coder might prove to be useful for the auditor as well. Streamlining the auditing process for RAC or any other third parties is achievable. Copyright 2011 Precyse Solutions, LLC. All Rights Reserved page 8

9 CONCLUSION A quote from the Milliman white paper titled Ten Critical Factors for Health Plan Success in Implementing ICD-10, October 2009, sums it up nicely: ICD-10 implementation requirements are much more extensive than any encountered with HIPAA to date, or even with Y2K. The most valuable lesson from both HIPAA and Y2K is that successful ICD- 10 implementation will be based on planning for the best and preparing for the worst. Implement an organized change plan. Do not fall victim to the old adage, He who fails to plan, plans to fail. The ICD-10 transition will impact people, process and technology well beyond actual ICD-10 implementation. It will be a long and winding road to successful ICD-10 transition. It will not be an easy or quick journey. As Robert Frost said, Two roads converged in the wood and I took the one less travelled. By choosing the right road, in our industry s case, through implementing the right technology, healthcare providers can take the most direct route and turn a regulatory nightmare into a competitive advantage. Footnote 1 Department of Health and Human Services, August 22, 2008, 45 CFR Parts 160 and 162, HIPAA Administrative Simplification: Modification to Medical Data Code Set Standards to Adopt ICD-10-CM and ICD-10-PCS Proposed Rules. Federal Register Volume 73, Number 164. Copyright 2011 Precyse Solutions, LLC. All Rights Reserved page 9

10 While the coding function is at the heart of NLC-enabled computer-assisted coding solutions, the kind of solution that is needed to meet the challenges that lie ahead will go beyond coding and unify and optimize the entire enterprise-wide workflow process, from physicians to coders to clinical staff to management. Copyright 2011 Precyse Solutions, LLC. All Rights Reserved page 10

11 Case Study: Geisinger Health System Geisinger Health System (GHS) of Danville, Pa., is an integrated tertiary health services organization that is widely recognized across the nation for its progressiveness, including its innovative use of the Electronic Health Record and the development of advanced care models. GHS serves roughly 2.6 million people spanning 42 counties in central and northeastern Pennsylvania. In addition to its main hub in Danville, the physician-led organization includes two other major campus sites as well as a multitude of clinical centers. The only provider of tertiary care in its area of the state, Geisinger Health System averages 1.3 million outpatient visits, 48,000 admissions and 83,000 Emergency Department visits per year. The sheer volume of patient encounters at Geisinger brings with it an equally overwhelming and constantly growing volume of data. Like all healthcare providers today, Geisinger is facing multiple challenges that include healthcare reform, meaningful use, the transition to ICD-10, accountable care, CDI, pay for performance and compliance, and will have to find new ways of gaining productivity, improving efficiencies, reducing costs and finding new sources of revenue in the face of these challenges. And in keeping with their commitment to growth and advancement, Geisinger executive management astutely recognized that the ability to transform the organization s voluminous clinical data into meaningful, actionable information using an integrated, enterprise-wide technology would be crucial to the system s future success. Realizing how important data was going to be to improving efficiencies now and in the future, our leadership team began to talk about what kinds of tools we would need to implement in order to make the best use of our data, said Sue Trewhella, Senior Director of Coding for GHS. We knew that the coding function would be at the heart of the matter, but we also knew that it was only one piece of the puzzle. In order to make the best decisions, we had to look across our enterprise at the entire workflow process and determine overlapping needs. As the senior leadership at Geisinger began evaluating the needs of its various departments in relation to the constructive use of data, a reoccurring theme was noted: Natural Language Processing (NLP) technology had a vital role to play in transforming data into actionable information, and several departments within the health system had already independently began to evaluate NLP software for this purpose. It was becoming more clear to us that in order to put data to optimum use, we were not going to be able to work in independent departmental silos anymore, explained Trewhella. We needed to find a way to make data work across the entire workflow of our organization, so we decided to get all of our departments together and see if there was one solution from one partner that could allow us to leverage NLP across our entire system. Copyright 2011 Precyse Solutions, LLC. All Rights Reserved page 11

12 The Geisinger leadership team had heard that Precyse, a leader in health information management (HIM) services and technologies, was about to introduce a revolutionary computer assisted coding platform that was uniquely equipped with a special type of NLP. They contacted Precyse, and a strategic partnership was born. As a result, Geisinger became the first healthcare organization in the nation to implement precysecode, the industry s first computer assisted coding solution that is driven by Natural Language Comprehension (NLC), a proprietary type of NLP developed by Precyse partner M*Modal, a pioneer in advanced speech understanding technologies. This powerful combination of ICD-10-ready computer assisted coding and NLC had the ability to provide Geisinger with a single, comprehensive platform to optimize coding processes; accelerate revenue cycles; help navigate compliance challenges, CDI initiatives and ICD-10 transition; and meet health reform and Meaningful Use initiatives head on. At Geisinger, precysecode is dramatically bridging the electronic health record, dictation, transcription, coding and CDI processes by capturing, editing, coding and directing physician dictation into Geisinger s EHR software platform. Geisinger physicians can now dictate directly into the EHR with minimal impact to their current workflow patterns. Clinical information is electronically tagged to be easily searched, mined and analyzed by healthcare team members responsible for driving hospital care and outcomes. Geisinger is already achieving positive results with precysecode. We ve already seen 20% increases in coder productivity with precysecode, and we expect that figure to climb as high as 50% as the system learns from its earlier coding assignments, said Trewhella. We made the decision to partner with Precyse because we shared in their vision about how Natural Language Comprehension could be applied to computer assisted coding technology to significantly accelerate the revenue cycle, said Barbara Tapscott, Vice President, Revenue Cycle for Geisinger Health System. Though we are still early on in our implementation of precysecode, the results we are achieving thus far are already validating our combined vision. I have no doubt that the improvement will continue and that we will be well prepared for ICD-10 and other challenges on the horizon. Copyright 2011 Precyse Solutions, LLC. All Rights Reserved page 12

13 Case Study: Baptist Health System When the Baptist Health System (BHS), which includes four hospitals in the greater Birmingham, Ala., area, needed to improve its coding team to be more efficient and productive and to streamline resources without compromising quality or accuracy, the healthcare system initiated a relationship with Precyse in 2004 in the form of a transcription outsourcing partnership. Over the next few years, Precyse supported BHS with coding, auditing, education, transcription and interim management services, advising BHS on methods to improve efficiencies and reduce costs. When Precyse partnered with M*Modal to integrate advanced speech understanding technology into its dictation and transcription workflow platform, the foundation technology was then in place to help improve efficiency, quality and patient safety for both the transcription and coding services for BHS. As a result, in 2009, BHS expanded Precyse s role, and Precyse performed an on-site assessment of the health system s HIM operations as BHS transitioned from a paper-based environment to an electronic health record system. Precyse provided solutions that would improve BHS s workflow and processes, with the goal of improving the efficiencies of the coding department. Precyse also offered its innovative coding platform, precysecode, to make the entire process easier to implement and manage. Based on Precyse s analysis and recommendations, BHS decided to create a system-centric rather than facility-centric team. By centralizing, the new system-wide coding team could share resources and manage the entire healthcare system s needs. BHS saw immediate improvements with precysecode. One major change was the ability to move the coding team off-site, allowing them to work from home. Having the coders telecommute was an innovative approach for BHS and improved employee morale significantly. BHS managers could quickly and easily see what each employee was doing, track their time online, view the files they have been coding and more. The Precyse solution has revolutionized the coding workflow at BHS, allowing BHS to virtualize the coding department and create an integrated, seamless and productive team. Working with Precyse s expert resources and advanced technologies has helped BHS increase productivity, accuracy and quality, while significantly reducing costs. Since implementing the system, BHS has experienced: A 20% increase in coding quality A 5% increase in DRG-based revenue through more accurate coding and improved Case Mix Index (CMI) A 10% reduction in voluntary auditing Coder productivity improvement A reduction in audit costs Copyright 2011 Precyse Solutions, LLC. All Rights Reserved page 13

14 A revenue increase due to better information More accurate coding By centralizing its coding department to handle coding needs for all four hospitals as opposed to having separate teams of coders for each hospital BHS is now able to better manage an everfluctuating workload. Additionally, Quality, Risk, Case Management and other departments can access records quickly and efficiently, without requesting a record pull from the HIM department. We re just thrilled with Precyse, said Chloe Phillips, Corporate Director of HIM for BHS. Their team truly understood our needs and carefully considered the best solutions for our challenges. Their recommendations were smart and strategic, and it was helpful to hear their expert opinions on how we could solve our various coding challenges. Not only were we pleased with Precyse s team of experts, but we ve also found their technologies to be instrumental to our coding department. Using precysecode, we ve seen a significant improvement in our coding department s quality, productivity and accuracy. They are truly a partner for life. Copyright 2011 Precyse Solutions, LLC. All Rights Reserved page 14

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