By Ken Congdon
Prior to March 31 of this year, I was fully prepared for the Healthcare Financial Management Association’s (HFMA’s) 2014 Annual National Institute (ANI) conference to be “ICD-10apalooza” — a last-ditch scramble for providers, payers, and vendors to get all their ducks in a row before the ICD-10 deadline hit. However, after the SGR Doc-Fix bill delayed the ICD-10 transition for another year, I wasn’t sure what to expect from this year’s meeting. I was encouraged to find the central theme of ANI (held June 22-25 in Las Vegas) to be one of financial and clinical harmonization in healthcare.
It appears that healthcare transformation isn’t only driving the integration and interoperability of health IT systems, it’s also compelling health systems to tear down the departmental silos that used to exist within the enterprise. ANI provided several examples of healthcare financial leaders striving to understand and work more closely with clinical teams. This trend is being driven not so much by ICD-10, but by the shift to value-based reimbursement, ACOs (Accountable Care Organizations), and improved care coordination.
“Until recently, financial leaders didn’t think clinical tools and workflows were important to them, but now they do,” says Bobbi Brown, VP of Finance for Health Catalyst, a provider of data warehousing and analytics technology solutions. “Now, finance teams realize how critical clinical effectiveness and efficiency will be to the bottom line of the health system. In response, they’re taking an active role in engaging with clinical teams to ensure IT adoption and utilization in an effort to optimize patient outcomes and maximize reimbursement.”
CDI CRITICAL TO FINANCIAL PERFORMANCE
A primary clinical focus area for healthcare financial executives is CDI (clinical documentation improvement). Claim accuracy is dependent upon the quality of the clinical documentation. To receive maximum reimbursement, health systems need to ensure that clinical documentation is a true representation of the diagnoses, services, and procedures delivered by the provider.
“Unclear clinical documentation can result in coding errors that degrade a provider’s reimbursement potential,” says Brown. “For example, in the case of an appendectomy, the maximum reimbursement allowed for a removing ruptured appendix is much higher than that allotted for a simple appendectomy. Clinicians can’t be vague. They need to provide comprehensive and precise documentation of the procedure actually performed to ensure it is reflected in the claim codes.”
PHYSICIAN ENGAGEMENT DRIVES REVENUE GAINS
To this end, health system financial leaders are working hand-in-hand with clinicians to implement CDI programs and technology tools to enhance the specificity and overall quality of clinical documentation. A key step in this process is physician engagement.
“For a CDI solution to be successful, physicians need to be involved,” says Dr. Paul Weygandt, VP of Physician Services for Nuance. “You can’t just install technology and walk away. You can’t tell them what to do. You need to listen to them and work with them to provide the solution that they need.”
According to Weygandt, every element of physician engagement needs to be linked to ultimately improve medical decision making. In other words, financial leaders should engage with physicians to optimize how CDI tools integrate with the EHR, voice recognition, and other supporting systems. “When physicians are effectively engaged in this fashion, health providers can expect an additional 4 percent to 8 percent revenue increase over and above the improvements gained through technology alone.”