Not long ago, in the Mid-Atlantic region, senior leaders at Western Maryland Health System (WMHS), a 200-bed hospital providing healthcare services for residents in Maryland, West Virginia and Pennsylvania, were looking to implement a system that would enable their physicians to answer clinical documentation queries more effectively and efficiently.
More specifically, the system would need to increase the quality of patient records by improving documentation, ensure full reimbursement for services, and increase collaboration between clinical documentation improvement (CDI) and coding staff. Given that the state of Maryland operates under the unique All-Payer Model with a strict quality-based reimbursement program—where hospital payment is dependent on accurate performance measurement—it became particularly crucial for WMHS to be thorough in capturing and coding episodes of care in order to accurately determine hospital revenue and avoid financial penalties. Physician participation in the clinical documentation improvement process was key to this effort, WMHS officials noted.
But the problem was that historically, WMHS has lagged in physician query response rates, which hovered between 62 to 65 percent. The clinical documentation improvement and coding teams were using disparate systems to query physicians, and the query formats and processes confused providers and limited accountability and tracking, according to organization officials.
What’s more, the query process was manual and paper-based, relying on faxing and scanning, resulting in response times ranging from four to 28 days. Without an easy way to consistently and compliantly clarify physician documentation for accurate coding and billing, WMHS was losing revenue on proper reimbursements.
Explaining the prior process, Maria Moore, R.N., supervisor of WMHS’ clinical documentation improvement program, says there simply was no way in the system the CDI team was using to get a query to the physician other than printing it off and hand delivering it to that doctor. “And this was almost impossible to do with any specialist because finding him or her at any given time or place is very difficult,” Moore attests.
Over in the coding department, meanwhile, queries would be faxed to physicians, but weeks could go by before they would get answered. Eventually they would get faxed back to the coding team, but the queries would then sit at that department waiting to be logged into the system.
“Put frankly, the process was broken,” adds Tracey Davidson, R.N., director of quality initiatives at WMHS. “Regardless of which end [the queries] came from—the coding department or the CDI team—it was cumbersome with so many steps involved, and it was easy to lose insight as to where you were in the progression.”
As such, WMHS clinical and quality improvement leaders determined it needed to invest in a mobile platform that would automate physician queries to enhance the quality of patient records. According to Davidson, “Among the hospital’s goals were to better engage our physicians, decrease response times, and increase response rates. We also wanted to send physician responses directly to the chart and support more accurate coding for better quality patient records, use a standardized, compliant query template library, and ensure proper reimbursement for our services performed.”
Last year, WMHS tapped Artifact Health, a solutions company that develops physician query software via a mobile platform, to enable the organization’s physicians to answer queries quickly and view supporting documentation right on their smartphones from wherever they chose.
Within a year of implementing Artifact, WMHS saw dramatic improvements and time savings for its staff, its executives point out. The average time for the CDI and coding team to create a query went from 30 minutes to five minutes—a time savings of 1,662 hours. Meanwhile, physician response rates to concurrent queries went from four to 10 days to less than one day, saving roughly three to nine days in response times, while the retrospective physician response rate went from four to 28 days down to one day.
Other results included the hospital’s discharged, not final bill (DNFB) dropping 27 percent in the first six months, and the response rate from physicians went from 62 percent to 100 percent indicating fully engaged physicians, WMHS executives stated.
What’s more, because of Artifact’s partnership with American Health Information Management Association (AHIMA), WMHS has access to a standardized set of industry templates that are up-to-date and fully compliant, its officials say.
How are WMHS physicians responding to the change? Davidson tells an anecdote of how one physician, who has been historically tough to get any query back from, has returned his queries within a few minutes every single time since the implementation of Artifact’s solution. “Physicians are really busy; they can’t sit at their desks entering their queries all day,” Davidson states.
She also notes that coders, who previously had to scan the queries that were sent back to them into the electronic health record (EHR), no longer have to perform that task. Now, the queries are automatically filed into the patient chart, meaning coders are freed up to do other tasks.
What made things even more seamless is that the CDI team had the full support of the organization’s chief medical officer (CMO) when implementing this new process, Davidson and Moore note. “He [alerted] the physicians that if they send the queries back in paper format, we will not enter them into the system. The only way is to use the electronic system. After about two weeks, we got total adoption. Having that backing made it go so smoothly,” says Davidson.
