Val Verde Regional Medical Center (VVRMC) is a Center for Improvement in Healthcare Quality-accredited 93-bed level IV trauma center serving Del Rio, Texas, and neighboring communities. Since 1959, VVRMC has made local healthcare and medical treatment its first priority and has expanded its facility, enhanced its diagnostic and treatment capabilities and added new services, improved its efficiency, and staffed a team of caring health professionals. Services include hospice care, a full-service imaging center, respiratory care, inpatient dialysis, rehabilitation services, and a special procedures unit including a cardiac catherization lab.
Following ongoing financial challenges, VVRMC appointed a new CEO and a new Health Information Management (HIM) Director and Privacy Officer to help reinvigorate the coding operation. The new HIM Director discovered that the organization’s coding staff needed more training and resources to help them succeed. VVRMC was also challenged by a medical staff who did not fully comply on documentation timeliness and completeness goals, hindering coders from performing their jobs efficiently. The result—accuracy, productivity and ultimately, revenue, were falling short of expectations set by the senior leadership team.
The issues were manifested in the following five red flags:
- Lack of pathways and education to achieve coder certification;
- relatively high Discharged Not Final Billed (DNFB), averaging 13 to 14 days;
- frequent coding-related denials; deficient assignment of Complicating or Comorbid Condition (CC), Major Complicating or Comorbid Condition (MCC), severity of illness, and risk of mortality; and
- lower-than-anticipated reimbursement levels.
Although VVRMC had used temporary outsourced coders to augment its team, the organization sought a more complete remedy to their coding challenges. Since Del Rio is a small, rural community, the availability of local certified coders was limited. VVRMC management selected nThrive as its partner to fully outsource the coding function. The outsource engagement included a coding manager, who started on-site and then transitioned into a remote role on the team.
Following initial on-site time, the nThrive Coding Manager held weekly calls with the hospital’s leadership to ensure clear communication and timely attention to any needs. As the new remote coding team settled in, greater emphasis on improving accuracy and productivity became the focus. The coders collaborated with CDI specialists and VVRMC’s new Coding Liaison to produce clear and complete clinical documentation that would lead to improved coding outcomes. “The team really focused on the accuracy and charts-by-hour productivity standards we put in place,” said the HIM Director.
The nThrive team adopted VVRMC’s concurrent inpatient coding practice, coding while the patient was still in-house, in order to help address VVRMC’s DNFB issues. Just 120 days after implementation of the coding outsource team, VVRMC reduced its accounts receivable (AR) days by 36% (five days), achieving the CFO’s goal. This threshold continues to be sustained. Additionally, coding-related denials have been minimized, and more accurate assignment of CC, MCCs, severity of illness and risk of mortality has become a standard practice.
Several months after the nThrive team was deployed, a more profound improvement was realized. After many months in the red financially in 2015, in 2016 VVRMC was in the black. “In large part due to improvements in coding performance,” noted the HIM Director, “VVRMC’s overall financial performance went from monthly losses to gains.” VVRMC continues to maintain coding quality and meets or exceeds all key performance indicators.