A code that you can live by

Feb. 1, 2011

OhioHealth needed technology that would enhance coding performance while minimizing the need to add staff.

Diane Setty, RHIA,
CPHQ, is OhioHealth's
director of HIM.

Founded in 1891, OhioHealth (www.OhioHealth.com) is a network of eight not-for-profit hospitals and numerous healthcare organizations serving patients in central Ohio. Growth in patient volume, regulatory changes and the acquisition of a number of physician practices have increased the demands on OhioHealth's coding personnel, necessitating a cost-effective tool that would significantly increase coder productivity while also improving the clean-claims rate.

Diane Setty, RHIA, CPHQ, OhioHealth's corporate director of HIM, was looking for technology that would enhance coding performance while minimizing the need to add staff. She needed a tool that would dramatically improve coder productivity, especially in light of the impending ICD-10 implementation. Compounding the situation, competition for capital with the clinical departments meant that the recommended investment must provide strong, measureable, positive returns.

For many years, Setty had been keeping her eye on computer-assisted coding (CAC) as a tool with the potential to hyper-boost productivity. She spent hours talking to a number of CAC vendors getting a clearer understanding of the technology and their offerings. She now believed the industry had matured enough that she could advise her executive team on the advantages of this new product.

The challenge

Evaluating new technology is a daunting process. Coupled with this was convincing the coding supervisors and coders that this application would make them more efficient — and that they could trust its accuracy. Also, capital funding did not become available for this project until eight weeks before the end of their fiscal year — and it would have to be spent before the fiscal year's end.

Setty and her team had already conducted the vendor evaluation and selection process, which enabled rapid implementation of the first phase of a CAC software deployment. In addition to ensuring a strong ROI, the selected software would have to make coders more efficient and more compliant, improve their medical necessity by reducing claim denials and boost their case mix for inpatient services.

The software would also have to accommodate the current workflow process, which meant it would have to integrate seamlessly with the existing legal medical records solution. Medical-necessity checking would have to be embedded in the product so that coders could access it in real time from within the application without having to exit one system and enter another.

Additionally, the team had to address coders' quality concerns — and how the technology would affect their lives and workloads.

The solution

The offerings of six prominent CAC vendors were reviewed; this was reduced to three potential contenders for more in-depth evaluation. The team burned the midnight oil further researching articles on the CAC industry and technology. They read product literature and conducted vendor discussions to identify those that best met their minimum requirements. A matrix was created to compare vendor functionality against the team's criteria.

“There were a number of reasons we selected A-Life,” explains Setty. “We had seen their NLP engine in action at University of Pittsburgh Medical Center and knew it had the capability to do what we needed. Secondly, we were pleased with the way their engine understood and interpreted medical terminology. Some of the other vendors' engines required updating every time a new resident class or physicians' group was added. That meant updating their engines indefinitely.

“In addition, the A-Life engine demonstrated an increased capability to understand both English language and medical terminology. The Actus aesthetics were more user-friendly than the other products we evaluated. A-Life also had successful installations of inpatient CAC at similarly sized hospitals, an advantage other vendors did not have at the time.”

According to Setty, A-Life was the only vendor interviewed whose representatives could succinctly explain how their NLP engine operated and how it differed from other vendors' products.

OhioHealth proceeded with a phased approach. Phase I entailed the implementation of the diagnostics component of the software, with phase II focused on same-day surgery, observation and interventional radiology. Final outpatient phases are already scheduled and include emergency department and clinics. Inpatient coding is the next step.

The benefits

A-Life's Actus software is providing OhioHealth with a strong positive return on investment through the ability to do more with less and the promise of cleaner claim rates and a better case mix. The organization currently uses Actus for outpatient diagnostics in five of its eight facilities. Same-day surgeries, observations and interventional radiology are in the testing phase.

According to Bobbie Vannatter, RHIA, CCS, CPC-H, the corporate coding manager and a member of the CAC selection team, “Phase I, outpatient diagnostics coding, resulted in approximately 75 percent of accounts being read by the NLP engine and results presented to the coders with no need for further action. Our 30 coders are all cross-trained in outpatient services so they cycle through the various services. A coder might only be scheduled to do diagnostics coding once a week — so they haven't all had the opportunity to spend a lot of focused time using the system and yet we've already seen a 17 percent average increase in coder productivity. In addition, we were able to achieve this dramatic improvement while also adding up-front medical-necessity screening and charge review to the coders' workflow.”

Feedback from coders has been largely positive. “The more they use Actus the more comfortable they are with it — and the more they like it,” adds Vannatter. “The expectation is that productivity will substantially increase as coders become more familiar and proficient with the system.”

The implementation of Actus has prompted OhioHealth's coding management to re-evaluate their existing productivity measures. Once proficiency and a comfort level have been achieved, standards for production will be adjusted to reflect the organization's goals and efficiencies gained from the engine. The standards for diagnostic coding production, which are currently 22 to 24 per hour, are now averaging 28 to 30 per hour. An overall 40 percent increase in coder productivity is expected in this modality. To put this in perspective, this is the equivalent of coding approximately 20,000 more diagnostic cases per coder a year.

Finally, A-Life customers of similar size and complexity as OhioHealth have experienced a 4 to 5 percent improvement in CMI resulting in a $10 million revenue boost, and all within six months of the system going live. OhioHealth expects to see similar benefits after inpatient CAC is installed.

For more information on
A-Life Medical solutions:

Solution: A-Life Medical's Actus CAC Software

Benefits: Immediate benefits include a 17 percent average increase in diagnostic coder productivity within 30 days of implementation, increased coder efficiency and more compliant coding. In addition, Actus supports pre-bill, medical-necessity screening resulting in fewer rejected claims, enhanced traceability for coding audits and fewer missed charges for outpatient services. Long-term benefits include a projected overall 40 percent increase in coder productivity, resulting in enhanced capability to absorb additional increases in workload, revised coder performance standards, improved case mix for inpatient services and better preparation of coders for ICD-10.

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