Disrupting Conventional Documentation and Coding to Improve Clinical and Financial Operations
Organizational change can mean many things to healthcare organizations: there are countless pain points for providers as well as opportunities to improve. This was certainly true for my organization, UAB Medicine, which is part of the University of Alabama at Birmingham Health System, a comprehensive health system that includes a 1,157-bed teaching hospital and over 150 ambulatory clinics spread throughout the Birmingham area. When UAB Medicine named Dr. Tony Jones as chief physician executive, we worked together along with our leadership group to evaluate current operations, with the goal of finding challenges and opportunities for improvement in provider satisfaction.
To determine roadblocks and barriers to effective and efficient care, Dr. Jones conducted focus groups with department leaders, physicians and other staff. The problem areas uncovered are not unique to UAB Medicine and included common struggles with documentation and coding in the electronic health record (EHR). Physicians were spending significant time working after-hours—up to 1.5 hours every night– finishing up their day and completing all record entries. In addition, coding inaccuracy and missed charges were impacting care quality and business performance. Given the organization’s size and scope of services, documentation and coding issues could have wide-ranging effects, impacting clinical care, patient satisfaction, revenue, compliance and provider burnout.
Innovative ideas bring about physician champions for a new technology platform
As a result of the focus groups and collaborative listening, Dr. Jones and the UAB Medicine team developed a plan to alleviate some of the challenges, including partnering with IKS Health and onboarding its Scribble solution to assist with documentation and coding. Scribble is a technology-enabled scribe service that pairs physicians with a virtual medical professional who creates an accurate, comprehensive clinical note for each patient visit based on the provider’s defined preferences, practice style and specialty requirements. The program also utilizes certified professional coders to complete all E/M and diagnosis coding. Within 24 hours of the visit, comprehensive documentation and coding information is seamlessly woven into the organization’s EHR.
UAB Medicine found that one incremental patient visit per half-day would cover the cost of the IKS service. To make the case for the technology, primary care physicians were asked if they would be willing to see an additional patient per day in exchange for easing the documentation and coding burden. UAB anticipated that productivity benefits, along with improvements in HCC capture and revenue integrity, would lead to a strong ROI for the solution. There was an enthusiastic response, and more than 50 primary care physicians began testing and promoting the program internally.
Outcomes to date are positive
Since implementation in July 2018, UAB primary care providers using the platform have seen improvement in several clinical and operational metrics. From a productivity standpoint, several physicians have seen a substantial increase in the number of patients, whereas some who were at maximum volume have been able to markedly decrease their time in the EHR. As an organization, we have seen an increase of 0.67 patients per half-day across all primary care providers. There has been a significant decrease in after-hours EHR use, and some providers have gained up to 30 to 45 minutes of additional time in their day during work hours. E&M coding is also more accurate and timely. Diagnosis coding is more robust with an increase in ICD-10 codes, which are now more accurate. Our notes are substantive and capture much more information from the visit, which has led to an uptick in HCC capture by 40 percent.
Key lessons learned
Overall, UAB Medicine has been pleased with the results of the Scribble and Coding services through IKS. A few takeaways from the project implementation include:
· Planning is essential. At the start of the program, administrative, backend and IT tasks can increase as things get up and running. Sufficient time allocation for providers and project leaders is critical at the beginning of the project.
· Timely signatures on documentation are still required. You will need to have a plan to account for the few providers who are historically delinquent, as this problem could persist.
· Virtual scribes have a learning curve as they develop documentation that mirrors the physician’s style. Physicians must allow time, sometimes several weeks, to institute and reinforce expectations to ensure documentation fully reflects their preferences.
· Establishing metrics up front is invaluable. This allows an organization to fully quantify improvements in patient care, operations and physician satisfaction.
Making things easier AND more precise
Streamlining documentation and coding can have far-reaching implications. By implementing a system that simplifies the process while preserving quality and accuracy, UAB Medicine has been able to realize stronger business performance and lift some of the physician burden. Even more important, the organization has enhanced its patient experience, freeing physicians to spend more time with patients and build better relationships that yield higher quality care.
Dr. Stephen W. Stair is a Board Certified (Internal Medicine) Clinical Associate Professor and Medical Compliance Officer at the University of Alabama, Department of Medicine.
