How Access Healthcare partnered to implement new process and help manage the system’s exponential growth
With more than 40 acute care facilities and numerous outpatient clinics spanning multiple states, this prominent Catholic healthcare system generates upwards of $9 billion in operating revenues annually. This system has seen remarkable financial growth in recent years due to its strategic focus on expanding services and optimizing operations.
Challenges
The healthcare system faced significant growth challenges in its Clinical Documentation Improvement (CDI) and coding processes. Access Healthcare collaborated closely with the healthcare system to deploy certified medical coders and clinical documentation specialists to work alongside its Health Information Management (HIM) leaders and hospital staff.
The partnership uncovered several critical issues hindering efficiency and performance: 1) inconsistent documentation practices, 2) extended delays in resolving discharges not final billed (DNFB) cases, and a 3) lack of continuous improvement protocols. These issues created inefficiencies that threatened to impact operational performance and financial outcomes negatively. Addressing these inefficiencies was essential to maintaining the organization’s growth trajectory and mission-driven service delivery.
Scaling the transformation from 10 to more than 40 facilities
After analyzing and discovering the root causes for the inefficiencies, Access Healthcare realized the client needed a more holistic solution rather than simply assigning CDI and coding resources. That’s when Access Healthcare shifted gears, approached the system, and suggested expanding the scope from transforming the processes of 10 facilities to include the system’s more than 40 acute care facilities. The system agreed.
Access Healthcare’s comprehensive six-part solution:
Deployed seasoned teams:
Access Healthcare deployed highly experienced inpatient coders and clinical documentation specialists to establish a minimum of 30 percent audit coverage, ensuring consistent quality and accountability.Addressed physician queries:
Missed physician query opportunities and DRG mismatches were thoroughly reviewed and resolved before routing them to the client and the hospital’s HIM team, thus streamlining query workflows.Established Focused Audit Groups:
Access Healthcare created two dedicated audit groups to manage findings from four external audit streams (Enjoin, CloudMed, EIQ, and Payor Audits). Audit results informed targeted education initiatives, reducing recurrent issues and ensuring continuous audit feedback.Fast-tracked DRG Mismatch Reviews:
Daily reviews of Epic queues with respective leaders expedited documentation resolutions. Leveraging the 3M 360 notification system expedited the DRG mismatch reviews and significantly reduced DNFB hold times.Concentrated on Knowledge Improvement:
Access Healthcare coders and CDI specialists conducted weekly tests and training sessions to help bridge any possible knowledge gaps. Audit findings informed these sessions, improving team proficiency in targeted areas.
Used a Multi-Tier Governance Architecture:
A multi-tier governance framework facilitated stronger collaboration between Access Healthcare and the client’s facility CDI and coding leaders, ensuring progress tracking and identifying new opportunities for improvement.
The Achievements
Access Healthcare achieved a significant milestone for the acute care system by accelerating cash flow through a substantial reduction in DNFB cases held for CDI review, cutting the turnaround to under five business days. This improvement enabled faster billing cycles and enhanced collections. Additionally, re-validation processes played a key role in improving coding accuracy by resolving quality issues and ensuring consistent code assignment by the CDI team. The reporting function also improved hospital performance metrics through enhanced tracking and maintenance of Hospital-Acquired Condition (HAC) and Patient Safety Indicator (PSI) rates.
Access Healthcare’s focus on documentation specificity proved transformative. The holistic approach to transforming CDI and coding processes enabled the client to achieve operational excellence, reduce delays, and realize significant financial performance gains. Access Healthcare can infuse scalability and apply best practices to help any healthcare system achieve market-leading clinical, administrative, and financial outcomes by taking a technology-led, people-first approach to transforming business processes.
“Again, I can’t say enough on how great our relationship is and the overall success we are having while working together, their overall quality from CDI’s standpoint is superb to that of competitors.”