The majority of hospitals won’t be staring down the challenges of ICD-10 clinical documentation improvement (CDI) on their own, Black Book Rankings says, but will seek consultants and service partners to help them make the necessary adjustments ahead of the new code set. By October 1, 2015, 71% of hospitals plan to have engaged a CDI partner, and nearly 25% have done so already. After gaining an extra year to prepare when the code set was delayed this spring, providers are finally realizing that collaboration is the key to a successful transition. “Transitioning to ICD-10 is a complicated process and hospitals are leaning on the expertise and successes of outsourcing vendors,” says Doug Brown, Managing Partner of Black Book. “We still operate in an ICD-9 world, complicated by EHR implementations, value-based reimbursement models, compliance issues and optimizing reimbursement; a perfect storm from which outsourcers have the expertise to shield their clients.” Eighty-eight percent of large hospitals that are already outsourcing CDI efforts have realized significant gains in revenue, the survey says, totaling over $1 million per facility. Eighty-three percent also noted improvements to the quality of care and increases in the case mix index. More than a quarter of hospitals that are already outsourcing their coding and CDI are considering upgrading their technology, as well, in an attempt to keep pace with physician practice acquisitions and EHR implementation efforts that have sapped time and resources from the ICD-10 transition. Throughout the lengthy and oft-delayed transition, experts have urged providers to start with the basics: ensuring that the documentation produced by physicians contains every piece of information necessary for a coder to select the most detailed ICD-10 code available. Physicians and coders often don’t view the same terms in the same way, which can lead to poor coding,
a loss of rightful revenue, and a dip in quality metrics that don’t reflect the actual level of care being provided. “The problem is that when physicians write in clinical terms that they understand, they assume everybody else understands those terms. But they don’t. We needed a bridge between clinical language and coding language, and we needed to explain to physicians that the coders cannot always interpret what they’re thinking,” said Dr. Georges Feghali Chief Medical Officer and Chief Quality Officer at TriHealth Medical, while explaining why his organization invested in a CDI program ahead of ICD-10. “My doctors were looking like terrible physicians just because they weren’t documenting care the right way.” “I’ve been doing CDI for 15 years and physicians still don’t provide all the details needed to ensure appropriate, thorough documentation,” says Mel Tully, MSN, CCDS, CDIP and Vice President of Clinical Services and Education at Nuance. “Unless they’re being prompted and given a tool or person to help guide them, they will always document pneumonia as pneumonia. There are many, many other ways to document it and even today, physicians still need guidance on how best to capture the specific details needed to accurately reflect the severity of the care provided.” In the Black Book poll, Nuance Communications received the highest customer experience and client satisfaction scores among vendors of CDI and coding products or services. Also ranking highly in the category were 3M, Optum, the Advisory Board, Navigant, ChartWise Medical, Precyse, and DCBA.
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