You will need to arm yourself with lots of data to show how CAC is really impacting the hospital.
Financial pressures, ICD-10 regulations and a shortage of coders are creating the perfect storm, making computer-assisted coding (CAC) all the more critical for healthcare organizations. But once you decide which CAC to use — and not all natural language processing (NLP) technology behind CAC is created equal — the next big question is: How do you measure its value?
CAC will significantly improve the efficiency and accuracy of coding professionals, helping them better manage the eightfold increase and complexity of codes, but its real benefit is in helping hospitals process and analyze large amounts of collected data over time. Numerous dashboards and auditing tools will offer managers and executives a clear view into the current state of coding operations, but the granularity of ICD-10 will provide greater specificity into patient clinical care and the NLP backbone will provide clinical analytics to help physicians identify best practices and outcomes tied to treatments in the future.
As you start using this technology, it will be crucial for all involved to develop a core set of metrics by which to measure the organization's success and to be cognizant of unexpected improvements from CAC that impact you clinically, financially or operationally while tracking these core metrics continually over time. We've come up with five best practices for measuring the success of CAC that providers should follow.
- Understand the metrics, and get widespread buy-in. CAC promises increased productivity, allowing billing managers to focus their coding staff on more complex cases, such as critical care and surgical procedures. While CAC elevates the role of the coder, the level of expectations for more and more output also increases. Therefore, coding managers need to understand the metrics (such as charts reviewed per hour and average touches per chart), how they may impact team roles and responsibilities, and how best to measure all of this in terms of overarching benefits to the organization. Then, the metrics must be clearly communicated to, and agreed upon by, the team. Involving the full team early on, from the implementation and training stages, will help ensure everyone is on board with the changes and new expectations to come.
- Consider consistency and quality when setting goals. CAC products don't have “off” days. This ensures output consistency, but quality can be a little trickier to measure. Take advantage of the auditing tools embedded in your CAC solutions — which let you compare agreement and disagreement rates between CAC output and the human coder inputs — to examine the software's holistic output versus what the reviewer codes into the system. While agreement rate isn't a pure measure of accuracy, it can be a good overall measure of the quality of the CAC results. Focusing audits on helping the system to improve its interpretation of inputs will help it to become smarter over time and suggest more appropriate codes moving forward.
- Benchmark. This means measuring the case mix index (CMI) — a key measurement for ensuring accurate Medicare and Medicaid reimbursement rates — before and after a CAC implementation. An increase of 4 percent in the CMI could bring in more than $10 million in additional revenue over six months for the average health system with five or more facilities. While CAC is not solely responsible for changes in the CMI, hospitals tend to see a jump in CMI with CAC, so benchmarking can help to identify the ways it impacts the CMI and the ways it does not.
- Measure continually. By managing, measuring and reporting metrics on productivity, reimbursement, agreement, etc., you will be armed with the data to show how CAC is impacting the hospital. Set realistic goals and metrics at the outset, continually measure the organization against these goals, leverage them as an opportunity to brainstorm ways of improving them and measure again once a change is implemented. No matter which metrics you choose, ensure that each time you perform an analysis, calculations are performed exactly the same way as before.
- Compare internal vs. external audits. Auditing offers numerous benefits: You can provide timely feedback to coders and arrange for any necessary training for the staff. Auditing also creates transparency throughout the revenue cycle, a cornerstone in any compliance program. But be sure to measure internal and external audits to determine which is more effective and when. Consider time-related metrics (i.e., how long it takes to complete a certain number of charts). Internal audits can often be done more quickly and cost effectively, but they may not be as effective overall. Be sure to conduct a cost-time-benefit analysis by checking the results of your internal and external audits against the time/cost of each.
About the author
Mark Morsch is VP of technology, OptumInsight (previously Ingenix). For more information on OptumInsight solutions: www.OptumInsight.com.