Becker's Hospital Review

24 Executive Briefing How Integrated CDI Technology Can Improve Clinical Performance Under Value-Based Care P hysicians today face increasing pressure to produce more accurate, complete and compliant clinical doc- umentation while trying to maintain a focus on patient care and satisfaction. Under ICD-10, government and commercial payers require significantly greater clinical detail to show medical necessity and clinical quality. This means a note that appears accurate and complete from a clinical standpoint may lack the level of specificity coders require to accurately document medical care under ICD-10. Hospitals that do not actively work to reconcile this disconnect in their workflow risk losing critical aspects of patient care — acuity, severity and risk of mortality — in the translation between medical treatment and insurance billing. This puts a hospital at a significant disadvantage under value-based care, where out- come and quality measurements affect payer reimbursement levels. "Hospitals historically used clinical documentation improve- ment programs to optimize revenue capture, not to improve the quality of their clinical notes," Anthony Oliva, MD, vice pres- ident and CMO at Nuance, said during a roundtable discussion at Becker's Hospital Review's CEO + CFO Roundtable in Chica- go Nov. 8. But as providers prepare to take on risk under alternative pay- ment models, more hospitals are turning to clinical documenta- tion technology for clinical performance improvement. Clinical Documentation Improvement (CDI) feedback in real-time Hospitals are increasingly realizing the value of partnering with health IT vendors that offer front-end speech recognition solu- tions to accurately translate physician dictation into a rich, de- tailed clinical narrative, which is fed directly into an EHR. "Once enabled, a program like this can analyze clinician notes in real time and suggest ways to make the medical narrative stronger and more specific to justify medical decisions and improve ICD-10 coding compliance," said Reid Coleman, CMIO of ev- idence-based medicine at Nuance. This type of responsive CDI interface can improve the quality of documentation, eliminate transcription costs, increase adminis- trative efficiency and improve physician satisfaction — all strate- gic priorities for hospitals in the transition to value-based care. Clinically driven CDI in the transition to value-based care Value-based healthcare delivery means hospitals must demon- strate a strong correlation between patient outcomes, cost and measured value. A key component and strong indication of val- ue in the inpatient hospital setting is medical necessity — name- ly, did the physician devise a thoughtful treatment plan in line with the patient's medical acuity? This means a physician's clin- ical documentation should include context that accurately re- flects physician clinical judgment and medical decision making. "A CDI program that focuses exclusively on improving fiscal gain may fail to demonstrate clinical value in the medical re- cord," Dr. Oliva says. For instance, clinicians and coders can en- hance revenue capture under fee-for-service models by speci- fying additional DRG codes during billing. In value-based care, however, clinical documentation and coding should reflect se- verity, acuity and risk of mortality in addition to diagnoses. "The only way your [hospital's] clinical performance is adjudi- cated by those outside of your medical facility is through billing data," Dr. Oliva says. Therefore it's crucial a coder selects CPT codes that maximize reimbursement and signify a high level of patient care and quality treatment. By helping clinicians docu- ment according to ICD-10 standards, CDI technology can help hospitals build robust, descriptive and complete documenta- tion for more accurate communication of patient care. Public reporting organizations like CareChex, Healthgrades and Thomson Reuters use billing data in part to determine quality rankings among top healthcare organizations. "Com- prehensive, clear clinical documentation of patient care can actually improve hospitals' baseline performance, which helps hospitals more accurately stack up against their peers and re- gional competitors on quality comparison sites," Dr. Oliva says. As more informed consumers increasingly rely on quality rating sites to decide between healthcare facilities, hospitals have a vested business interest in achieving high scores. Sponsored by: "Comprehensive, clear clinical documentation of patient care can actually improve hospitals' baseline performance, which helps hospitals more accurately stack up against their peers and regional competitors." — Dr. Anthony Oliva, Nuance Vice President and CMO

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