This monthly blog will discuss all the components of quality clinical documentation with a comprehensive approach to cover all areas of the healthcare industry.
By Marisa MacClary
Hospital billing is complex and accuracy is critical, as it can affect not only reimbursement, but hospital and physician quality scores as well.
Hospitals employ dedicated staff to ensure the accuracy of medical codes on bills, and they often must check facts with physicians—a process called physician query. Traditionally, the query process has been somewhat manual, with clinical documentation specialists (CDSs) and coders reaching out to physicians via email, over the phone, and in person to ensure patient information is accurately documented in the medical record. The process is time-consuming and can be irritating for physicians, most of whom would rather spend time with patients than on paperwork. One query can take as long as 15-20 minutes for a physician to complete because of the multiple steps involved in responding to the CDS and documenting the response in the medical record.
However, physician queries provide significant financial impact for hospitals. Artifact Health research has found that approximately 63 percent of physician query responses have a positive financial impact on the inpatient record. Each response with positive financial impact can increase reimbursement by $5,000 on average. On the flip side, every unanswered query reduces the hospital’s potential reimbursement by an average of $3,150. For example, for a 200-bed hospital with 13,000 inpatient admissions per year querying on 30 percent of admissions, the difference between a physician query response rate of 80 and 98 percent is more than $2 million.
Hospitals, already under enormous financial pressures, cannot afford to leave $2M on the table over something so easily fixed. There is no greater opportunity to maximize hospital reimbursement than to immediately streamline the physician query workflow and more effectively engage physicians in the query process.
Until recently, however, the physician query process has been a tedious clerical task that takes time away from patient care. Physicians are constantly interrupted by documentation queries, fielding them by email, by fax, and in person in the hallways of the hospital. In fact, a newly released study from ACDIS found that respondents believed the second most effective technique for querying was a verbal discussion with the physician—something most physicians likely dread due to the interruption and time it takes.
Fortunately, as mobile technology has improved, hospitals now have the option to streamline the physician query process, removing much of the administrative burden from physicians, CDSs, and coders.
For example, a large health system in Maryland has seen dramatic improvement by focusing on query workflow automation. At one of its community hospitals, CDSs typically queried 25 percent of eligible beds. They received a 40 percent response rate to queries placed in the electronic health record, and a 69 percent response rate when they visited the physician in person. However, it often took three to four in-person visits to get a query answered—a high resource cost to the hospital.
After implementing a mobile query solution with automated query tracking, notification, and reporting, the numbers improved drastically. CDS productivity nearly doubled, as they were able to increase their coverage to 45 percent of eligible beds by eliminating time spent following up with physicians for query responses.
The physician response rate leapt to 98 percent. Physicians were relieved of the steady interruptions from CDSs and found it satisfying to answer queries when convenient for them. Some physicians even reported answering queries from their smartphone at the grocery store and while at their children’s soccer games.
More than a year later, the health system has sustained an overall 98 percent response rate and an average query response time under 48 hours. These data included hundreds of community physicians, many of whom had never before answered a hospital query.
When innovations in technology, such as mobile query platforms, can be introduced to the physician query process, hospitals are able to get the reimbursements they deserve, clinical documentation becomes more accurate, and physicians have more time to engage in patient care. We see a much brighter future on the horizon for CDI thanks to developments in mobile technology and are excited to see both the clinical and financial benefits for physicians and hospitals as they implement these new types of solutions.
Marisa MacClary is CEO of Artifact Health.