Computer Assisted Coding & Natural Language Processing RFP

Transcription

1 Computer Assisted Coding & Natural Language Processing RFP Assignment 4 Team CAC/NLPL Russ Abercrombie Bill Dailey Jeremy Lutz

2 Contents Contents Overview Opportunity Terms Confidentiality Cost of Proposal Right to Reject Schedule Intent to Participate Proposal Submittal Payments Functionality and Scope of Services Costs Software Hardware/Storage/Network Implementation and Support Services Training Administrative Technical Contact Contractual Contact Proposal Submittal Contact Due Dates Appendix A Vendor Information Appendix B Functional & Technical Requirements Appendix C Training Plan Appendix D Abbreviations References Page 2

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4 1 Overview Golden Valley Memorial Healthcare (GVMH) is located in the rural community of Clinton, MO. GVMH is a healthcare system comprised of one hospital and four multispecialty clinics dispersed throughout the Clinton, MO community. The multispecialty clinic has 30 providers, 6 of which are specialists and 24 are primary care providers. Golden Valley Memorial Healthcare inpatient volumes continue to decrease at approximately 4-5% per year while outpatient volumes continue to grow. Over the past 5 years, the healthcare system profit margin has been driven by this increased outpatient revenue. Optimizing efficiency with regard to this revenue stream is critical to the continued success of GVMH. The electronic medical record system used in the outpatient setting is McKesson IC-Chart (formerly Med-3000/InteGreat). Increased pressures on coding accuracy coupled with this increase in volume have created a large opportunity for improvement in the revenue stream. There are significant bottle-necks in the processes that currently exist between the point of care and the resulting reimbursement. The methods previously in place for coding, billing and subsequent reimbursement have not scaled well in response to increased outpatient volumes and the looming ICD-10 transition will only complicate matters. The impending requirement for all healthcare organizations to transition from the ICD-9 code set to the ICD-10 code set in October of 2015 will create many challenges for HIM and coding professionals. The significant expansion of the code set allows for more specific and granular coding, but also brings with it more complexity. This complexity, along with the need for coders Page 4

5 to learn, essentially, a brand new code set, will require more time and effort for the coding process. The conversion to ICD-10 has the potential to increase data quality, analyze gaps in care, improve clinical and billing processes, and facilitate quality reporting. But in order to fully realize this potential, and avoid the possible negative effects of the ICD-10 conversion, GVMH will need to take advantage of technologies that will help ensure coding accuracy and efficiency. These issues create a great impetus to change GVMH approach to coding. 2 Opportunity Golden Valley Memorial Healthcare wants to replace the current HIM coding solution with a solution that is integrated with natural language processing and is capable of interfacing with the electronic health record system that is in use today. The overarching goal of this project will be to increase coding and billing efficiency to shorten the time between date of service and reimbursement to recoup a portion of the cost. The calculations are straightforward -- each day saved in the coding process results in $65,000 savings over the year. We believe this goal can be accomplished through the implementation of Natural Language Processing (NLP) and Computer Assisted Coding (CAC) technologies to reduce coding costs, increase coder efficiency, and increase coding accuracy. Our goal will be met by leveraging NLP and CAC to accomplish the following objectives: Capture lost revenue by improving efficiencies in the coding life cycle. Minimize or eliminate the risk of reductions in coder productivity or accuracy due to the impending conversion to ICD-10. Page 5

6 Minimize or eliminate coding backlogs. Protect the organization from potential shortages of certified coders if some level of automation is implemented. Provide valuable data and insights for any current or future efforts to improve evidencebased care and standardization of care. Golden Valley Memorial Healthcare desires a solution that will provide benefits in the following areas: Financial o Improved financial reporting allowing for more categorization and analysis of results o Support for all data collection required for Medicare cost reporting o Capable of handling additional lines of business in the future, e.g. orthopedic surgery o Reasonable acquisition and recurring expense o Reduced dictation/transcription cost o Reduce risk cross-section with respect to RAC audits Technical o Interface with McKesson InteGreat and Meditech C/S o Easy to deploy and support o Capability for customization with vendor assistance and continued vendor support o Capability to be deployed internally via private cloud Page 6

7 o Scalable architecture o Open architecture to allow the use of third party reporting tools. o Ability to retain data for at least ten years 3 Terms This Request for Proposal (RFP) is being sent to candidates who have been identified through the RFI process as potentially having the capability to satisfy GVMH preliminary requirements for an integrated NLP/CAC solution. The solution selected will be chosen on the basis of GVMH s evaluation and determination of which solution provides the greatest benefit to the GVMH community. The following terms will apply to this RFP process. Submission of a proposal in response to this RFP indicates your acceptance of all the following terms. If you do not agree or intend to comply with any term in this RFP, you must clearly indicate this in your Proposal. 3.1 Confidentiality Any data that you consider confidential (Vendor Confidential Data) shall be conspicuously marked as such in your Proposal. GVMH will not disclose any Vendor Confidential Data to any party other than its agents supporting this RFP process, and agrees that such data will not be used for any purpose other than evaluation of the Proposal. You may not make any public announcement regarding this RFP or its contents. Breach of confidentiality may lead to GVMH s enforcement of any other remedies available. Page 7

8 3.2 Cost of Proposal GVMH shall not bear any responsibility or liability for any costs incurred by you in the preparation, submission, or delivery of a proposal, or any subsequent demonstrations or presentations. 3.3 Right to Reject GVMH reserves the right to reject any proposals submitted which it finds nonresponsive, late in submission, or unsatisfactory in any way. GVMH reserves the right to request additional information from you in response to any proposal you submit and shall have no obligation to award a contract for products, work, goods, or services as a result of this RFP. 3.4 Schedule Below are the key dates in our RFP process: Date Jan , 2015 Feb. 9-13, 2015 Feb , 2015 March 19-20, 2015 April 13, 2015 May 4, 2015 Event Request for Proposal distributed electronically by GVMH GVMH receives Intent to Participate from Candidate vendors Selected candidate vendors execute Confidentiality Agreement GVMH hosts RFP Question and Answer conference call for participating vendors GVMH receives Proposals from candidate vendors GVMH notifies candidates regarding status of their Proposal and next steps 3.5 Intent to Participate If you are interested in responding to this RFP, please send your written intent to participate via to Dr. William Daily (docbill@gvmh.org). Notice of Intent to Participate must be submitted by 1700 CST on February 13, Once we have received your Notice of Intent to Participate, we will a copy of our Confidentiality Agreement to the address from which the Notice of Intent was sent. This Page 8

9 Confidentiality Agreement must be executed and returned to GVMH by 1700 CST on February 20, Return instructions will be sent in the with the Confidentiality Agreement. 3.6 Proposal Submittal Send one electronic copy of your Proposal via to by 1700 CST on April 13, Payments Payments will be made in the following manner: 1. 50% payment made upon signing of contract 2. 25% payment at a mutually agreed upon project milestone 3. 25% remaining payment will be made when GVMH is satisfied with the installation, training, and overall implementation. 4 Functionality and Scope of Services Please provide responses to all items in both Appendix A Vendor Information and Appendix B Technical & Functional Requirements. Please provide complete and accurate answers to all questions. While responding, please note the following: You must provide responses that are in accordance with existing software and services which can be immediately procured and implemented if GVMH desires. Any features or functionality planned for future releases of projects or services must be clearly identified as such. You must clearly state if your product does not fulfill the stated requirement. Any deviation from the stated requirements must be specifically identified and explained. Page 9

10 Please respond to all items in Appendix C Training Plan to outline the training capabilities offered. In addition to the software and support requirements, we are also seeking vendors who will supply thorough and ongoing training to our staff on proper use of the product. We prefer a blended learning model that includes the following elements: Training in a variety of formats, including instructor-led classroom training, CBT/online training, and hands-on training in a test environment (TrainingToday, 2014). Training for all current and future end-users, including role-based and processed-based training (HealthIT.gov, 2013). Training for super-users (a.k.a. train the trainer ) to develop in-house experts and training resources (HealthIT.gov, 2013). A system that monitors the training progress of all users and allows users to give feedback regarding your system and the training itself. 5 Costs Please insure that your proposal covers ALL costs associated from being awarded this business. Please provide costs for the following scenarios: Hosted/SaaS solution. GVMH data center located solution Costs should include any of the applicable items listed below, as well as any items you foresee that are not mentioned here. Please identify and indicate all one-time costs and recurring costs over the expected life of the proposed solution. If any costs associated with implementation are Page 10

11 not included in your pricing those costs must be specifically identified and explained as part of your response Software List all proprietary software. Each component or module should be listed separately. List all third party software required. Each component should be listed separately. Provide detail regarding types of licensing and associated fees (e.g. enterprise, per seat, per server, etc.). Provide software maintenance terms and costs. Identify which items are required or optional, as well as the term, calculation method, and annual increase amounts. 5.2 Hardware/Storage/Network List all required hardware, storage devices, and associated operating systems or software required. List any specialized printing, scanning, or other devices required. List any common off the shelf items required. List all network and data communication devices required. List all maintenance terms and fees associated with any hardware/storage/network devices. 5.3 Implementation and Support Services List all fees associated with installation, configuration, hosting, project management, implementation services, integration services, data conversion, training services, travel expenses, third party data, support fees, etc. Page 11

12 All such fees should be provided with supporting documentation, including rate, quantity, estimated duration, and incidental expenses. 5.4 Training Please provide pricing for any and all training you provide for your product. We prefer a blended learning model. Costs for all training materials, including any physical materials, training software, learning management system access, instructor time, and use of off-site training facilities. Costs involved in modifying and/or customizing the training materials to match any modifications and/or customizations made to the software to meet our needs. 6 Administrative The following is a list of contact information and 6.1 Technical Contact Any questions concerning technical specifications or Statement of Work (SOW) requirements must be directed to: Name Steve Ballou, IT Director Address 2 nd Street Clinton, MO Phone FAX Sballou@gvmh.org Page 12

13 6.2 Contractual Contact Any questions regarding contractual terms and conditions or proposal format must be directed to: Name Kyle Adkins Address 2 nd Street Clinton, MO Phone FAX kadkins@gvmh.org 6.3 Proposal Submittal Contact All proposals, confidentiality agreements, and any other materials related to the RFP should be directed to: Name Mike Gaul Address 2 nd Street Clinton, MO Phone FAX mgaul@gvmh.org 6.4 Due Dates A written confirmation of the Vendor s intent to respond to this RFP is required by (see schedule in section 3.4). All proposals are due by 17:00 CST. Any proposal received at the designated location after the required time and date specified for receipt shall be considered late and non-responsive. Any late proposals will not be evaluated for award. Page 13

14 Appendix A Vendor Information Question Response Company Name Address of Headquarters Number of years as a Medical Coding vendor Number of years integrating NLP into Coding software Has your product won any awards or received any certifications? (KLAS, HIMSS, etc) Please list any company mergers, acquisitions, and sell-offs and year completed How many employees do you have? Is the company Public or Privately owned? Have there been any bankruptcy/legal issues? If so, please include under which name the bankruptcy was filed and when, or any pertinent lawsuits, closed or pending, filed against the company. Number of entities actively using software How many of these entities are multi-site? How many of these entities are licensed as long term acute care? Please list your top three WOW factors based on client satisfaction data Do you have a formal users group? Please provide references that are available for contact Page 14

15 Appendix B Functional & Technical Requirements Item # Area Functionality Y/N Comments 1 HIM Are multiple groupers allowed based on payor requirements? List any limitations. 2 HIM Does system support workflow creation for coding? 3 HIM Can the system support computer assisted coding? 4 HIM Is NLP Integrated or is it an addon? 5 HIM Does the system provide support and updates for ICD-9 codes and ICD10? 6 HIM Can ICD9 & ICD10 be used concurrently? 7 HIM Does your system suggest both ICD-9 and ICD-10-CM/PCS codes simultaneously in one view for the coders? 8 HIM Does your system handle outpatient codes for ICD-9 and ICD-10? If so, for which departments? 9 HIM Does your system generate early warning indicators when there might be insufficient documentation for ICD-10 coding? 10 HIM Does your system suggest both ICD-9 and ICD-10-CM/PCS codes simultaneously in one view for the coders? Page 15

16 11 HIM Does the system provide support and regulatory updates for CPT, DRG, APC, HCPCS? 12 HIM Does the system include a DRG grouper? 13 HIM If a DRG grouper is included, are updates provided? 14 HIM Does the system include an OP/APC grouper? 15 HIM If the system does not include an OP/APC grouper can the system interface with an external system and what are the costs for the interface? 16 HIM Can we load historical MPI from previous system? 17 HIM Does the system allow for users to establish special studies to support clinical data collection where applicable? 18 HIM Can each facility define which types of ROI requests need to be written to a disclosure log? 19 HIM Can alerts be established when multiple ROI requests are received from same auditing entity (ie QIO/RAC)? 20 HIM Does your system provide any tools that would assist with RAC audits and tracking? 21 Interfaces Does your software support standard HL7 formatting for importing and exporting data to/from other systems or outside providers? If any limitations describe. Page 16

17 22 Interfaces Have you interfaced with another Clinical Information System? If yes, please provide the names of the other systems. 23 Interfaces Have you interfaced with another Patient Financial System? If yes, please provide the names of the other systems. 24 Interfaces Do you have experience with the InteGreat ICChart EMR? 25 Interfaces Regarding ADT interfaces do you specifically allow an inbound ADT interface to create a patient encounter? Audit Do audit logs track actual activity that has been changed? 28 Audit Are audit logs available to track what users have viewed and or edited in the system? 29 Audit Are audit logs available to track any user who has printed and or exported patient data from the system? 30 Audit Does the system provide reports on encoder and CAC utilization and productivity? 31 Audit Does the system provide coder productivity statistics? 32 Audit Does the system support the ability to build quality audit alerts for management review? 33 Reporting Does system provide standard revenue and usage reports with Page 17

18 YTD information flexed by hospital/provider FTE. 34 Reporting Does the system allow for ad-hoc reporting? 35 Reporting Are all data elements captured within the system available from a reporting perspective? Please list any limitations. 36 Reporting Does the system provide roll-up reporting from single facilities, grouping of facilities and corporate wide? 37 Reporting Are clients able to directly access backend production database for creating own custom queries and reports? 38 Reporting Does the system provide the ability to export data to MS Office applications? 39 Reporting Does the system provide the ability to restrict access to reports by employee role? 40 System Is your system available in a SaaS model? 41 System Is your system available in a hosted model? 42 System Can your system be located in our data center? 43 System If hosted at our data center, what technical and hardware requirements are needed for your product? 44 System Is there a limit to the number of financial classes allowed? Page 18

19 45 System Is there a limit to the number of payor codes allowed? 46 System Is there a limit to the number of patient types allowed? 47 System Is there a limit to the number of adjustment and payment codes allowed? 48 System Does the system allow users to access enterprise and facilityspecific reports from remote locations? 49 System Please provide a description of how the system would support a centralized management model for multiple facilities? 50 System Does the system run multiple locations on a single relational database? If so, please describe how security functions for corporate users? 51 System Does system support the technical requirements set forth in HIPAA and the HITECH act? 52 System Does vendor adhere to standards of ICD9/ICD10, LOINC, CPT, SNOMED? 53 System Has your CAC/NLP product been certified by an authorized certification body? If so, please list all certifications achieved. 54 System Do you provide 24/7 customer support? 55 System Where is your support center located? Page 19

20 56 System Does the system support online help function/feature within the application? 57 System How often are software releases scheduled? 58 System How often is your product updated? How are they deployed? 59 System Is downtime required for software releases? If yes, please provide average down time. 60 System Describe your disaster recovery plans including the protection of source code as well as patient data. 61 System How are customer requests for enhancements handled? 62 System Describe your flexibility in customizing base product for hospital specific rules and alerts. 63 System Does vendor allow for a separate test system at no cost? 64 System Does the system provide configurable error checking on data entered? 65 System Is the system accessible through mobility devices? 66 System- Implementation & Training 67 System- Implementation & Training Does the system provide for a separate training system? If yes, is there a cost associated? For implementation and training do you utilize a third party partner? If so please provide the partner name. Page 20

21 68 System- Implementation & Training 69 System- Performance 70 System- Performance 71 System- Performance 72 System- Performance What is the typical time frame for installation of a site? What are the performance and accuracy benchmarks we can expect from the NLP engine? What are the performance and accuracy benchmarks we can expect from the CAC system? Have these performance benchmarks been met in organizations similar to ours? Have these performance benchmarks been met in organizations that are larger than ours? 73 Users/Security Does the system support the configuration of password rules (e.g. length of password, strength of password, special characters, keyword exceptions, etc.)? 74 Users/Security Can passwords be configured to expire in a configurable amount of time? 75 Users/Security Does the system provide selfservice password reset functionality? 76 Users/Security Does system allow for users to be set up once and then granted access to all facilities required? 77 Users/Security Does system allow for creation of master roles to be assigned when creating new user? 78 Users/Security Is there a limit to the number of concurrent users allowed to access system? Page 21

22 Appendix C Training Plan Question Do you offer instructor-led classroom training? Response Do you have classroom training facilities? Do you offer online/cbt training? Do you offer interactive/hands-on training in a simulated live environment? Do you customize your training to match any system customizations that are required? Do you offer an LMS or other system to track training progress? Is all of your training available to us throughout the term of our software license agreement? Do you offer training specific to major system updates? When can we begin training our endusers? Page 22

23 Appendix D Abbreviations ADT APC APC CAC CPT DRG FTE HCPCS HIPAA HITECH ICD LOINC MPI NLP OP QIO RAC ROI SaaS SNOMED YTD Admit Discharge Transfer Ambulatory Payment Classification Ambulatory Payment Category Computer Assisted Coding Current Procedural Terminology Diagnosis-Related Group Full Time Equivalent Healthcare Common Procedure Coding System Health Insurance Portability and Accountability Act Health Information Technology for Economic and Clinical Health International Classification of Diseases Logical Observation Identifiers Names and Codes Master Patient Index Natural Language Processing Outpatient Quality Improvement Organization Recovery Audit Contractor Return on Investment Software as a Service Systemized Nomenclature of Medicine Year To Date Page 23

24 References Freifeld, L. (2013). 5 Tips for a Successful Training Program. Training Magazine. Retrieved from: The Most Effective Training Techniques. (2014). Training Today. Retrieved from: Training-Techniques How should I train my staff?. (2013). HealthIT.gov. Retrieved from: Page 24