The Data Integrity Department: Optimizing Health Information Management

Transcription

1 MGMA 2017 ANNUAL CONFERENCE OCT ANAHEIM, CA The Data Integrity Department: Optimizing Health Information Management Randy Jones, DHA, FACHE, FACMPE Senior Vice President, Management Consulting Culbert Healthcare Solutions Inc., Woburn, MA Elizabeth Morgenroth, CPC Senior Consultant Culbert Healthcare Solutions Inc., Woburn, MA Randy Jones and Elizabeth Morgenroth do not have any financial conflicts to report at this time. 1

2 Learning Objectives Summarize how roles and responsibilities of HIM have evolved Explain how practices can identify and close HIM process gaps to respond to the data integrity and value-based care needs Describe the enhanced skills needed in the evolved HIM department and provide concrete approaches to developing a world-class HIM infrastructure Our Thoughts Medical Records and Data Integrity One Patient = One Medical Record Privacy, ALWAYS EHR technology is leveraged to improve documentation and/or the availability of information essential to the care team, coding performance, and population health initiatives Interfaces are better than paper Discrete data is better than unstructured text / transcribed notes Some aspects of HIM need to re invent themselves in response to a changing landscape 2

3 Polling Instructions Text the word Leave to 22333, if you have been in a session previously with polling Join my poll by texting the word 17mgma to the number or if using and internet browser go to PollEV.com/17mgma When I get to a polling slide, text your answer (A, B, C, D, etc.) or if using and internet browser, simply click or select your answer. You do not need to join again for the next question Participating with Poll Everywhere Pollev.com/17mgma Or 17mgma <send> <then send your response> Internet browser voting Text voting 3

4 9/19/ mgma mgma 17mgma A Text voting 17mgma FMPC17 Pollev.com/17mgma Internet browser voting 4

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7 Roles & Evolution of Health Information Management (HIM) HIM Gaps how to identify and close Agenda Gap identification, current state workflows, and valuebased reimbursement challenges around information Client Case Study Preparing for the future skills medical group need now on their HIM team 7

8 Learning Objective 1 Summarize how roles and responsibilities of HIM have evolved Explain how practices can identify and close HIM process gaps to respond to the data integrity and value-based care needs Describe the enhanced skills needed in the evolved HIM department and provide concrete approaches to developing a world-class HIM infrastructure Key HIM Functions & Roles Custodian of Legal Medical Record, both paper and electronic Maintenance, Retention, Security, and Privacy Forms management Release of Information (ROI) Patients Third Parties (insurance companies, governmental agencies, and attorneys) Procedure/Diagnosis Coding & Management of Incomplete Charts/Open Encounters Inpatient and Outpatient Technical Coding Professional Encounter Coding Other Transcription, in house and/or outsourced Health Information Exchange Reporting Master Patient Index Disease Registries 8

9 HIM: Past, Present & Future 1980s Technology 1980s Medical Records Technology HIM: Past, Present & Future 1990s Technology 1990s Medical Records Technology 9

10 2000s Technology HIM: Past, Present & Future 2000s Medical Records Technology, Past, Present & Future Cartoon Source: 10

11 , Past, Present & Future HIM: Past, Present & Future 2010s Technology 2010s Medical Records Technology

12 HIM: Past, Present & Future Approximately 55% of physicians using one of six EHRs 1 1 Jeffrey L. Brown, LinkedIn Post, August 10, 2017 citing HIMSS, KLAS, Medscape publications research. HIM: Past, Present & Future 2015 National Electronic Records Survey of Office Based Practices showed the 86.9% have an EHR 77.9% are using a certified system 443,962 Office Based Physicians in the U.S. (April 2017) 12

13 HIM: Past, Present & Future 2015 National Electronic Records Survey of Office Based Practices showed the 86.9% have an EHR 77.9% are using a certified system 443,962 Office Based Physicians in the U.S. (April 2017) 443,962 Office Based Physicians x 77.9% = 345,846 Office Based Physicians Using Certified EHR with 60% (207,508 physicians) Demonstrating Meaningful Use in 2016 HIM: Past, Present & Future >200,000 physicians are a significant risk in a value base care reimbursement model because of a lack of an EHR or use of an EHR that has limited capabilities How can HIM help mitigate this risk? 13

14 HIM: Past, Present & Future Are medical groups investing enough in HIM and getting value? Expenses per FTE Physician (Trending) Benchmark (Percent of Operating Costs) 50th%tile 50th%tile 50th%tile n = Total support staff Information technology 1.5% 1.4% 1.5% Medical secretaries, transcribers 0.5% 0.4% 0.5% Medical records 1.0% 0.7% 1.0% Total general operating costs Information technology operating cost 3.0% 2.6% 3.5% Administrative supplies and services 1.8% 1.5% 1.8% TOTALS 7.8% 6.7% 8.3% Presuming Total Medical Revenue of $1,033,217/per FTE $ 85,661 Medical Records/HIM Related Costs (Labor & Operating Costs) 33,901 Information Technology Related Costs (Labor & Operating Costs) 51,760 Source: MGMA Data Dive (2015 Cost & Revenue Report [based on 2014 data]) HIM: Past, Present & Future Is HIM an issue for MGMA members? Source: 14

15 Future State HIM: Past, Present & Future Clinical data is rapidly becoming essential to value base contracting initiatives because of risk sharing provisions Patient attribution information Chronic disease registries Compliance with clinical pathways / care protocols Compliance with health information exchange policies Ancillary and pharmaceutical utilization Future State (Continued) HIM: Past, Present & Future HIM skillsets will need to evolve, shifting from a pure administrative roles to more technologycentric roles a few examples File Clerks and Scanning Clerks migrate to EHR technicians Forms Management to EHR enhancement technician Telehealth documentation administrator Professional Coders to EHR & Coding Educators 15

16 HIM: Past, Present & Future Future State (Continued) HIM will become a critical business partner of Chief Medical Information Officer Chief Information Officer Chief Quality Officer Chief Financial Officer & Chief Revenue Officer Managed Care Contracting executives Learning Objective 2 Summarize how roles and responsibilities of HIM have evolved Explain how practices can identify and close HIM process gaps to respond to the data integrity and value-based care needs Describe the enhanced skills needed in the evolved HIM department and provide concrete approaches to developing a world-class HIM infrastructure 16

17 Gap Analysis Our Model think of it as a storyboard Functional review of key HIM activities Workflow mapping of key activities (Visio tools help) Personnel assessment Leadership (skills and training) Staff (skills and training) Job Description Review Interviews with external organizational stakeholders Medical staff, finance, operations, information technology, etc. Compliance and regulatory findings What s the Big Deal? HIM Operations have evolved as healthcare regulations have become more stringent regarding patient privacy, clinical documentation, provider education, and coding Scanning Release of Information Transcription Analysis Data Integrity 17

18 Scanning What s the Big Deal? (Continued) Ensure clinical information is available to providers of care in the right place, all of the time, on time Ensure that scanned images are appropriate for the medical record Release of Information What s the Big Deal? (Continued) Ensure that releases are not completed without proper authorization Ensure that releases are limited to minimum necessary Ensure that releases come from the established source of truth 18

19 Transcription What s the Big Deal? (Continued) Quickly being replaced by voice recognition software and outsourced models Employees laid off or re purposed Analysis What s the Big Deal? (Continued) Technology provides ability to assign deficiencies realtime and concurrent to the patient stay (acute care) Technology provides ability to provide reporting on incomplete documentation to leadership In addition to quantitative analysis, qualitative analysis provides additional layer of documentation quality check 19

20 What s the Big Deal? (Continued) Data Integrity More bolt on systems require SME understanding of use and function Potential for specialists in business intelligence Enterprise MPI and participation in Health Information Exchange (HIE) leads to greater risk in duplicate patients and overlays Correction of identity errors is more than just merging patients. Un merging is like detangling spaghetti, and has great impact on patient safety What is Data Integrity? Data integrity means that data should be complete, accurate, consistent, and up to date. Ensuring the integrity of healthcare data is important because providers use them in making decisions about patient care. Source: Health Information Management Technology: An Applied Approach (2 nd Edition, p. 851) 20

21 The Client Regional Health System (4 Acute Care Hospitals, >1,000 combined licensed beds) $1.6 billion in net patient service revenue (2016) Drug & Alcohol Rehabilitation Hospital & Outpatient Treatment Center 5 Major Free Standing Outpatient Health Centers Employed Medical Group with >1,000 providers >2,000 physicians on the medical staff Awards All acute care facilities in the Top 10 of their region (U.S. News Best Regional Hospitals) for System Nursing Magnet Designation The Joint Commission Gold Seal National Quality Approval System Wide Epic implementation in progress The Client (Continued) System Wide Epic implementation in progress (continued) Leveraging the opportunity to transform clinical and administrative workflows in a proactive and thoughtful project plan Funded a dedicated project team with a two in the box methodology using SMEs Gap analysis conducted on all major workflows and processes The gap analysis for Health Information Management showed significant opportunities for improvement Initial focus on coding workflows and CDI Secondary focus on other workflows identified significant skillset gaps for Epic functionality within the health system s HIM group 21

22 Client Case Study Current State Assessment identified significant opportunities: Front line staff deficits Change to insourced ROI model Transcription to analysis Need for centralization for direct supervision of front line staff Enhanced enterprise identity integrity team Need for System Management of Revenue Cycle and HIM Operations Client Case Study (Continued) 22

23 Health Information Management (Leadership Team Only) Client Case Study (Continued) Client Case Study (Continued) Health Information Management (HIM Operations only) 23

24 Client Case Study (Continued) The project remains a work in progress over the next 6 to 8 months What are the next steps? Job Descriptions HR Buy In, execution Delivery of messaging to front line staff Employee Selection with goal of training on time Learning Objective 3 Summarize how roles and responsibilities of HIM have evolved Explain how practices can identify and close HIM process gaps to respond to the data integrity and value-based care needs Describe the enhanced skills needed in the evolved HIM department and provide concrete approaches to developing a world-class HIM infrastructure 24

25 Traditional Method Enhanced Skills Needed HIM staff manually scan and index paper documentation at a central location Evolved Model To achieve HIMSS 7, HIM staff will decentralize and all scanning will be performed at various practice locations Enhanced Skills Needed (Continued) Traditional Method Physician practice staff fulfill releases. Typically, not considered a priority and often times requests for information lapse and becomes a significant patient dis satisfier. Or handled by outsourced vendor who has no connection to the patient Evolved Model Release of Information to be handled by centralized, call center, who processes all releases. Patient Information Navigators provide a more customer focused approach to ROI and support the 24/7 ROI activities and the patient portal 25

26 Traditional Method Enhanced Skills Needed (Continued) Transcription handled by employed and vendor transcriptionists Evolved Model Limited transcription needs due to integrated electronic medical record Significant reduction in costs related to limited transcription needs Enhanced Skills Needed (Continued) Traditional Method Employees perform quantitative analysis related to chart documentation completion following discharge from acute care setting Evolved Model Employees perform quantitative analysis concurrent to the patient stay and qualitative analysis which includes record documentation review and ongoing provider education to all providers within the enterprise 26

27 Traditional Method Small identity Integrity team Enhanced Skills Needed (Continued) Evolved Model Creation of new identity integrity and chart correction team whose primary functions are: Researching and correction of duplicate patients and overlays, with greater risk when participating in HIE HIM may also have system administrators who can provide technical expertise to the HIM department for HIM specific bolt on applications, and can support specific reporting needs for the department and the enterprise Enhanced Skills Needed (Continued) HIM Curiosity Critical Thinking Skills Soft Skills Customer Focus 27

28 The HIM Department of the Future Changing landscape of healthcare. HIM must adapt or be left behind HIM is known today as leaders in coding and healthcare privacy HIM plays a key role in EVERY operational area of healthcare and bring value to the enterprise with new careers and opportunities emerging such as: Quality Improvement Analytics supporting value based reimbursement models Risk Management Financial Management Analytics supporting coding optimization and revenue integrity initiatives Project Management support electronic health record optimizations in partnership with the clinical informatics team The Future of HIM In Your Organization Streamlined processes Minimized risk Professional, world class staff Fertile ground for a growing health system with a focus on process, continuous quality improvement, operational strength and stability 28

29 HIM of the Future Data needs in a value based care environment Patient attribution information Chronic disease registries Compliance with clinical pathways / care protocols Compliance with health information exchange policies Ancillary and pharmaceutical utilization Our Thoughts Medical Records and Data Integrity One Patient = One Medical Record Privacy, ALWAYS EHR technology is leveraged to improve documentation and/or the availability of information essential to the care team, coding performance, and population health initiatives Interfaces are better than paper Discrete data is better than unstructured text / transcribed notes Some aspects of HIM need to re invent themselves in response to a changing landscape 29

30 Continuing Education ACMPE credit for medical practice executives. 1 AAPC Core B, CPPM credit 1 ACHE credit for medical practice executives 1 CME AMA PRA Category 1 Credits.. 1 CNE credit for licensed nurses 1 CPE credit for certified public accountants (CPAs) 1.2 CEU credit for generic continuing education 1 Let the speakers know what you thought! Evaluations are available on the MGMA mobile app Randy Jones rjones@culberthealth.com Culbert Healthcare Solutions Inc., 800 W Cummings Park, Ste 6000 Woburn, MA Elizabeth Morgenroth emorgenroth@culberthealth.com Culbert Healthcare Solutions Inc. 800 W Cummings Park, Ste 6000 Woburn, MA

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