It began as an initiative to improve documentation for ICD-10. But the data-driven clinical documentation improvement training program was so successful, a Texas health system has expanded it to the entire revenue cycle. And along the way, the organization noticed an unintended consequence: Patient satisfaction also improved.
Prior to the program, the revenue cycle, business office, HIM, coding and patient access was under Wise Health's chief financial officer. The chief nursing officer oversaw nursing, case management, utilization review and discharge planners. The problem: there was little communication between clinical utilization review, revenue cycle and the hospitals and clinics. Its multiple hospital and clinic systems were not integrated, which created process problems, coding issues and audit denials.
So the organization decided to build a bridge so to speak from its case management, CDI, coding and denial management departments to its ambulatory clinics. The process involved physician education, an examination of the daily work flow, and measurement of outcomes for congestive heart failure, diabetic education and behavioral dual diagnosis. As the relationships between coders, physicians and the financial team grew stronger and the teams shared data, the system decided to use the data across the system to improve outcomes.
One initiative targeted follow-up care after discharge to patients who had congestive heart failure. Initially the organization identified patients admitted to the hospital for observation. Later, the groups expanded the analytic capability across the enterprise to include patients seen at all 18 clinic locations in order to make sure staff were following-up on care post-discharge. The organization soon began to see a drop in readmission rates specific to patients with congestive heart failure, Giddens-Branscum said, and the cardiology department decided to expand the program across all of the system’s acute cardiac facilities.
The continued collaboration among the physicians, nurses and revenue cycle also led to an unexpected result, she said: an improvement in customer service and satisfaction scores. Patients responded positively to the relationship that they developed with the transitional coordinator prior to discharge. The nurse practitioner also calls them at home to remind them about care instructions and also may send a postcard.
“This has been a two to three year beginning-to-end process to see the relationship and culture within the departments evolve,” she said. "It makes it a place I love to work at.”