As the vice president of Clinical Services at CoxHealth, a 900-bed health care system based in Springfield, Missouri, Amanda Hedgpeth works to find ways the organization can streamline operations while still providing excellent patient care. Currently, she is focused on helping physicians to properly document care — work that is projected to help improve the organization’s revenue by more than $25 million each year.
Coding is a headache for physicians — especially as the requirements keep changing. It is understandably difficult for physicians to make the documentation of treatments and diagnoses as specific as possible.
That’s why, at CoxHealth, we have created a team to evaluate how well each physician documents care. Our team looks at how physicians have coded over time, and then we sit down with them one-on-one to show them ways they can improve their documentation. (We prefer to call them “opportunities.”)
Our IT partner is a big help. Working together, we create physician scorecards that show each person’s case-mix index (CMI), a number that “reflects the diversity, clinical complexity, and resource needs of all the patients in a hospital. A higher CMI indicates a more complex and resource-intensive case load.”
Our partner helps us analyze our filings by benchmarking each physician to other subspecialties around the nation. Then we run tools to show how each physician can improve the accuracy of his or her CMI. The tool also tracks other metrics such as severity of illness, risk of mortality, number of queries and denials. Our goal is to fully deploy these scorecards to our more than 600 physicians by the end of 2019.
As you would expect, we tie this work to the overall dollars at stake. According to our projections, this work should save CoxHealth more than $25 million annually through improved physician coding and documentation.
Meeting the right expectations
One area of focus in this project is a risk-adjustment payment model from the Centers for Medicare and Medicaid Services (CMS) called Hierarchical Condition Category (HCC) coding.
HCC estimates future health care costs for patients. Through HCC, we use ICD-10 codes to assign risk scores to patients, which helps us capture a patient’s severity of illness and ensure we are reimbursed appropriately for care.
These codes flow to CMS both for billing and our expected rates of readmission and mortality. In many respects, this work is really about ensuring providers select the most specific diagnoses codes, when possible, for each patient. CMS will penalize us for failing to meet these quality metrics. Accurate coding ensures CMS understands the severity of the illnesses our providers are treating.
Automating repetitive tasks
In the face of the coming labor shortage, we are also implementing robotic technology or “bots” in various departments to help us automate manual, repetitive processes.
In our HR department, we have traditionally used many manual processes to get an applicant a job offer, get them hired and get them onboarded. Now, a bot will get new employees set up in our payroll system and make sure they have a name badge, get letters generated, etc.
Bots can run in the background, performing tasks 24 hours a day, 365 days a year. We anticipate that these bots will free up two FTEs to perform other, higher-level tasks.
Where did we get these ideas?
We run ideas like this through our “Innovation Accelerator.” Each year, we take 50 employees off site for two days. Each participant must come forward with a one-minute pitch for something innovative they feel Cox Health should be doing. We vet those ideas and we break into teams to flesh them out.
At the end of those two days, different teams report out to a panel of judges — what we call the “Shark Tank," which includes our CEO, CFO and others on our board of directors. Then we spend the next few months implementing and developing these innovative ideas. Our winner from January’s Innovation Accelerator? The bots.
These off-site meetings are a great way to engage our employees. We know the best ideas, process improvements and innovations tend to come from our frontline employees — they're the ones doing the work every day. They have the best opportunities to affect and drive change.
In the context of declining reimbursements, our work around innovation performance improvement and identifying cost opportunities is important for the future. We know we must always look for better, more cost-efficient ways to provide care. This work ensures we can give our employees raises, invest in the best technology and be competitive for another 110 years.
We have embraced innovation for decades— the status quo is not OK with us. We are constantly looking for ways to better serve our community.
Hear more from Amanda Hedgpeth during her session at the 2018 Cerner Health Conference, "Don't Leave Money on the Table: How CoxHealth Discovered Millions in Lost Revenue (Session #1550)." Make sure to visit the Enhance Health System Performance zone on the Solutions Gallery Floor on Tuesday, October 9 at 11 a.m. CST. Register for CHC18 here.
