79th Annual Conference Capitalizing on Our Strengths June 1 to June 4, 2014

1. 79th Annual Conference Capitalizing on Our Strengths June 1 to June 4, 2014

2. Embracing CAC Beyond Reimbursement Bonnie S. Cassidy, MPA, RHIA, FAHIMA, FHIMSS & AHIMA Approved ICD-10-CM/PCS Trainer and Ambassador June 2, 2014

3. Agenda • What is Computer-Assisted Coding (CAC)? • Why should I consider CAC? • Embracing CAC Beyond Reimbursement: • Quality Results Reporting • Information Governance: • Assessing your Readiness for CAC • Q&A

4. What is CAC? Computer-assisted coding is a solution based on technology which offers gains in efficiency and coding workflows and improves quality of coded and clinical data.

5. What is CAC? CAC has been defined by the American Health Information Management Association (AHIMA) as “…the use of computer software that automatically generates a set of medical codes for review, validation, and use based upon clinical documentation provided by healthcare practitioners.”

6. How Does CAC Work? CAC reads electronic documentation using Clinical Language Understanding (CLU) and assigns ICD-9-CM, CPT, SNOMED, ICD-10 or other codes • Uses structured electronic narrative text to determine context and assign codes • Allows doctors to use their natural language which is analyzed and processed real-time in context to return applicable codes

7. WhyShould I Consider CAC? Could be a mitigation strategy for: • Transition to ICD-10 • Incomplete documentation • Incomplete or incorrect coding • Sequencing errors leading to financial loss • Not understanding complexity of data (severity and Mortality risks) • Data integrity is at risk • Coding compliance

8. CAC Benefits • Reduce AR days and DNFB • Reduce HIM labor and outsourcing costs

9. CAC – Benefits Realization • CAC produces an audit trail tracing clinical documentation • Clinical documentation is verified • Coding can be validated • Coding is consistent • Potential for improved Case Mix (CC/MCC capture) • Enhances coding compliance

10. Embracing CAC Beyond Reimbursement Embracing Technology • Computer Assisted Coding (CAC) with its Clinical Language Understanding capabilities will be integrated into the coding workflow of every organization. • The challenge for HIM professionals is to leverage the CLU or NLP technology by demonstrating its value and championing its use for additional purposes.

11. Embracing CAC Beyond Reimbursement Embracing Technology • One area to consider is chart abstraction. The demand for organizations to abstract clinical data for registries and quality measure reporting continues to expand. Often this involves costly manual abstraction of data with limited budgets. • A system which provides a core data source to provide the capability of collection of required data and use for many other purposes is in your future.

12. Our World Today of “Identifying” Quality • From • Joint Commission Surveys every 3 years • To • Public Reporting and Recognition Programs • Pay for Performance • VALUE BASED PURCHASING • All payers are in the game • Measures being used are becoming more aligned

13. Quality Measures/Reporting To Supportappropriate reimbursement CAC solution helps Reducetime-consuming abstracting tasks Must be able to Provideappropriate reimbursement real-time quality measure results Ensureaccurate and complete transmission to regulatory agencies

14. Healthcare Reform • New models of transparency, accountability and value-based purchasing • Focus on • Processes • Clinical – Core Measures • Outcomes • 30 day all cause Hospital Readmissions and Mortality • Patient Safety Indicator Composite • Patient Experience • Hospitals will be competing against each other • There will be winners and losers

15. Embracing CAC Beyond Reimbursement Collect Once, Use Many • It will come as no surprise to HIM professionals that the fiscal health of hospitals and the scope and quality of patient care and physician practice patterns are directly intertwined. • As organizations struggle to remain compliant with an ever increasing and often confusing landscape of regulatory and reporting requirements they are also competing for a dwindling share of reimbursement revenue.

16. Embracing CAC Beyond Reimbursement Collect Once, Use Many • Conversely as requirements increase, the resources often remain static. • Leveraging available tools and processes to capture and analyze data proactively and thus predict their clinical and financial outcomes will position organizations to remain both solvent and competitive. Adopting a “collect once; use many” approach to record processing and reviews will yield broad benefits.

17. Embracing CAC Beyond Reimbursement Leverage your EHRs Investment • One of the promises of EHRs is the automation of abstraction and aggregation of results for quality measurement and reporting, but much work remains. • It is acknowledged that “retooling” of existing measures to be “machine readable and processable” with results comparable to human abstraction is challenging.

18. Embracing CAC Beyond Reimbursement Leverage your EHRs Investment • One automation obstacle is identification and abstraction of data from “free text” or “narrative text” which is referred to as “unstructured data.” • There is growing recognition that Clinical Language Understanding/CLU/NLP is a useful technology to address unstructured data.

19. Embracing CAC Beyond Reimbursement Using CAC concurrently • The HIM professional may choose a prospective approach to Quality Measurement by promoting the value of concurrent coding using CAC to identify patients whose data will be aggregated into measure results. • Concurrent identification of patients can be used to trigger clinical documentation improvement activities, clinical decision support tools and quality measure processes while the patient is in-house thereby improving patient outcomes and measure results.

20. Embracing CAC Beyond Reimbursement Using CAC concurrently • HIM leaders will advocate for CAC and the “collect once, use many” approach to break down silos within the organization, automate Quality Measurement and bring value to the organization.

21. Embracing CAC Beyond Reimbursement HIM Foundations Critical for CAC Use • As the nation strives to meet the goals of the national quality strategy, HIM principles are foundational for supporting timely, accurate, and complete data collection, appropriate release of data, and the transformation of data into information. HIM professionals will lead information governance and ensure data integrity through the management of all types of data and across the continuum of stakeholder groups.

22. Embracing CAC Beyond Reimbursement HIM Foundations Critical for CAC Use • The HIM professional’s role is to combine emerging technologies with innovative processes to meet the aims of this strategy—improve the quality of healthcare, improve the health of the US population, and reduce the cost of quality healthcare.

23. Embracing CAC Beyond Reimbursement HIM Foundations Critical for CAC Use • HIM professionals have a responsibility to help foster the transformation of data collection in new and innovative ways. • Computer-assisted coding is an example of innovation to improve productivity and consistency of encoded data. • This technology provides the opportunity for HIM professionals to drive the adoption of tools that turn information into new and strategic assets.

24. Embracing CAC Beyond Reimbursement

25. Current State of Information Governance • Our Story as Health Information Professionals is one of Protecting and Managing Health Information • Our Primary Ethical Obligation to Protect Patient Privacy and Confidential Information Incudes: • Oversight of disclosure of information. • Management of health information systems and health records. • Quality of information.

26. Know Your Data • What are the causes of readmission? • Diagnoses of Readmission • Readmission by Provider (Physician or Facility) Rates • Readmission rates at different time frames • Discharge Status & Point of Origin • Discharge Process • Self Management • Medication • Diet • Physician/Provider Follow Up Appointment • Referrals to Next Care Provider • Instructions/Order Sets • Assessed need for care • Transition to the next level of care planned

27. Mortality • Know the mortality rate • Identify high DRGs with mortality • Mortality Reviews • IHI- Review all ICU deaths • Review all deaths • Review low risk mortalities • Look at surgical readmissions/ returns to OR • DO not waste your time looking at cases that were identified at admission as being terminal or expected to expire

28. Skills Needed For Advancing Improvement • Data Analysis • Process Analysis • Facilitation • Project Management

29. Top-Performing Hospitals Attributes • Priority of the executive team • Understanding what is being measured • Engage clinicians from the start of the planning process • Structure and approach of quality department • Manage data analysis and collection effectively • Communication of strategy – you have to have a plan • Regularly share performance data to all levels in organization  • Commit to sharing best practices • Celebrate the achievements

30. Lesson Learned “Quality and safety improvement is as much about communication and relationships as it is about protocols and techniques of process improvement” (P. Levy 2012)

31. Assessing Your Readiness for CAC

32. Successful Health Information Governance Embracing All of the National HIT Initiatives • Requires the Right People, Processes, and Technology

33. Assess your current state • Evaluate, Update and/or Create a Coding Compliance Plan that identifies your core clinical documentation record set for coding compliance. • Understand the types of clinical documentation capture. • Readiness for ICD-9 Coding Compliance. • Know the technology that will be affected by CAC and/or other ICD-10 preparations within your organization. • Review your current workflow.

34. What Technology Will CAC Impact? • Has your legal medical record been defined? • Where does it exist—paper or electronic? • What other systems are in place? • Clinical • Financial • Dictation/transcription/speech recognition • Encoder • Scanners • Interfaces • What IT resources are available?

35. CAC Readiness DEFINING YOUR CORE CLINICAL DOCUMENATION RECORD SET Available at ahima.org Available at nuance.com

36. Align all of the HIM priorities • HIM Assessment: Do you have a defined clinical documentation record set for coding compliance? • Align ICD-10 efforts with Meaningful Use preparation • Meet reporting deadlines of October 1, 2015 • Plan to fulfill ICD-9 and ICD-10 requirements during transition periods • Foster open communication with all stakeholder groups • Utilize HIM and CDI professionals as process leaders

37. In Summary • Understand the Information Governance infrastructure needed for CAC • Embrace CLU Technology • Set high expectations for utilizing your CLU/NLP engine • Beyond reimbursement • CA-CDI • CA-PD • CAC

40. Presenter Today Bonnie S. Cassidy, MPA, RHIA, FAHIMA, FHIMSS • AHIMA-Approved ICD-10 CM/PCS Trainer and Ambassador • Senior Director of HIM Innovation at Nuance • Past President of AHIMA • Contact Information: Bonnie.Cassidy@Nuance.com

41. References/Resources • Cassidy, Bonnie S; Gorman-Klug, Catherine; Taylor, Lisa Brooks. “Embracing CAC Beyond Reimbursement Initiatives.” Journal of AHIMA 83, no.11 (November 2012): 54-55. • Cassidy, Bonnie; “Defining the Core Documentation Record Set for Coding Compliance http://journal.ahima.org/2012/11/16/defining-the-core-documentation-set-for-coding-compliance