With nearly one million people across southwest Michigan, Borgess Health has secured $9 million in additional appropriate revenue within one year of implementing the Nuance Compliant Documentation Management Program (CDMP), part of the Nuance Clintegrity 360 | CDI solution. Supported by clear, measurable and compliant clinical documentation improvement (CDI) guidelines, and expert training and technology from Nuance, Borgess improved the overall clinical accuracy of physician documentation in its facilities, which led to better quality indicators, including a 23 percent reduction in the predicted mortality rate in the first full fiscal year of the program implementation.
“Clinical documentation is not a coding issue, and we knew we needed to engage physicians with the right tools and strategy to improve the accuracy of documentation to support patients, physicians, and downstream reporting. The Nuance approach helped us focus on improving clinical documentation at its origin: physicians at the point-of-care,” explained Dr. Robert Hill, vice president of medical affairs at Borgess Health. “When physicians document in the chart, they’re documenting based on care, not codes. We use a collaborative approach to ensure the right information is being captured and is in the hands of clinicians.”
Cost of Incomplete Documentation
In order to ensure clinical integrity and safeguard its bottom line, Borgess conducted an analysis to determine potential opportunities for improving the clinical documentation process and reimbursement. Data showed the organization had not been consistently charting information such as case severity, which resulted in incomplete coding, higher predicted mortality rates, and a financial loss of $6 million in one year alone. Borgess then implemented Nuance’s fully-managed, comprehensive CDMP solution to improve clinical documentation by engaging physicians at the point-of-care.
Beginning in 2011 with an initial assessment of Borgess’ diagnosis-related group (DRG) based records and documentation needs, Nuance helped the organization create and implement a customized plan with clear, measureable CDI program objectives to better reflect the care that was being delivered. Borgess worked with an experienced CDI team from Nuance to align clinical documentation with specific codes. Nuance professionals then taught clinical documentation specialists to serve as translators for physicians to ensure the right terminology was included in the chart to facilitate proper coding. This education and hands-on collaboration helped physicians understand the correlation between good clinical documentation and severity of illness, and the benefits for the physician, the provider and the patient. A review of all patient cases impacted by the CDI program implementation showed that Borgess improved the clinical accuracy of documentation and saved physicians’ time by helping them provide necessary details up front.
Improving Clinical & Financial Outcomes
“Every health system today needs to approach clinical documentation improvement in a way that not only eliminates the risk of lost revenue, but also creates minimal impact on the clinicians working on the front lines with patients,” said Anthony F. Oliva, DO, MMM, FACPE, regional medical director, Nuance Communications. “With our help, Borgess took the right steps early on to ensure they would achieve significant clinical and financial gains, while establishing a system that overcomes the increasing barriers to accurate coding.”
As a 2014 recipient of Healthgrades’ “Distinguished Hospital Award for Clinical Excellence,” which recognizes the top five percent of hospitals in the U.S. based on quality measures, Borgess continues to use the Nuance CDI program to track core metrics, such as hospital-acquired infections (HAI) and conditions that are present-on-admission (POA) as part of their review process. This helps them identify additional areas where quality is impacting the reputation as well as the financial health of the organization and opportunities for improvement.
Drawing from the more than 20 years of clinical documentation expertise from Nuance’s J.A. Thomas and Associates, Clintegrity 360 | CDI empowers hospitals and engages clinicians in steps that improve the clinical accuracy of documentation and support appropriate reimbursement.
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