Case Study:
Outpatient CDxI

Multi-specialty health system outpatient clinics increase RAF scores by 15+ percent.

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CDxI Helps Multi-Specialty Health System

Many outpatient clinics make substantial efforts to improve their clinical documentation. These efforts often require extra resources, coding and software implementations — and still fail to produce significant results. The answer to any CDI program is physician education for more accurate charting.

Challenge

A major regional multi-specialty, multi-site outpatient health system was frustrated with its clinical documentation and RAF scores. Neither reflected an accurate picture of their patient population or fair compensation. The clinic and its outside management team had expended significant resources to tackle the issue by bringing more coders and scribes onsite. However, the providers themselves still did not grasp how often they missed diagnoses. These misses cost their patients in terms of continuity of care and the health system in terms of lost revenues.

Solution

ModusOne Health became involved as a partner to add to the existing CDI efforts. We added the CDxI solution into the mix and the results were nearly immediate and dramatic. First, our proprietary analytics determined which conditions were being missed the most, which posed the greatest patient risk, which presented the greatest legal risk and which cost the organization the most in lost revenue.

The baseline study revealed that more than 70 percent of the most common hierarchical category conditions (HCCs) — such as coronary artery disease, major depression, diabetes or morbid obesity — were being missed in routine clinic encounters.

ModusOne gave providers detailed metrics of their baseline performance and real examples taken directly from their patient populations. Providers also received evidence-based medicine reference materials. Armed with current diagnostic criteria, providers received in-person education sessions and a mobile app as reinforcement.

After the initial physician engagement meetings, ModusOne began reviewing charts on a monthly basis. We scored the accuracy of the facilities’ physician groups and the individual physicians, along with the supporting information from the EMR. The real-life examples reinforced the areas of inconsistency until accuracy was essentially automatic.

Outpatient CDxI
Case Study

Multi-Specialty Health System Outpatient clinics increase RAF scores by 15+ percent.

Results
The individual and group accuracy scores went up at all outpatient clinics. Group accuracy scores rose from less than 30 percent in some cases to more than 70 and 80 percent in a matter of months. The RAF scores went up by 15-20 percent in the same time period, adding millions of dollars in previously earned, but unrealized, revenues to the bottom line. The outpatient health system and the providers have been extremely pleased with the financial performance and the improved alignment between the provider perspective and the coding perspective.
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