3M™ 360 Encompass™ System for clinical documentation integrity (CDI)

Clinical documentation drives much of the data that health care organizations use for analysis, billing and payment. The ability to assess and share this data in real-time is increasingly important as the health care industry transitions to value-based payments. CDI teams play a critical role because they can identify relevant data, improve it and share it with other clinical and administrative teams to improve outcomes that directly affect reimbursement. As organizations expand the scope of their CDI programs, many find they simply aren’t staffed to meet increased patient volume. Productivity suffers as CDI teams strive to improve documentation in the inpatient, outpatient and professional services settings and review cases for quality metrics and scores, clinical validity, denials prevention and risk adjustment.

Computer-assisted CDI features within 3M 360 Encompass System provide CDI teams with multiple workflow enhancement tools that provide users with electronic query capability, prioritized worklists, access to CDI reference materials, auto-suggested queries, and CDI edits. The technology also automates common types of queries directly within a physician’s workflow. Together, these tools not only increase physician response rates, but they also boost CDI specialist productivity. In addition, 3M 360 Encompass System’s top-rated computer-assisted coding tools reveal hidden diagnoses and procedures buried deep within the documentation to help establish patient risk and severity more accurately.

3M’s prioritization algorithm analyzes unstructured data using natural language processing to identify the following types of high-priority reviews:
 

• Organization-specific focus DRGs, including those that trigger bundled payments
• Cases for which there are multiple principal diagnoses or those without a CC or MCC
• Cases for which the length of stay doesn’t correlate with the patient’s severity of illness or risk of mortality
• Discharges for which there is a pending query
• Records with auto-suggested diagnosis and procedure codes and an auto-suggested working DRG
• Cases that include an automated query to the physician (CAPD)
• Documentation that includes clinical indicators of a condition without a corresponding diagnosis
• Cases where there may be an early-warning quality indicator that may need a documentation review.

3M 360 Encompass System not only prioritizes cases, but it also provides insight into why each case is a priority opportunity. Users can customize and define the types of cases for review as well as assign custom hierarchies of worklists (e.g., based on system, facility, team, or user). 3M 360 Encompass System also uses machine learning to continually update and improve CDI priorities based on new documentation. Customizable self-service reports allow CDI teams to continually monitor and improve outcomes, impact of the program, and accuracy of the algorithm and priority cases.

3M 360 Encompass System identifies potential quality flags concurrently, helping organizations ensure accurate value-based reimbursement related to the following:
 

• Patient Safety Indicators (PSIs) from Agency for Healthcare Research and Quality (AHRQ)
• Hospital Acquired Conditions (HACs)
• 3M™ Potentially Preventable Complications (PPCs) Software
• 3M™ Potentially Preventable Readmissions (PPRs) Software
• All-Cause Readmissions (ACRs)
• AHRQ’s Pediatric Quality Indicators (PDIs)
• AHRQ’s Neonatal Quality Indicators (NQIs)

As with 3M’s other artificial intelligence engines, 3M 360 Encompass System provides users with details about each identified quality indicator, such as the inclusion/exclusion criteria, methodology, and reason for inclusion. Quality and CDI teams can act immediately to correct documentation or enhance care planning in real time.

For hospitals to meet the rising demands of competition, compliance and patient care, they must have an efficient and accurate revenue cycle management system.

But what does that really look like?

It looks like coding and clinical documentation working from the same content, reducing duplication. It looks like facility and professional services coders using one application, putting an end to disjointed workflows and communication breakdowns. It’s timely, complete query responses from physicians and full confidence that HCCs are captured. It’s big-picture insights so hospitals can stay ahead of market changes.

It looks like your teams, workflows and applications are focused on improving patient care. The 3M™ 360 Encompass™ System platform can make this possible.