There’s no question that hospitals form the setting for many of life’s pivotal events—the birth of a child, the healing of an illness, or even the loss of a loved one. Ideally, a hospital’s sole focus should be caring for the patient, but today some hospitals are fighting for their own financial survival. Facing a countless number of challenges from clinical to quality measures, many are slipping into the red.
How gloomy is this picture? Ongoing changes in health care regulations and reimbursement have created a landslide of new responsibilities, spreading hospital staff thin. Instead of focusing on core competencies, hospitals are expanding to meet a myriad of needs. Unfortunately, trying to do everything is usually the path to irrelevance.
Instead, hospitals should consider outsourcing. Even Amazon, who appears to do everything, focuses keenly on the one thing it does very well—online retail—and then outsources the rest.
Forward-thinking hospitals have embraced this new model by partnering with organizations to leverage cutting-edge technology, so they can get back to their core mission: patient care.
Without sophisticated technology to capture, analyze and advance patient data, hospitals can struggle to keep up. For example, manual clinical documentation improvement (CDI) teams face enormous patient volumes with limited time and resources. The average CDI specialist can only review approximately 20-25 cases a day⁴, and only 35-45 percent of reviewed cases have a query opportunity.⁵ When automation and an intelligent worklist are missing, high opportunity cases can be buried and patients discharged before review or follow up. The results are lost time, missed financial opportunities and poor patient outcomes that don’t go unnoticed.
Every day, hospital quality scores are made public on the internet. A hospital’s reputation can suffer because of the scores published on Medicare’s Hospital Compare website or dozens of other private media companies, not to mention comments posted by dissatisfied patients.
To make matters worse, hospitals are also financially punished for poor results. New data released by the Centers for Medicare & Medicaid Services (CMS) shows that during 2018, 2,634 hospitals will be penalized for hospital readmissions and 749 more for hospital-acquired conditions (HACs).
It’s no wonder so many hospitals must fight to stay in the black. But with the right strategic partnerships, hospitals do not have to fall behind.
As an industry leader with over 30 years of coding, CDI and quality metrics experience, 3M is uniquely positioned to help clients navigate changing regulations. Our goal is to help clients gain competitive advantage with their quality measures, rather than falter in their quality and outcomes performance.
Let’s see how it works.
Within the 3M™ 360 Encompass™ System, powerful natural language processing (NLP) technology automatically analyzes available patient data—including electronic health record (EHR) templates and dictated documents—to identify unclear, unspecified or missing diagnoses and gaps in documentation.
When information is missing or needs clarification, 3M query technology puts both automated and customized physician queries into action. Our automated case-finding logic then uses algorithms to identify the specific cases that have early-warning quality indicators, so your quality team can zero in on the cases that matter most.
Type: Integrated, multi-specialty, non-profit
Annual admissions: 150,000+
This health care system recognized an increase in patient safety indicators (PSIs) and HACs that were affecting quality. At the time, their mechanism for evaluating quality performance was a retrospective review process: a team of professionals analyzed patient documentation to determine the root cause, often months after a HAC or PSI was submitted. Without the tools to make the process more concurrent, CDI and quality teams were unable to access critical information while the patient was still in-house.
Adopting a truly concurrent approach allowed them to analyze potentially preventable complications or safety issues in near real-time, often while the patient was still in-house. When these issues were identified as a physician documentation problem, a coding rules or claims submission issue, or an actual patient care issue, the quality and CDI teams could immediately drill into a root cause analysis while it was still fresh in the caregivers’ minds.
The 3M™ 360 Encompass™ System provided this concurrent review solution. Leveraging 3M’s artificial intelligence tools, this health care system can now monitor and prioritize documentation throughout the patient stay. In addition, this organization can now break down the silos separating the coding, CDI and quality teams to enhance communication and tackle quality issues before it’s too late.
When you partner with 3M Health Information Systems, you get an army of experts and a comprehensive health care data set working for you. We work with more than 5,000 health care organizations, both providers and payers, to deliver software and services that help them succeed. Our aim is to do the same for you: Provide leading-edge technology and service so you can stay ahead of the curve in an ever-changing health care world.
Let’s work together to solve today’s challenges.
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