Pc-assisted doctor documentation (CAPD) options assist shut hole in outpatient care, giving clinicians a extra correct and detailed image of each affected person’s persistent situation and making certain well being methods obtain applicable reimbursement. Dr. David Jordahl from MyMichigan Well being shares his expertise implementing an AI-powered instrument to assist clinicians enhance medical documentation integrity and enhance RAF scores.
Within the earlier articles on this collection, we’ve checked out the evolving outpatient reimbursement panorama and the important significance of suspecting, capturing, and recapturing Hierarchical Situation Classes (HCCs). On this remaining installment, we’ll discover how one well being system makes use of AI to enhance medical documentation integrity and enhance Threat Adjusted Issue (RAF) scores.
MyMichigan Well being is a non-profit well being system that serves 25 counties throughout Michigan. It offers a full continuum of care in varied settings, together with pressing care facilities, house well being, digital care, and medical places of work overlaying greater than 30 specialties and subspecialties.
Dr. David Jordahl is a Household Doctor and Senior Council Chief at MyMichigan. He spoke to us about how computer-assisted doctor documentation (CAPD) helps the group adapt to the world of risk-adjusted care.
“I’ve been working with the HCC program for the final couple of years, and we’ve lately applied an AI-powered instrument that’s actually helped us transfer the dial on our efforts,” mentioned Dr. Jordahl.
The answer offers in-workflow steering for clinicians to determine affected person threat and intervention alternatives whereas precisely capturing and recapturing HCCs. “It’s enabled us to enhance HCC seize and RAF scores with out including guide work for our coders,” Dr. Jordahl defined. “They will depend on the AI to assist clinicians make the best choices and seize the right codes.”
Overcoming adoption challenges
Clinicians usually have particular methods of working which they’ve grown accustomed to over a few years in observe, and it may possibly generally be tough to steer them to undertake new expertise. Nonetheless, Dr. Jordahl confused the significance of working by means of adoption challenges to realize the specified outcomes. He additionally advisable beginning with smaller teams of clinicians and increasing over time.
“Initially, we centered on major care,” mentioned Dr. Jordahl. “We have now 100 clinicians on the answer now, and our technique is to broaden by concentrating on specialties which might be more than likely to have an effect on RAF scores. We’re taking a look at areas like cardiology, rheumatology, and endocrinology, the place there are alternatives to seize extra and extra particular HCCs.”
“Earlier than deploying the answer, we ran some periods with clinicians, educating them on HCC coding usually and on easy methods to use the instrument,” he continued. “Whereas we’ve had some struggles partaking clinicians in utilizing the instrument, we’ve seen incremental enhancements in HCC seize, as evidenced by our RAF rating.”
Bettering RAF scores with AI
The AI-powered instrument offers MyMichigan’s clinicians and CDI crew a broader image of every affected person’s persistent circumstances, and the well being system’s RAF rating for claimed HCCs noticed an 11% improve in 2022 in comparison with 2021. “Our RAF rating is bettering regardless of downward stress attributable to variances in inhabitants, in addition to normalization and coding depth elements,” mentioned Dr. Jordahl.
Importantly, the instrument offers AI-driven recommendation for suspecting circumstances. “The elevated RAF rating demonstrates not solely the success of recapturing recognized HCCs, but in addition capturing extra HCCs and bettering prognosis specificity,” Dr. Jordahl defined. “To suspect circumstances manually would require a whole lot of heavy lifting by lots of people. It’s nice to have the AI to inform us the issues we don’t know, or which may have been missed.”
Whereas My Michigan’s journey to medical documentation excellence is ongoing, the well being system is making wonderful progress, giving Dr. Jordahl trigger to be optimistic concerning the future. “Admittedly, we’ve had some struggles alongside the best way,” he mentioned. “Nonetheless, I’m excited to see what continued developments with this instrument can supply us for bettering our HCC coding.”