In 2014, hospitals and health systems faced immense challenges as they approached ICD-10 mandates.
According to a 2014 Sterling Associates survey of 650 hospitals, approximately 50% expected to outsource ICD-10 coding services come October 2015—an increase from the 19% already outsourcing at the time.
The survey noted that, “Primary reasons for outsourcing included a desire to access specific talent and a fear of productivity declines resulting from the ICD-10 transition…. higher costs of outsourcing and the loss of control over coding involved with outsourcing have led most hospitals to seek to keep coding internal as much as possible…”
This cuts to the direct problem for many hospitals at that time. They needed to find a partner to help achieve outcomes but faced a daunting challenge of finding the right partners and integrating them successfully.
This paper examines the business challenges, solutions, and outcomes of Vee Healthtek’s efforts to take over coding services for a full-service community hospital, with a women’s and children’s specialty hospital, outpatient specialty offices, and urgent care clinics in 2015.
As their CFO himself articulated in October 2015, “We had to shift urgently: Vee Healthtek trained, set up our account, and transitioned into taking over all of our coding types in 18 days, a truly remarkable feat…”
Hospitals and Health systems of all sizes face incredible challenges in today’s healthcare market. Revenue cycle best practices are hard to realize: utilizing data, centralizing systems, streamlining processes and procedures, and achieving financial outcomes.
Add in political, regulatory, and quality of care challenges and it is easy to see why these types of clients turn to the vendor market to help provider better outcomes.
This particular client faced a DNFB (Discharged Not Final Billed) that was rising daily to untenable levels. They were having difficulty interfacing and communicating with their vendor and helping the vendor to help their organization achieve best outcomes pertaining to turnaround times, service level agreements, and documentation issues.
They struggled with quality concerns, inconsistent communication, and the impending mandate of ICD-10, which would fast-track their need for high quality, trusted support
They also faced integrity and quality issues with their existing coding vendor and needed to make an abrupt change, as their contracts allowed.
That allowed 18 days from signatures for Vee Healthtek to get mobilized.
Staff at Vee Healthtek raced to understand the new client environment and the effort involved.
The client demanded intimacy and accountability so Vee Healthtek immediately established a stateside point of managerial contact with sole responsibility for the account. A representative from the offshore team immediately came on site for two weeks to build client relations and internalize the client environment first-hand.
The system spanned 111 beds, 11 outpatient centers, and four urgent care centers. Data was located across three disparate systems, requiring laborious cross walking efforts. Nineteen different outpatient and inpatient specialties of coding were necessary, starting in 19 days. In addition, all resources needed to be qualified/trained in the new ICD-10 requirements that had just recently been released.
Client Operations worked alongside Coding Operations to determine the volumes of records that would have to be coded, and the specific experience needed to manage the effort. Needless to say, an annual estimate of nearly 75,000 facility medical records and 197,000 outpatient medical records across 19 specialties, required very disciplined planning.
Fifty-three highly trained resources were dedicated immediately. Vee Healthtek had invested in a coding school within its own Sona College of Technology to prepare its coding team for the coming ICD-10 requirements. It had also invested in a scalable bench of professional resources that could be deployed at breakneck speeds.
Data was cross-walked across the client’s three distinct systems. Progress reports, quality benchmarking efforts, communication matrices, and reporting mechanisms were integrated into the account to a build business rhythm.
A year later, the results of a methodical, communication-driven, partnership approach were realized:
All coding was now completed within 48 hours of receiving complete documentation.
Quality levels were consistently exceeding expectations of 95%.
Client points of contact and their dedicated Vee Healthtek’s team engaged in systematic, outcome-driven communications that were engineered to hold not just people, but processes, and tools accountable as well.
As the HIM Director at the hospital said at the time, “Before I arrived here, the decision was made to go completely outsourced. I think it was because they were very unhappy with the coding staff.... They had really long delays in getting things completed.”
The decision to outsource all medical coding is not a simple thing for hospitals and health systems. Most tend to do so cautiously, or in compartmentalized fashion, as this sample from the Sterling Associates Study demonstrates.
Less than 40% outsourcing indicates more of an augmentation approach. Only about 22% of respondents outsourced the majority of their work, taking on a full outsourcing approach.
According to the study, “77% of interviewees experienced declines in productivity after the ICD-10 ‘go live’ date—and 39% of those expect those problems to persist beyond approximately three months.”
In this case, the key to avoiding such a bad outcome was to take a client-first approach that prioritized aligning the right people, proven processes, and the best tools to create a superior environment for outcomes.
