The state of Maryland operates under the unique All-Payer Model with a strict quality-based reimbursement program, where hospital payment is dependent on accurate performance measurement. Because of this, hospitals must be meticulous in capturing and coding episodes of care in order to accurately determine hospital revenue and avoid financial penalties.
Western Maryland Health System was lagging in physician query response rates, which were hovering between 62-65%, and affecting performance measurement.
Previously, the clinical documentation improvement and coding teams at WMHS were using disparate systems to query physicians. The varying query formats and processes confused providers and limited accountability and tracking. Furthermore, the query process was manual and paper-based, relying on faxing and scanning, resulting in response times ranging from 4 to 28 days. Without an easy way to consistently and compliantly clarify physician documentation for accurate coding and billing, WMHS was losing revenue on proper reimbursements.
WMHS determined it needed to invest in a mobile platform that would automate physician queries to improve the quality of patient records and ensure full reimbursement for services. According to Tracey Davidson, MSN, RN, Director of Quality Initiatives at WMHS, "Among the hospital's goals were to better engage our physicians, decrease response times, and increase response rates. We also wanted to send physician responses directly to the chart and support more accurate coding for better quality patient records, use a standardized, compliant query template library, and ensure proper reimbursement for our services performed."
In 2018, WMHS selected Artifact Health, which provides the first and only mobile platform that streamlines the physician query process. With Artifact Health's mobile platform, WMHS had an easy-to-use mobile app for physicians to answer queries quickly and view supporting documentation right on their smartphones from wherever they chose. And because of Artifact's partnership with American Health Information Management Association (AHIMA), WMHS has access to a standardized set of industry templates that are up-to-date and fully compliant.
"This first year with Artifact Health has been a major win for our hospital. We are seeing drastic improvements in response rates and response times, more complete patient records and more charts getting reviewed and queried, all which have a direct effect on reimbursements. Artifact's partnership with AHIMA also ensure our queries are compliant and current."
– Tracey Davidson, MSN, RN, Director of Quality Initiatives at WMHS
Within a year of implementing Artifact, WMHS saw dramatic improvements and time savings for its staff and providers:
- Physician response rate peaked at 100%, up from 62%, indicating fully engaged physicians.
- Physician time to respond to concurrent and retrospective queries went from typically 4-28 days down to 1 day.
- The hospital's discharged, not final bill (DNFB) dropped by 27% in the first six months after the Artifact go-live.
- The average time for the CDI and coding teams to create a query went from 30 minutes to 5 minutes on average - a time savings of nearly 1,700 FTE hours for the hospital.
Davidson remarked, "More charts are getting reviewed and queried. Coders are getting final code sooner, improving the hospital's cashflow, and we're giving physicians back valuable time in their day to treat patients."