How hospitals can better manage documentation and maintain revenue amid the pandemic

Liz Guyton recently became the director of the 3M Health Information Systems division for the U.S. and Canada, a role she earned with years of experience managing healthcare reimbursement, revenue cycle, supply chain and IT engagement.

With a background in finance, Ms. Guyton was drawn to the healthcare sector early in her career after working as an accounting manager for a small hospital. In that role, she saw how beneficial the changes she made in the finance department could be for the hospital as a whole.

She joined 3M HIS in 2016, running its healthcare consulting practice in Atlanta. She believes the company is a valuable partner to hospitals, helping organizations achieve accurate healthcare documentation while reducing the work necessary to maintain revenue levels.

"We are the one vendor with an integrated platform that helps organizations from the moment the physician is having that conversation — first speaking that documentation into existence — all the way to auditing the codes onto a final bill," she said.

Below, Ms. Guyton discusses how 3M HIS is helping hospitals amid the pandemic, especially as they take on the shift to virtual operations.

Note: Responses have been edited for length and clarity.

Question: A top-of-mind topic today among healthcare executives is the shift to virtual. What are some of the ways 3M has been able to pivot to a virtual environment?

Liz Guyton: There are no other organizations as directly impacted by the pandemic as hospitals. When the pandemic began, we started getting lots of requests and questions about documentation and coding. What is the right code to use for the different services that we are now rendering with COVID-19? How do we make sure that we document this correctly?

Our team felt such a responsibility to make sure that our clients had the correct information. We quickly launched a series of COVID-focused webinars to help answer these questions for our clients. Webinars have always been a great way for us to connect with our customers and to help lead and educate on coding changes and clinical documentation best practices, but there was just this groundswell of needing COVID coding facts and education. More than 10,000 people dialed in to the first sessions. We had to then add, as you can imagine, additional  sessions, so people could ask questions, get answers and feel comfortable about the COVID ICD-10 codes.

Beyond the growing virtual connection to clients for in-the-moment education, we had to address how we’d play host to our annual Client Experience Summit, our summer users’ group meeting. As the pandemic spread, we made the tough but necessary choice to shift it from an in-person event in Salt Lake City to be an entirely virtual event. Much of what our teams and our clients love about the event has always been the personal connection and engagements, and the ability for our clients to chat one-one-one with us and each other, gain insights, best product practices and identify enhancements.

Despite the challenges of pivoting to a virtual event, our 2020 Client Experience Summit was incredibly successful. We had nearly 2,000 people attend, more than we’ve ever had. Through it all, our clients were able to virtually connect with us and with each other, earn continuing education credits (up more than 160 percent from 2019), and share their knowledge and experience, just in a different format than usual. 

Q: As you work with healthcare organizations around the U.S. and globe, what are they expressing as their biggest needs in a virtual environment?

LG: Our clients face reductions in revenue and certainly have had an increase in costs, so they're challenged. They’re facing a demand for staff, and filling gaps on the fly for their revenue cycle. In clinical documentation, many of those gaps are often being filled by nurses. They've had staff members who have been ill and not working. They've had people who are taking care of people who are ill and not working. So, the gaps are very real.

Clients also need to figure out how they can meet their current goals and objectives for coding and clinical documentation in a way that streamlines people and processes, and costs less money. Their most immediate need is staffing to fill their production needs for coding and clinical documentation. There is also the question “How do we get the revenue up and the costs down?,” which is always a hospital’s challenge, pandemic or no.

Q: How has 3M HIS partnered with organizations to help in their success during these tough times?

LG: One particular client in New York needed to stand up a hospital within a week of COVID first hitting that area. Their coders had to have a tool in place to code the services that were being given. We partnered with them to remotely get our technology, 3M™ 360 Encompass™, live and ready for them to serve their patients quickly. It was an all-hands-on-deck effort for our team to make it happen incredibly fast and we are proud to have been able to successfully launch our technology to help this client when they needed it most. 

Beyond the immediacy of launching technology for temporary hospitals, we’ve had clients tell us they have to think of a different way to deliver clinical documentation, and ask 3M HIS “Will you take on the entire process of clinical documentation for us, use your own staff, use your own system and then just deliver to us the final work product?” 

We've been able to work closely with clients so that they can completely outsource their entire  clinical documentation integrity department to us. We handle that for them, which in turn means they and their leadership can focus on other things while we deliver the results to them. Our clients are loving this model, especially now, and they don't intend to ever go back. 

Additionally, clinical documentation integrity teams sometimes have had to move back to the bedside to help as needed. 3M HIS helps organizations insert technology in a way that reduces that labor burden. In clinical documentation, a lot of the work historically has happened post documentation, when the physician has completed their note, then CDI will review for documentation gaps and discover, "Oh, I need to get this. I need to ask the physician this question." 

Our technology uses artificial intelligence that reasons across documents as well as the entire patient encounter in real time, and so many  of those questions to the physician then occur during the time of their documentation, removing the administrative burden for them of having to revisit and clarify documentation so late in the patient care journey. This is important not only for revenue cycle objectives, but crucial for the accuracy of patient information, supporting better clinical care and continuity of services. 

We call those documentation clarifications, nudges, where we offer the nudge to the physician at the point of documentation. We call it a nudge as opposed to an edit because none of us like to get these little pop-up things that stop us from doing our work. Physicians can respond to them if they want to. We desire that they do, but if they don't, it doesn't stop their work. 

A recent sample analysis from an academic medical center client that uses our nudging concepts shows incredible results. This client wanted to take the concept slow, so it began with five nudges based on the most common CDI backend queries like heart failure and pneumonia diagnoses, and kidney disease specificity. In a sample of only 1,000 accounts, those five clinical concept nudges gained our client an estimated quarter of a million dollars in revenue.

For another health system client, physician steps to complete tasks, measured in clicks, went from seven to three – an incredible time savings. CDI user clicks went down from 19 to five, which is fantastic. An orthopedic surgeon said, "I don't need training. I'm already using it. It's so easy." Those tools were able to reduce the burden on the caregiver and immediately create more time to spend with the patient. 

I share these examples to show how 3M HIS meets clients where they are in their documentation and coding journeys, and how important that is for us, especially in the pandemic when virtual connections are of utmost importance. It is always our goal to give clients a path from capture to code, with demonstrable results and successes along the way.

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