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March 2020

HIM Challenges: Mobile Solutions Tackle Query Concerns
By Marisa MacClary
For The Record
Vol. 32 No. 2 P. 28

Physician queries are a necessary part of a day’s work for hospital clinical documentation improvement (CDI) and coding staff. The process is also essential to ensuring accurate quality scores and proper reimbursement for the hospital.

However, most CDI specialists, coders, and physicians find the query process burdensome and time consuming. As a result, most hospitals don’t query as many records as they could, and most physicians don’t respond to as many queries as they should. Given current multistep, cumbersome workflows—as well as a lack of transparency in the process—hospitals are unable to reach their documentation improvement potential. Low query rates and low response rates affect the integrity of patient records and negatively impact reported quality outcomes and reimbursement.

Two technology trends are reversing the effects of these legacy challenges: the growing use of mobile physician query software and standardized, compliant electronic query templates from AHIMA and the Association of Clinical Documentation Integrity Specialists (ACDIS), the two largest standards bodies for CDI and coding.

When used together, mobile technology and templates enable physicians to answer queries on their smartphones quickly and compliantly. Furthermore, they increase the productivity of CDI staff by enabling them to spend less time creating and tracking queries and more time reviewing records. The resulting increase in records being reviewed and subsequent increase in queries sent enhances overall quality and ensures full reimbursement for services.

Speedy Turnaround a Must
At most hospitals, doctors are already overwhelmed with administrative work, leading to physician burnout. In January 2018, the New England Journal of Medicine reported that “increasing clerical burden is one of the biggest drivers of burnout in medicine.”

Physicians are interrupted by documentation queries throughout their day, fielding questions through various mechanisms, everything from e-mail and faxes to sticky notes within the chart and in person in the hospital’s hallways. Queries on discharged patients force physicians to recall details of the case, adding stress to their already demanding day.

Most often, physicians must go back to the EHR to review the patient’s chart before answering a query. Additional time must be taken to update the chart and then notify the CDI specialist or coder that the query was answered and the location of the response. Because of the many steps involved, physicians report spending 15 to 20 minutes addressing a single query.

While CDI specialists and coders don’t enjoy harassing physicians, it’s often a necessary evil of the traditional query process. While they understand that physicians’ first priority is patient care and not necessarily getting the bill right for the hospital, they are often frustrated by physicians’ inability to answer queries in a timely manner. As a result, CDI specialists and coders may have to follow up on each query multiple times.

If administrators calculated the full-time equivalent hours spent on getting queries answered, they might find the toll on CDI productivity to be astounding.

Queries answered on time support accurate coding, which drives a number of important benefits—both on the clinical and financial sides—for hospitals, physicians, and patients, including the following:

• patient record integrity;
• continuity of care and patient safety;
• quality measure capture;
• population health data capture;
• optimal reimbursement for the hospital and the physician;
• accurate case-mix index;
• accurate hospital-acquired condition and patient safety indicator classification;
• accurate quality rankings, which drive reputation and patient market share; and
• risk avoidance related to noncompliant query methods.

A Couple of Clicks
Mobile physician query software simplifies a traditionally time-consuming, multistep process, allowing physicians to respond to queries anytime, anywhere in seconds, with the context of the patient’s record readily on hand. Standardizing query formats and leveraging compliant, multiple-choice questions where appropriate can help reduce decision fatigue for providers. Mobile query responses automatically become part of the patient record in the EHR, relieving the provider from going back to the chart to document the query response.

Hospitals using this technology report immediate, measurable results.

For example, a large health system in Maryland has seen dramatic improvement by focusing on query workflow automation. At one of its community hospitals, CDI staff typically queried 25% of eligible beds. They received a 40% response rate to queries placed in the EHR, and a 69% response rate when they visited the physician in person. However, it often took multiple in-person visits to get a query answered—a high resource cost to the hospital.

After implementing a mobile query solution with automated query tracking, notification, and reporting, the numbers improved immediately. Productivity nearly doubled, with CDI staff noting that they were able to increase their coverage to 45% of eligible beds by eliminating time spent following up with physicians for query responses.

The physician response rate increased to 98%. Physicians were relieved of the steady interruptions from CDI specialists and found it satisfying to answer queries at their convenience. Some physicians even reported answering queries from their smartphone at the grocery store and while at their children’s soccer games.

More than a year later, the health system has maintained an overall 99% response rate and an average query response time under 35 hours. These data included hundreds of community physicians, many of whom never before answered a hospital query.

Another hospital system—a well-known pediatric facility—reported an increase in physician response rates to 99% and a 200% boost in query volume. It also reported changes in physician documentation, noting that providers began proactively addressing some items in their notes that CDI staff used to regularly query for, leading to more accurate and comprehensive charts.

Further Streamlining
Hospitals using mobile physician query solutions have already reduced the time spent on creating and answering queries. Layering standardized electronic templates on top streamlines the process further while helping to ensure compliant query workflow.

Both AHIMA and ACDIS offer these standardized electronic templates within mobile physician query technology to provide guidance for physicians, CDI specialists, and HIM professionals when clarifying clinical documentation.

These comprehensive query template libraries address critical areas of query practice, including the following:

• ICD-10 CM/PCS coding classifications;
• diagnosis-related group assignment;
• complication/comorbidity-related data;
• hierarchical condition categories; and
• severity of illness/risk of mortality.

CDI staff and coding specialists need only familiarize themselves with the technology and the standardized templates to apply their expertise. The ACDIS templates are updated semiannually for regulatory changes.

Improved Workflow Leads to Robust Reimbursement
Hospital administrators must be on top of revenues and costs. Consider a hospital with approximately 50,000 discharges per year and a true (ie, using methodology that designates a query as a nonresponse after a reasonable amount of time—not weeks or months after it is sent to the physician) query response rate of 60%. Boosting that figure to 98% could capture another $18 million per year in reimbursement—revenue left on the table at most hospitals because physician documentation is not consistently clarified. In light of the financial hardships hospitals face today, such an impact is immeasurable.

Physicians generally want to help the hospital achieve its financial and quality goals. However, they need convenient, easy-to-use technology to manage their demanding work schedules and keep patient care their top priority.

The good news for hospitals is that they can improve this process quickly and track the results. A cloud-based, mobile query solution and standardized query templates can be implemented within just a few weeks. Hospitals can immediately capture revenue lost due to missed query opportunities and eliminate the high resource costs associated with current inefficient workflows.

In an era where mobile technology is adding convenience to our everyday lives, it makes sense for hospitals to adopt solutions that do the same for their extraordinarily hard-working physicians and HIM staff.

— Marisa MacClary is cofounder and CEO of Artifact Health.