Reshaping AHDI 2011 Vallie Piloian, CMT, AHDI-F Ann Donnelly, CMT, AHDI-F.
Ahdi 2010
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Transcript of Ahdi 2010
Transcription for the Future
ACE 2010
All information methods and concepts contained in or disclosed by this document is confidential and proprietary to Multimodal Technologies Inc. By accepting this material
the recipient agrees that this material as well as the information and concepts contained therein will be held in confidence and will not be reproduced in whole or in part without express written permission from Multimodal Technologies, Inc. Client use of M*Modal
tools or information (excluding any services or tools provided to the Client that are covered under a separate written agreement) is subject to the terms of a legal
agreement between the Client and M*Modal.
Company Confidential
Agenda
What is transcription and why is it still relevant?
The Career-Minded MT
Managing for efficiency
Transcription Innovation in the World of Meaningful Use
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Company Confidential4
Electronic Health Record Universe
Two opposing needs
Enterprise need for structured and coded information capture
Physician’s practical need for a fast and easy method for creating clinical notes.
Company Confidential5
The Current Situation
Tedious manual process,
Time-consuming,
Documentation lacks expressiveness of natural language
Transcription can be expensive
Subject to longer turn-around times
Clinical data lost, because documents are neither structured nor encoded.
Direct Data Entry: Structured and encoded information.
Dictation: Fast and easy, expressive.
Company Confidential
Substance V Form – Dee Hock
“Substance is enduring, form is ephemeral. Failure to distinguish clearly between the two is
ruinous. Success follows those adept at preserving the substance of the past by
clothing it in the forms of the future. Preserve substance; modify form; know the difference.
The closest thing to a law of nature in business is that form has an affinity for expense, while
substance has an affinity for income."1
1 - Waldrop, M. Mitchell. (October 31, 1996). “Dee Hock on management.” Fast Company. Retrieved from http://www.fastcompany.com/magazine/05/dee2.html , December 18, 2007
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Company Confidential
Reality
Medical Transcription is competing with –
• Front-end speech recognition
• EHR – Direct entry
• Front-end speech rec
• Templating
• Direct data entry
Hospitals are looking for the most cost-effective solution…
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Company Confidential
Changing Face of Documentation
Back-end speech recognition
Front-end speech recognition
Dictation and speech recognition
Direct into EMR
Eliminates transcription costs
Direct data entry
Physician data entry into fields of EMR
8 M*Modal Proprietary and Confidential
Company Confidential
Transcription and Editing
Backend speech recognition plus MT editing
• Efficiencies and cost savings
• Cost avoidance
• Comprehensive and complete documentation
• High adoption by physicians
• Pricing opportunities
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Company Confidential
Value of Narrative Dictation
Doesn’t interfere with the doctor’s day
• Where and when he wants to do it
• Lots of information in a little bit of time
• Comprehensive information
• Documents intuition and inclination
• Physician behavior modification -
None!
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Company Confidential
Physician Adoption
We can’t rely on lack of adoption to save us for long…
Power shift - Physician to CFO
Physicians will eventually be forced
Alternative methods -
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Company Confidential
The “Scribe” Strategy: Could You Use a Scribe?
Are your patient encounters hampered by incessant charting and documenting? Perhaps a medical
scribe can help.
By Shirley Grace
http://www.physicianspractice.com/display/article/1462168/1590060
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Company Confidential
The “Scribe” “Rather, they allow the physician with whom they work
to shift his focus off of his tablet PC or paper chart to his patient. Specifically, a scribe is responsible for:”
Patient histories
Transcribing exams and orders
Documenting procedures
Follow – labs and x-rays
Recording discharge information
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Company Confidential
The CDI Specialist
Evolving role…
“More important than coding”
“…pharmacology; knowledge of official medical coding guidelines, CMS, and private payer regulations related to the Inpatient Prospective Payment System; an ability to analyze and interpret medical record documentation and formulate appropriate physician queries; and an ability to benchmark and analyze clinical documentation program performance.”
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Company Confidential
The “Chart Reader”
“…when Dragon Medical was integrated with the organization’s EHR, emergency department (ED) transcription costs went from $1.4 million per year to zero.2
2 - Shepherd (July 22nd, 2009) Vive La Voice. For the Record. Vol. 21 No. 14 P. 24
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Company Confidential
Value of Narrative Dictation
CMS reduction in hospital base rates
Clinical Documentation Improvement
MS-DRG for coding - reimbursement
Specificity requires documentation
ICD-10
POA indicators
RAC review
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Company Confidential
Reimbursement
MS-DRG1
• Uncompensated CHF with
• COPD - $4,820
• Obstructive bronchitis and acute exacerbation
• Acute respiratory failure - $6,921
• Difference of >$2,000 (base rate of $5,500)
• For how many patients per year?
1 - Pam Wirth, RHIA and Kerry Chase, Amphion Medical Solutions, April 23, 2009, The
Impact of Coding and Increased Demands on Specificity in Healthcare
Documentation. MTIA
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Company Confidential
The Career-Minded MT
Professionalism
Remote workers
Scheduling
Productivity based pay
The Independent Contractor
The “hobby MT”
I’m not budging
Compensation
Training and education
Credentialing
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Company Confidential
Measuring Success
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Increased % gain is only one metric to be monitored! Increased OUTPUT = organizational efficiencies!
FACT!!MTE 2 with a 50% gain will produce 450,000 more lines over the course ofa year than MTE 1 with a 125% gain!!!
Company Confidential
Workforce Management
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Workforce
Management
Output –not “% Gain”
Editing –Typing
distribution
FTE/PTE work
assignment
Gap Analysis
Headcount Impact
Output – not “% Gain”
Editing – Typing distribution 75% rule
Use productive typists
FTE/PTE work assignment
Total efficiency – Headcount impact Gap analysis Assign editing to high producers
Company Confidential
Performance Management
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Performance
Managemen
t
Effective
Training
Weekly
Mentoring
Most-Common
Edits
KeyboardShortcuts
Final Document
Quality
• Monitor final quality
• Effective training
• Ongoing Mentoring
• Basic editing skills
• Can your MTEs quickly –• Create sections/subsections• Create numbered lists• Replace incorrect text• Insert text
Company Confidential
The New Buzz Words
Meaningful Use
Structured Data
NLP
Validation
Reconciliation
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Company Confidential
Back to Basics
Valuable Implementation
Meaningful Documentation
Useful Documentation
Partnership
Be the expert
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Company Confidential
Meaningful Documentation
Old Ways
• Sacrifice content for productivity
• “You get what you say”
Or
• Customization
• Invisible service provider
• Focus on print format
• Reactive to complaints
New Way
Standards based on usefulness
Expert service provider
Focus on content
Proactive to needs
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Company Confidential
Standard Content
What content is required in each document type for –
• Patient care
• Coding and billing and revenue cycle tasks
• Compliance
• CMS
• Pay for performance
• Quality improvement – PQRI
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Company Confidential
Service Level Options
Lowest Cost Line
Optimal Cost Reduction
Meaningful Clinical Document
Useful clinical documentation
EMR readiness
Useful documentation
Premium Service
Retention of demanding difficult customer
Customization
Keeping speech invisible
33 M*Modal Proprietary and Confidential
Company Confidential
Lowest Cost Line
Attract the low-cost seeking customer
Retain the high-priced existing customer
Financial incentives to hospital
Driven by draft quality
Hospital requirements changed to accommodate
Transcription “as dictated”
Most accurate drafts
Highest productivity
Involved at typing stage if possible
34 M*Modal Proprietary and Confidential
Company Confidential35
Meaningful Clinical Document Standards based on useful content
Highest quality for patient care
Compliance CMS
JCAHO
Ease of use for healthcare providers Physicians
HIM
Risk management
EMR readiness The Health Story
Content requirements
CDA4CDT
HL7 CDA
M*Modal Proprietary and Confidential
Company Confidential
Premium Service Offering
Keep the demanding customer
Speech invisible to hospital
Customized requirements
Expectations for productivity adjusted
Optimal account implementation including
DMs to the work type and physician level
Rendering automation
Requires highest level of MTE skill
Appropriate MT compensation
Appropriate hospital billing
36 M*Modal Proprietary and Confidential
Company Confidential
Premium Service Offering
Cost Impact
High-cost implementation
Customization =
Lower productivity
Higher transcription production costs
Higher implementation cost
Lowest productivity benefit
High-range line rates for MT
Value proposition
Invisible to healthcare provider
Satisfy demanding physicians37
Company Confidential
Speech Technology and Pricing
Warning!
Beware of demands for customization at the price of a low-cost line
Don’t provide a Cadillac for the price of a bicycle
Educate customers about what they are paying for
Would they rather pay for –
Physician specific preference
Meaningful Clinical Documents
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Company Confidential
Transcription and the HIM
Re-connect with your HIM roots!
What are the documents used for?
Are they used for coding?
If not, why?
What works?
What’s missing?
“What can I do to make this document more useful?”
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Company Confidential
Coding – ICD-9-M
Wanted – more documentation!
3 – 5 digit codes
Additional digits add specificity
“unspecified” is bad
Severity indicators - resource consumption
CC – Complications and Co-morbidity
MCC – Major CC
MS-DRG
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Company Confidential
Coding – ICD-10
And even more documentation!
~ 5x the number of codes
Lots more specificity required
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Company Confidential
The CDI Specialist
The value of complete, comprehensive information…
How can transcription help?
“ICD-9-CM Coding Essentials: What every CDI Specialist needs to know”
CCDS credential
Focus on documentation affecting the DRG (diagnosis Related Group) and payment
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Company Confidential
Standards for the future..
The Health Story
www.healthstory.com
CDA4CDT
HL7 CDA
More than electronic standards – think content standards!
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