Providers Ready for AI Clinical Documentation Improvement Tools

Forty-four percent of healthcare organizations already use artificial intelligence (AI) in one form or another, and more hospitals are looking to apply the technology to coding and clinical documentation improvement, a recent Black Book survey revealed.

Approximately 88 percent of providers are ready and willing to implement more sophisticated clinical documentation improvement tools that leverage artificial intelligence to improve spend, accuracy, and efficiency of coders, according to the survey of 3,300 coding and health records professionals from 278 hospitals and 1,889 physician practices.

Ninety-three percent of respondents also said they were optimistic that artificial intelligence can streamline document creation and support clinicians as they develop a “holistic patient history.” Clinical documentation improvement (CDI) that creates a more complete picture of the patient is key to not only improving outcomes, but also revenue integrity, the survey stated.

“AI-enhanced CDI also allows providers to explore new opportunities with payers because hospitals have the data to show where quality outcomes are performing best,” Doug Brown, president of Black Book, stated in the survey. “Physicians are facing an increasing battery of measurements meant to drive quality, satisfaction and efficiency, but the complete and compliant evaluation and management coding is critical for physicians despite mixed reactions to measurements.”

Providers are at a crossroads, Black Book researchers explained. Hospitals and practices are shifting from volume to value while facing a more consumer-driven market and a barrage of more stringent regulation.

All of these challenges necessitate more accurate clinical documentation and coding, researchers emphasized. Reimbursement in value-based care models, for example, hinge on providers demonstrating improved outcomes and reduced costs. Payers rely on the codes and clinical documentation to determine value-based reimbursement and incentive payments.

Yet clinical documentation and coding topped the areas most vulnerable to errors that could lead to lost or decreased revenue, a recent survey of hospital leaders conducted by BESLER and HIMSS Media found. Respondents reported that clinical documentation and coding systems are not equipped to manage diagnosis-related group (DRG) coding and opportunities to improve technology remain.

Artificial intelligence has the potential to elevate the performance of computer-assistant coding and other clinical documentation improvement technologies, the Black Book survey found.

On average, hospitals saw $1.6 million in financial improvements stemming from average case mix improvements due to AI-driven clinical documentation improvement initiatives occurring between the third quarter of 2018 to the third quarter of 2019. The average financial improvement was based on a survey of 128 hospitals with 150 to 400 beds, Black Book reported.

Ninety percent of hospitals said they realized documented quality improvements and increases in case mix index within six months of clinical documentation improvement implementation.

“Improvement of clinical documentation provides the opportunity to maximize reimbursement and CDI is the process of enhancing medical data collection, improving quality of care while maximizing payer reimbursement income. It definitely maximized the revenue cycle efficiency,” stated Brown.

Hospital and practice leaders also noted other positive outcomes from clinical documentation improvement technology implementation.

Overall, 89 percent of hospitals surveyed said transcription costs fell by half or more within one year of implementing end-to-end coding, clinical documentation improvement, and transcription software tools. The organizations also reported better dictation transparency and transcription processes during the year.

Another 94 percent of providers told Black Book that they realized operational efficiencies without detracting from clinician workflows.

The survey showed that providers are seeking coding and clinical documentation improvements now that payment models are becoming more complex. The biggest motivator for adopting new clinical document improvement tools according to survey respondents is to realize improvements in case mix index, which will boost revenues and result in optimal utilization of high-value specialists.