Shifting the paradigm: How technology can expand efficiencies beyond mid-revenue cycle through collaboration

A strong collaboration between physicians, revenue cycle teams, quality and audit teams is crucial to ensuring a hospital patient’s most accurate clinical picture and balancing the organization's financial picture with overall quality.

Hospitals face many challenges today, specifically around physician satisfaction/burnout and limited revenue cycle resources. To address these challenges, organizations must relieve the administrative burden on physicians and create even more efficiency in the revenue cycle process.

To succeed, organizations must leverage technology and services focused on engagement and partnership, said Garri Garrison, division vice president of 3M Health Information Systems (3M HIS), which provides technology and services to healthcare organizations worldwide.

Here, Ms. Garrison discusses her new role at 3M HIS, how hospitals can more easily connect with clinicians on the front end of the revenue cycle and audit teams on the back end of the revenue cycle, and the driving principles for revenue cycle in the future.

Editor's Note: Responses were edited for length and clarity.

Question: Garri Garrison was recently appointed to division vice president, health information systems division. Tell us more about your background and new role.

Garri Garrison: Growing up, I wanted to be a physician. In order to fund my education, I entered a nursing program thinking I could work nights and weekends while I went to medical school. I found that I loved nursing and ultimately made the decision to continue with my nursing career and spent 15 years as a critical care, open heart and trauma nurse. I then made the transition to corporate life and joined a health care accounting firm. This company started clinical documentation improvement (CDI), so my unique background helped me bridge the gap between coding and clinical as I worked in consulting to help organizations achieve regulatory compliance and educate physicians, as well as achieve appropriate reimbursement.

The company was acquired by 3M in 1999, thus launching my 3M journey. In 2005, I became a Six Sigma Black Belt and took a leadership position in our consulting practice. After that, I led the emerging business/analytics team and later the 3M HIS performance management group. Most recently, I led the 3M and M*Modal integration, and was then named the U.S. and Canada director prior to this role. In this new role, I now have global responsibilities for 3M Health Information Systems. 

Q: 3M HIS has a 35+ year history of keeping customers up to date and compliant with regulatory events and changes in the clinical documentation and coding industry. What are some of the ways 3M has accomplished this?  

GG: Currently, 3M HIS processes millions of documents a month from more than 2,800 facilities – capturing clinical and coding information, and creating workflows for our customers through our artificial intelligence-based platform. Our technologies work with over 250 different EHR systems and an additional 50 clinical systems to create a seamless workflow. Rough estimate, we have over 80 percent of U.S. hospitals using some of our coding software, so we have great access to information.

We keep clients ahead of the curve by first investing in the development of our methodologies that support coding and classification of diseases, which allows all of that data to be meaningful. We've contracted with CMS for over 30 years to continually develop and fine tune DRG and MS-DRG patient classification systems.  

Second, we consistently expand and update our methodologies to address quality and prioritization initiatives to drive an efficient and compliant revenue cycle. We continue to develop methodologies that identify potentially preventable readmissions and complications, as well as invest in tools that look at disease burden. These methodologies are vital for commercial and government payers, including state Medicaid agencies. Many states currently use the 3M™ All Patient Refined DRG methodology (APR DRG) for inpatient risk adjustment and payment. Payers use 3M APR DRGs, 3M™ Clinical Risk Groups (CRGs) and our suite of potentially preventable events tools in their value-based care arrangements and business models.

Outside the U.S., 3M methodologies are often used by ministries of health for reimbursement or quality. For example, with COVID, a region of Spain is using our Clinical Risk Grouping methodology to identify its most vulnerable citizens, those people with the highest risk of complications if they contract the virus, for prioritized mask distribution. We've also been contacted by several state Medicaid agencies and global department of health organizations to use our methodologies to prioritize the distribution of eventual vaccines using the illness burden as defined by the 3M CRGs. This is critical if there were to be a limit on the number of vaccines available, as the technology can identify who would benefit the most.  

Third, we are centered on evolving with our industry and its specific needs. Aligning our goals with industry was the driving force of our acquisition of M*Modal. We wanted to give physicians direct connection to our platform and, at the same time, offer them ways to reduce their administrative burdens – moving activities that were normally done retrospectively into a single integrated workflow so that they could proactively complete those activities and capture documentation in the EHR.

Q: Mid revenue cycle team efficiencies depend on their ability to easily connect with clinicians on the front end and audit teams on the back end through technology and services focused on engagement and collaboration. How does an organization accomplish this?

GG: 3M HIS began with coding tools and has a long history of leadership in clinical documentation improvement. Historically, our solutions and services have been created to allow the ability for a CDI specialist, a coding specialist and a quality specialist to operate in a single platform. The single platform creates workflows for each of them, but now provides visibility and transparency between those workgroups so they can gain improved efficiency through communication between the healthcare team.

In addition, through the acquisition of M*Modal, 3M HIS connects the physician to the process as well. The physician now has access to context specific information at the point of patient care, receiving communication or nudges that assist them to complete the clinical documentation, ensuring completion and accuracy with regulatory requirements. This reduces the burden on the physician, but also reduces the burden on the coders and CDI staff.

3M HIS also develops tools that assist hospitals to meet regulatory components, following guidelines for queries and clinical evidence. Reference packages, embedded in our tools, help avoid the need to search for information and provide quick access to published guidelines. In addition, 3M HIS provides manuals and education, best practice workflow design related to our technology solutions, and performance monitoring and improvement to stay up to date.

Q: What does it really look like to have all these people working on one platform?

For CDI, coding and quality, we use artificial intelligence to automate workflows – focusing staff on the most pertinent cases and driving best practice workflows to prioritize their work. This leads to improved productivity and accuracy, and less missed documentation and coding opportunities for more accurate CMI and quality reporting. 

Our clients are able to identify potential quality issues concurrently surfaced within our platform, allowing quality teams to conduct analysis in a concurrent setting versus performing this function retrospectively post discharge. We include the Agency for Healthcare Research and Quality's (AHRQ) methodology into our workflow so that it can be viewed proactively to catch potential documentation and coding issues in the quality space. 3M HIS expanded the foundation of our technology address the needs requested by hospitals today on the administrative side, to identify and report on quality metrics.

For hospital and professional coding, our clients leverage our AI-backed computer-assisted coding to gain more efficiency and increase accuracy in the coding process. Clients can then flex to the “single path” workflow to code both the professional claim and the facility claim in one session. In situations where physicians perform their own coding, our technology can identify documentation inefficiencies or discrepancies alerting the hospital to conduct a quality review before submitting the claim for reimbursement.  

Q: With constant innovation, what should be the driving principles for revenue cycle in the future?

GG: Leverage automation, embrace how artificial intelligence can work in the revenue cycle, and remain vigilant about compliance. It can be overwhelming for hospital leaders because they need the right partner to collaborate and guide them, while providing technology that will augment the hospital’s EHR system and support current workflows.  Embrace the goal of moving from reactive queries (those identified by a CDI specialist after documentation has occurred) to proactive nudges (use of artificial intelligence to identify gaps for physicians at the point of documentation) across the continuum of care to include inpatient, outpatient, clinic, and imaging departments and practices. 

Leadership must empower the teams and individuals.  In partnering with our clients, our approach is three pronged – people, process and technology. It is not about taking a piece of software and plugging the software into their workflow. 3M HIS partners with its customers to look at where they are on their journey and what they are trying to accomplish as their overall strategy.  Our teams help find real opportunities and how to achieve sustainable improvement. 

With that approach, our consulting teams estimate our clients exceed anywhere from two to four times our projected return, with a cost vs. benefit return up to ten times, even in a competitive space with a disadvantaged patient population. By treating our clients as a business partner to solve a problem, we show higher results because at times they’ll need to change their entire process and workflow to achieve the highest benefit. Innovation of the future should be the way to drive revenue cycle performance.  

Q: Times are challenging right now for healthcare organizations. What would you want them to know about 3M as a partner for the future?

GG: 3M is the only vendor with an integrated platform that reaches from the moment a physician connects with a patient to auditing codes on their final bill. 3M HIS meets organizations where they are and helps them reach where they want to go.

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