Using data analytics to improve coding: 5 questions with Ardent Health Services' Adrienne Younger

Within the revenue cycle, data analytics can help identify problem areas for staff to address and improve upon.

Adrienne Younger, RN, certified clinical documentation specialist manager of clinical documentation improvement education at Nashville, Tenn.-based Ardent Health Services, recently spoke with Becker's Hospital Review about the system's partnership with MedeAnalytics and how the use of data analytics helps Ardent ensure accurate documentation. She also offers coding improvement tips for other hospitals and health systems.

Note: Interview has been lightly edited for length and clarity.

Question: How has coding changed with the shift from fee-for-service to value-based care? 

Adrienne Younger: We've talked a lot about this amongst our coding team. As the industry has changed, we've had to change the culture of our coders and our clinical documentation improvement approach because we were ingrained in receiving pay for a certain diagnosis-related group. Since we code what's in the record, we have really focused on changing the culture of the coder to first look at: What does value-based purchasing mean for healthcare; What does value-based purchasing mean for documentation?

And then we had to get it down on a level where a coder or a CDI can understand how it affects them.

I think it's natural for any of us in our jobs to ask what does this mean for me, and what does this mean for my role as a coder? And I think the main thing is that value-based care takes on a quality aspect that we've never really paid attention to or focused on. Clinical validation is a huge thing that I think goes along with both quality and value-based care and will determine what we're going to see in terms of reimbursement in the future.

So, I think the biggest difference in coding under value-based care is changing how the coder looks at the record compared to how they previously looked at it. Their role has morphed into something a little bit different and it is important that we, as leaders, provide them with the resources they need to understand the differences in fee-for-service and value-based care.

Q: What resources do hospitals need to navigate ICD-10? 

AY: To prepare for ICD-10, we put our coders and our CDIs through boot camps and our providers through modules on what they need to know about ICD-10. But the biggest resource we needed and the biggest resource we've been able to utilize are our own records. Our own records showed us what is new in ICD-10, and we didn't realize it until we coded enough of them to see a trend. With our experience, I think the biggest resource for hospitals is their own data, creating their own case studies and sending records to their coders and providers. Industry modules and resources are great, but what really makes the impact is when you use your own work to teach yourself.

Q: How was your organization able to improve access to clinical information through data analytics?

AY: First we made a commitment as an organization that we were going to tackle this and be consistent on it, not just for a few months after ICD-10, but several years down the road. We made sure we were consistent in what we did, holding forums and engaging our quality workforce. Once the newness of ICD-10 wore off, we couldn't stop there. We had to continue bringing it up, even if it was the same case, the same situation. We had to continue to put it in front of everybody. We've been credited in how successful we were in getting education out to people. I think repetition and commitment are the main ways we accomplished this. We understood that it was going to take a lot of effort but we figured out that progress is made when you continue to hammer in that directive.

Q: How did data analytics improve care and reduce costs?

AY: It took a while and overall, it's all about a culture of change. It's about changing the way everyone thinks. It's getting everyone to think outside of the box and think of things differently. We've been able to improve care based on how we look at the record. From a coding standpoint, our coders are looking at it and saying, "Gosh, this may be a complication but I don't have to automatically code it as a complication." Instead, they are able to query the provider. We've instilled a mindset in everybody to look at things a little differently. It's not about coding as fast as we can. It's not about putting the length of stay exactly where we want it. It's about the outcome of the patient. If the outcome of the patient doesn't reflect everything they did while they were here, then we're not doing ourselves a service by being able to control costs and improve care. It really comes down to getting everyone to focus as a team. At Ardent, CDI works with the quality team and attends case management meetings to let them know what they need and how they can partner with them. I think by developing that partnership amongst everybody we're not working in silos but instead share the same goal to improve care.

Q: What is your coding advice for hospitals?

AY: Collaborate with your coders. Coding is such a unique profession. I think historically coders have been left on their own. But I think by providing coders with resources to better understand what it is they are coding and to help them understand the clinical side of it, they become more vested in what they do. They're not just there to code a record. They're actually looking out for the patient outcome. They're identifying things they may not have identified before because now they think it needs to be brought to the attention of somebody else on the team. So collaborate with them and make them feel like they are part of the entire hospital system team.



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