Introduction
The Health System faced the challenge of physician burnout leading to attrition of medical staff, low provider productivity and below market compensation plans, leading to hindrance in acquiring new patients. The Health System was also initiating value-based care contracts, but the clinical documentation did not align with acuity, resulting in lower Risk Adjustment Factor (RAF) scores due to poor coding of Hierarchical Condition Category (HCC)/International Classification of Diseases (ICD-10). In response to these challenges, the organization implemented solutions to improve provider engagement and productivity while also capturing accurate HCC codes.
Diagnosis of the Problem
- Physician burnout leading to attrition of medical staff
- Provider productivity not at optimized levels due to fatigue and disengagement
- New patient acquisition hindered as a result of provider fatigue/disengagement
- Clinical documentation not aligning with acuity (RAF scores lower than indicated due to poor coding of HCC/ICD10)
Solutions Deployed
- Implemented automated pre-visit HCC capture system which altered providers when HCC was recommended.
- Providers received prompts for recapture/suspect codes, which improved coding accuracy, completeness, and enhanced reimbursement.
- Implemented Virtual Clinical Assistant™ to ensure a highly robust clinical note integrated with concurrent HCC review/recommendation. This solution allowed providers to capture all necessary information accurately while reducing the administrative burden of documentation.
Results within 12 months
- Improvement in physician engagement, productivity, and RAF scores, resulting in average monthly RVU enhancement of from 604.4 to 717.1
Contributed to an additional $3.9M in annual reimbursement - Reduced physician turnover by 43%
- Produced a 35% first pass capture rate of HCC Codes w/o query involved
