David Gillis Design

A Clearer View:
Improved Clinical Documentation

One of the least appreciated factors contributing to higher value care is clinical documentation that accurately reflects the complexity of a patient’s condition. But clinical documentation, specifically ICD-10 diagnosis coding, is at the very core of value-based care. The important population health component of value-based care, particularly in Medicare Advantage plans, depends on precise documentation to qualify patients for enhanced disease-related services and access to care management programs. Patient acuity, as expressed in diagnosis coding, is also used by Medicare and private insurers to set cost goals for providers participating in value-based agreements.
In 2018, the coding gap rate for providers across the ACO was 22 percent, meaning that nearly a quarter of patients’ chronic or permanent medical conditions documented in the previous year did not appear in a claim submitted during the current year. Since it’s unlikely that a chronic or permanent condition disappeared in that time, this coding gap points to opportunities for improving documentation by assuring that the claim submitted to the health plan reflects these conditions.
To better understand the influence that diagnosis coding has on patient care and provider satisfaction, the ACO convened a documentation improvement work group in 2018. The team is made up of members with varied skill sets, including data analysis, communications, project management, clinical care and medical coding. The group quickly set a goal of reducing the coding gap to 15 percent in 2019 and set to work on strategies.
“Having a diverse team led to a broad spectrum of strategies we could apply to documentation improvement,” says Jennifer Tardif, team leader and a Provider Relations Manager for the ACO. “We determined that there needed to be a training component to the work and specific data to show each provider where they could make improvements. And since we know providers are extremely busy, we needed to make improvement as easy and low-impact as possible.”
Digging in to the challenge, the team first designed and launched an on-demand clinical documentation training that the ACO has asked all providers to complete by the end of 2019 to meet annual Conditions of Participation. Then, it set to work on creating a coding toolkit and a provider-by-provider coding gap report to help pinpoint specific improvement opportunities. Detailed coding gap reports are being produced using the ACO’s Arcadia population health management tool and toolkits are being distributed with the help of the ACO’s Improvement Advisors and Physician Liaisons. To date, more than 400 providers have completed the training and the coding gap percentage is trending downward. The final 2019 coding gap result will be available in early 2020.
Digging in to the challenge, the team first designed and launched an on-demand clinical documentation training that the ACO has asked all providers to complete by the end of 2019 to meet annual Conditions of Participation. Then, it set to work on creating a coding toolkit and a provider-by-provider coding gap report to help pinpoint specific improvement opportunities. Detailed coding gap reports are being produced using the ACO’s Arcadia population health management tool and toolkits are being distributed with the help of the ACO’s Improvement Advisors and Physician Liaisons. To date, more than 400 providers have completed the training and the coding gap percentage is trending downward. The final 2019 coding gap result will be available in early 2020.