Measuring the Real Impact of Clinical Documentation Improvement on Value-based Reimbursement


Executive Summary

The U.S. healthcare industry is rapidly evolving toward a new value-based business model that rewards quality care at the lowest possible cost, while penalizing providers for care that is inefficient, of poor quality, or not safe. In this new environment, the delivery of quality care is a continuous challenge, particularly with changing rules and expectations in terms of how to document, measure and follow best practices in care.

As public and private payers begin to link payments to quality, outcomes and costs, physicians and hospitals must prove that they are meeting or exceeding quality standards, achieving better clinical outcomes and controlling costs. In this value-based healthcare economy, accurate clinical documentation and a reliable method for measuring quality care become even more necessary.

Study Confirms Value of Clinically-focused Clinical Documentation Improvement

A study conducted in 2015 by Nuance Communications, Inc. and Quantros, Inc. evaluated the quality performance of hospitals using the Nuance Clinical Documentation Improvement (CDI) program against other hospitals. Results show that hospitals with a clinically-focused Clinical Documentation Improvement (CDI) program consistently outperform benchmarks for Hospital Care Quality standards by more than 3 times the national average.

Methodology

More than 300 hospitals were included in the measurement during the full federal fiscal year from 2011 to 2014 looking at quality ratings as represented in the Quantros CareChex® national database -- an innovative medical quality rating system designed to assist providers and purchasers in evaluating the quality of inpatient care. This was done looking at overall mortality ratings and also using pre- and post-implementation outcomes for overall mortality ratings, inpatient quality indicator ratings from AHRQ, and expected mortality. Additionally to review for bias the pre-implementation overall quality rating was measured for FFY 12, 13, and 14.

The CareChex® Quality Rating System was developed by Comparion Medical Analytics, recently acquired by Quantros.

Study Findings

The study showed that hospitals using Nuance’s CDI program outperformed other peer hospitals at greater rates in quality overall and specific categories where clinical documentation improvement programs could make the greatest impact including:

  • 93 percent of Nuance clients are in the top 50 percent of CareChex overall mortality ratings of U.S. hospitals, and exceeded national benchmarks for mortality rating performance.
  • 36 percent of Nuance CDI clients are in the top 10 percent of hospitals in analysis of CareChex overall mortality rating performance.
  • Hospitals that deploy Nuance’s CDI program see significant improvement in quality ratings post implementation, including up to two times improvement on mortality ratings, and up to seven times improvement on expected mortality ratings.