Academic Hospital (Value-Based Care) Found $24 Million More in Revenue

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The Situation

A 740-provider academic institution has EPIC as their EHR. There is one auditor to identify providers with "Gaps In Care", to pull appropriate charts, audit the charts, and educate the provider and/or scribe on proper documentation and coding to close those "Gaps in Care" and avoid RADV audits. They have Medicare Advantage, and 4 payor risk plans. 

The Challenges:

Due to limitations the one auditor is only auditing and educating Family Practice (114 providers) and Internal Medicine (26 providers). 

The EPIC system is not user friendly. to select a provider to audit their 10 charts, the auditor pulls all patient encounters for a provider for patients seen in the last 6 months. Of the hundreds or thousands of encounters, the auditor must find and select 10 patients with the highest "Gaps". Then remove deceased patients from the list before auditing charts. After auditing the 10 charts, the auditor has a face-to-face encounter with the provider or scribe to assess or plan the education to close gaps, avoid a RADV audit, and show RAF scores. There is no way to measure ongoing success for the auditors and providers.

The EPIC 10-chart selection process takes approximately 4 hours.

STrategies - Reveal hcc raf:

Utilize revealMD analytic application that would complement EPIC to assist in areas that will make the auditor's job easier and more effective to close gaps and improve revenue. 

The results:

Physicians want to see their individual progress which creates improved buy-in. When this revealMD HCC RAF process began, there was provider resistance, now there is 80% acceptance due to benchmarking progress and the communication skill of the auditor.

Using revealMD HCC RAF, the time requirement to find 10 patients is 30 minutes instead of the 4 hours using EPIC to perform the same search and selection functions. An 800% improvement in efficiency in determining patients with gaps. 

After 8 months, YTD value of closed "Gaps" totals an additional $15.7 million more revenue over the same period in 2020. 30,475 patients were seen in 2021 with no gaps in care. The one full-time auditor still has 4618 patients with "Gaps", or 9% of the total VBC patients yet to be audited in 2021.

They are no longer using EPIC for this purpose. After 12 months, the value of closed "Gaps" totaled an additional $24 million in revenue.

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