Amidst national recovery efforts, US health systems face a series of challenges exacerbated by COVID-19, including decreased margins and volumes, flattened revenues, increased expenses, staffing challenges, and dangerous levels of provider burnout. To survive in the “new normal,” health systems must accelerate digital transformation and introduce new operating models and capabilities enabled by digital technology and automation. 

While digital care delivery solutions like virtual visits can help systems emerge stronger, integrating digital solutions into clinical operations is also essential. Digitally enabled and automated clinical operations can impact functions across the entire enterprise, from improving provider experience to driving revenue and efficiency to boosting clinical outcomes. An analysis conducted by AVIA found digital clinical operations solutions can drive up to $185 million in cost savings and revenue opportunities for an example $2B health system. 

Health systems can make an immediate and powerful impact on provider and patient experience, patient outcomes, quality of care, and their bottom line by focusing on coding and clinical documentation integrity, computer-assisted physician documentation, predictive staffing, and access and orchestration, among other solutions. 

Digital solutions to transform clinical operations

Access & orchestration

What if your patients can experience a seamless journey throughout your health system, getting the care and support they need when they need it? 

The COVID-19 pandemic has made safe, efficient, and effective patient transfers and capacity management an imperative. Barriers, like diagnoses discordance between points of care, may prevent patients from receiving high-quality care during the transfer process. These issues are compounded by a lack of interoperability between hospital systems, siloed staff, and communication challenges. One large hospital system reported that an ineffective transfer process was costing the system $40 million in leakage annually.

Health systems use digital command centers to aggregate data from multiple sources to support clinical and operational improvement. To help combat inefficient transfer processes, health systems are turning to the access and orchestration model. The model sits at the core of these command centers by enabling real-time visibility and management throughout the patient journey, so patients are seamlessly directed to facilities that have the resources and expertise that fit their specific needs. 

Digital access and orchestration solutions embedded into a command center can provide:

• Automation of all aspects of a patient transfer, including inter-department and inter-hospital transfers, behavioral health transfers, and discharge
• Intelligent non-emergent transport within the health system
• System-wide bed visibility to ensure immediate patient treatment
• Integrated on-call scheduling 
• Real-time analytics to monitor access operations

The benefits of investing in access and orchestration solutions extend far beyond improved patient care. One estimate found that each transfer yields $10,800 per patient, which can make a substantial impact on revenue if patients are kept in-network. One health system with 70,000 referrals per year used digital access and orchestration solutions to gain an additional $26.4 million in potential revenue while reducing average transfer times by 67 minutes. 

Predictive staffing

What if you could predict the exact staffing levels you’ll need for the next week, month, or even three months? 

Ensuring that staffing plans match demand is a time-consuming process. Surveys show that 24% of nursing leaders use paper-based tools for staffing, with 19% relying on Excel spreadsheets. As a result of these manual processes, health systems may be facing understaffing, which is directly linked to worse patient outcomes.  

The ability to utilize predictive staffing analytics to optimize scheduling is essential. Predictive staffing digital solutions use historic data on staffing, volumes, patient acuity, and other factors to allow health systems to predict patient demand months in advance and match patients with appropriate staff. 

Predictive staffing tools can reduce labor spend, improve patient outcomes, increase productivity, and have a direct impact on provider and patient satisfaction. Solutions can accurately predict staffing needs 30 days in advance with 97% accuracy, leading to one large health system seeing $4.3 million in labor cost savings from predictive staffing models. 

Coding & clinical documentation integrity (CDI)

What if your nurses and physicians could accurately and easily capture the complete patient story in your EHR, every time? 

In a 2019 survey, 84% of healthcare finance leaders highlighted clinical documentation and coding as the key area of vulnerability for lost or decreased revenue. With provider and staff burnout spiking, mitigating inaccuracies in coding and documentation are increasingly important for health systems. Additionally, the increase in value-based care contracts for Medicaid, Medicare, and commercial payers has amplified the focus on risk-based coding. 

Digital solutions must be implemented to alleviate and minimize human errors and improve coding accuracy in the documentation and coding process. Coding/CDI solutions allow health systems to apply correct billing and diagnostic codes for claims, improving the integrity and quality of the documentation, patient outcomes, and related reimbursement. These solutions also can increase productivity and efficiency by reducing manual tasks and can tackle the cause of coding inaccuracies at multiple stages in the process:

• Providers: After years of testing and refinement, AI-powered natural language processing solutions have advanced to the stage where they can accurately and efficiently help providers capture the complete patient story into a health system’s EHR.
• CDI teams: AI solutions can automatically and instantly share clinical insights across teams, providing evidence-based analysis, worklist prioritization, and a clinically-driven review process. While these capabilities are a work in progress, the algorithms are rapidly advancing and will provide increasingly significant benefits to early adopters. 

Successful deployment of digital and automated coding and CDI solutions can lead to decreased labor spend and increased quality scores. Accurate coding can also increase the case mix index (CMI), driving higher reimbursement and lower adjusted cost per patient, which equates to a significant revenue increase for hospitals. It’s estimated that a 13% increase in CMI can provide $45M in revenue realization.

Computer-assisted physician documentation (CAPD)

What if your providers could dedicate more of their time to caring for patients instead of completing paperwork?

A third of providers say they spend 20 hours or more a week on paperwork and administrative tasks, and they spend an average of 16 minutes per patient encounter inputting data into the EHR. Physicians fatigued with excessive administrative tasks may submit incomplete documentation and incorrect code assignments, resulting in lower reimbursements for the health system and plummeting provider satisfaction.  

Health systems must focus on decreasing the administrative burden on providers to drive reimbursement accuracy and improve patient and provider experience. Computer-assisted physician documentation (CAPD) solutions leverage ambient technology and natural language processing to enable the automatic capture of data for physician documentation. Using CAPD digital solutions, providers can provide a verbal recap of a patient visit, and machine learning algorithms transform the recorded content into required notes, orders, and referrals in the EHR.

These solutions drastically reduce the need for transcription costs, producing an estimated savings of $3 million for one health system. Providing physicians with a more accurate, efficient method of documentation can also increase hospital and physician quality ratings that may have suffered due to burnout and incomplete or inaccurate documentation. 

Transforming clinical operations with AVIA

Clinical operations are an essential component of improving patient and provider experience and exceeding revenue goals. If your health system is ready to emerge as a healthcare leader, the experts at AVIA’s Center for Operational Transformation are here to help. 

We partner with health systems to help your team build the business case for digital action, design a digital strategy to tackle your operational challenges, find the digital solutions that address your unique needs, and more. Contact us today to learn more about how digital can transform your clinical operations strategy.

This article is part one of our series on digital solutions for clinical operations. Part two, which explores command centers, clinical asset management, and intelligent scheduling, can be found here.