The final day for live education at the AHIMA20 Virtual Conference occurred on Friday. We’ve curated a sampling of the education sessions on offer.
To learn more about education opportunities for the duration of the conference, click here.
Making Data Accuracy Fun
In her session Making Data Accuracy Fun, Amy Richardson, RHIA, CHDA, vice president, Haugen Consulting, shared results of a data accuracy project she undertook with Colorado’s Small Rural Hospital Improvement Grant Program. She worked with 11 hospitals—through on-site and virtual meetings—to address data accuracy topics chosen by each hospital.
For example, one hospital wanted to increase the accuracy of capturing social determinants of health (SDOH) data elements in the social history portion of a patient’s electronic health record. Richardson helped this provider realize that the social history that nurses were entering in the record weren’t available for physicians to read and respond to, which resulted in only 69 percent of substance abuse issues were being documented correctly system wide.
In order to help her clients determine how to tackle a given data accuracy issue, Richardson created safe meeting spaces where data stakeholders could talk through root cause analyses and possible solutions in an open and honest environment. That meant performing fun team-building exercises and instituting a Las Vegas-inspired meeting room policy—in other words, the frustrations and opinions shared in these sessions didn’t leave the room.
Avoid and Protest Denials
In an era of shrinking reimbursements, it’s more important to capture every dollar owed to your healthcare organization—and as far forward in the process as possible. It’s a matter of time and money.
Average deductible and co-insurance costs have swelled over the past 15 years and continue to grow while copays are continuing to decline. The shift toward high deductible health plans has fueled that rise.
We may never eliminate denials, but there are ways to proactively prevent them, particularly recurring denials caused by your claim workflow. This was the subject of the lively and hard-hitting panel discussion, Avoid and Protest Denials on Friday, which featured five industry subject matter experts on the negative impact of denials, how to avoid them, and how to fight them.
With each expert’s experience coming at this problem from a different angle, attendees gathered multiple denials management strategies to bring back to their organizations to improve results.
Artificial intelligence (AI) is being used in many cases to predict which cases are ripe for denial. Then it pays particular attention to supplementing and ultimately properly filing the claims. Many providers are properly using AI from outside vendors to address issues in claims before they are submitted. The ongoing measurement of clean claims should be increasing as organizations learn more from payments and denials.
Creating the High Performing Triad—Finance, HIM and Clinical Executives
Panelists representing the perspectives of healthcare finance executives, physician executives, and health information management executives discussed the need for collaboration among this triumvirate of stakeholders to help providers thrive in the current challenging landscape as part of the session Creating the High Performing Triad—Finance, HIM and Clinical Executives held on Friday.
According to audience polls taken throughout the session, the working relationships of these three parties could be better. In response to a poll asking: “How many believe you have a ‘good’ relationship between the HIM, Clinical and Financial team?” 56 percent of attendees said these relationships need improvement. A follow-up audience poll offered some clues as to why this might be the case. When asked “What impacts effective relationships in the triad the most?” 74 percent of respondents attributed insufficient communication as the leading factor.
Strong collaboration between finance, clinical, and HIM executives is growing in importance due to “changing payment models over the past 10 years, episodic and bundled payments, ACOs, the shift to value,” noted panelist Katie Gilfillan, CHFP, MSW, director of healthcare finance policy, physician and clinical practice at the Healthcare Financial Management Association. “It requires collaboration between finance, HIM, and clinical to understand how best and most efficiently provide care. Predictive modeling becomes more important. Changes to E/M office visits are real world, practical example of what physicians will be dealing with. The pandemic created more stress for physicians in addition to EMR burdens.”
Using AI to Safeguard PHI Across Healthcare Organizations
Machine learning and artificial intelligence are the buzziest tools on the market for managing the privacy and security of healthcare data, and in their session Using AI to Safeguard PHI Across Healthcare Organizations, Daniel Fabbri, PhD, and Andrew Rodriguez, MSHI, HCISPP, CHPC, CHPS, CDP, discussed the benefits and some drawbacks of using them.
Fabbri, who’s an instructor at Vanderbilt University, and Rodriguez, the privacy and information officer at Shriners Hospital for Children, are encouraged about the potential to use AI and machine learning to assist with things like SQL query outliers, and EMR access monitoring, but agree that there are risks.
“Machine learning and AI are great tools but they’re not a panacea,” Fabbri said. “One of the issues that comes up is bias. Does machine learning, based on labels, learn a model that is biased, that is not generalizable across the population? For example, Amazon thought they could use AI for recruitment, but it turns out that the AI system ended up not recommending women based on hiring based on historical patterns. Machine learning works by leveraging historical patterns. If you have systemic bias your system will never learn to hire women.”
Managing Insider Threats through Collaboration between Covered Entities and Business Associates
On Friday, the presenter at the session Managing Insider Threats through Collaboration between Covered Entities and Business Associates explored the growing cost and frequency of insider threats in healthcare and at large.
Elizabeth McElhiney, MHA, CHPS, CAHIMS, CRIS, privacy officer and regional director of client services at ScanSTAT Technologies, explored the Ponemon Institute’s Cost of Insider Threats: Global Report 2020; Verizon’s 2019 Data Breach Report; and Vectra’s Healthcare Spotlight Report.
She also talked about covered entities’ responsibilities to ensure business associate compliance and the barriers to monitoring and compliance. Finally, they highlighted why a collaborative relationship needs to occur in order to identify areas of concern, ensure staff training, and protect patient data.