Introduction to Oregon Health & Science University Hospital
Oregon Health & Science University Hospital is a 576-bed teaching hospital, biomedical research facility, and Level I trauma center located on the campus of Oregon Health & Science University in Portland. It is at the heart of OHSU, a large health system of hospitals and clinics across Oregon and southwest Washington.
The Challenge
Like much of the industry, OHSU has faced a persistent shortage of medical coders, hugely impacting coder case volumes and operational efficiency. The hospital’s director of revenue cycle, Tammy Bickle, noted that planned growth, including the expansion of additional beds, would further perpetuate increased coder volumes and backlog. This backlog resulted in longer billing turnaround times, which increased coding-related denials. Payers have timely filing periods, which is a deadline for getting the claim into the payer. OHSU’s shortage was such that they struggled to meet timely filing deadlines, so payers were having to adjust charges. OHSU was losing money from reimbursement for those services, and coders were working an unsustainable amount of overtime.
Proposal
OHSU decided to try AI-driven autonomous coding for a few reasons. First, the organization could not increase the number of coders on staff but still wanted to support work/life balance for the current coder team. Second, to reduce the backlog. And third, to increase coder volume. So, OHSU turned to vendor CodaMetrix for AI-powered radiology coding. Medical coding is considered one of the most time-consuming, understaffed, and error-prone parts of the health system revenue cycle. The vendor’s proposal was to use AI to automate OHSU’s radiology coding cycle, which helped them end their backlog of cases, provide more efficient and accurate coding, and relieve pressure from their coding team.
Meeting the Challenge
As the coding team looked at what was sitting in the work queue, the volume and backlog just kept growing. OHSU wanted autonomous radiology coding to reduce the backlog. The AI-driven platform is fully automated and integrated with OHSU’s Epic EHR. OHSU knew they had to reduce overtime for their coding team, not only for costs but because their team was putting in long hours and deserves work/life balance. AI-autonomous coding helps reduce their backlog and overtime, makes the workload on their coding team much more manageable, and helps free up their team to code more complex work.
Results
The results from using AI-driven autonomous coding have been immediate and impressive. For radiology, OHSU’s automation rate has reached 92%. Their coder workload was reduced by nearly 28%. Coding-related denials for autonomously coded radiology cases are 70% lower than manually coded cases, and their automated denial rate was substantially lower – 0.33% percent for AI-coded cases versus 1.09% for manual coding. MR case denials, a high-cost imaging category, dropped 65% with automation, with an automated denial rate of 0.48% versus 1.38% for manual coding.
Advice for Others
Don’t be afraid to try something new, Bickle advised her peers at other hospitals and health systems. All health systems have similar problems, but not everyone is embracing autonomous coding. Understanding what the end result would look like was important for getting buy-in internally. There was a lot of change management that took place to have key stakeholders embrace the implementation. When the team had tried computer-assisted coding – on top of an unwieldy onboarding process – the backlogs continued. It made it a bad experience for their team, and many of them lost faith in automated coding. What’s more, coders often are worried about losing their jobs to automation, so they’re concerned about whether, if implementation goes well, it means they’ll be completely replaced.
Conclusion
In conclusion, OHSU’s experience with AI-driven autonomous coding has been a success. The hospital has reduced its backlog, decreased coding-related denials, and improved the work/life balance of its coding team. Other hospitals and health systems can learn from OHSU’s experience and consider implementing AI-driven autonomous coding to improve their own revenue cycle operations.
FAQs
Q: What is AI-driven autonomous coding?
A: AI-driven autonomous coding is a technology that uses artificial intelligence to automate the coding process, reducing the need for human coders and improving efficiency and accuracy.
Q: How did OHSU implement AI-driven autonomous coding?
A: OHSU turned to vendor CodaMetrix for AI-powered radiology coding and integrated the platform with their Epic EHR.
Q: What were the results of implementing AI-driven autonomous coding?
A: OHSU’s automation rate reached 92%, coder workload was reduced by 28%, and coding-related denials were 70% lower than manually coded cases.
Q: What advice does Tammy Bickle have for other hospitals and health systems?
A: Don’t be afraid to try something new, and understand what the end result would look like to get buy-in internally.
Q: Will AI-driven autonomous coding replace human coders?
A: No, AI-driven autonomous coding is designed to assist human coders, not replace them. It can help with complex cases and improve work/life balance for coders.
