On Target recognizes a client who is showing process improvement from putting Capstone’s processes and advice into action.
Pain points
ICD-10 was the tipping point. CMS’s implementation of the new edition of the coding system was the point of no return for Senior Total Life Care (STLC), a PACE organization serving 175 participants in a rural area less than 20 miles outside of Charlotte, North Carolina.
“When the ICD-10 conversion occurred, we thought our staff had the skillset to monitor and code,” says Cathy Kenzig, executive director, “but we found out by accident that things had to be manually converted (to the new codes).”
David Smith, BSN, RN, clinical informatics specialist, remembers the repercussions. “We noticed a change in numbers of codes submitted. Specifically, our report was not picking up encounters that were still open by the providers and this resulted in fewer codes being submitted to CMS.”
The need for outside expertise
“As we grew, we felt we needed restructuring in medical records and the medical finance department,” Kenzig says. Along with the coding issues, “we were concerned about a potential drop in risk score. Our providers knew they were doing a great job taking care of our participants, but were unsure if their coding was adequate.”
The leadership team realized they needed outside expertise. “After cost benefit analysis we projected that for what we were paying a coder…It didn’t make sense to have someone in-house without the skills we needed,” Smith explains. “Dr. (Alan) Clark (medical director) had heard of other programs who had realized ‘as much as an additional million dollars in revenue’ using Capstone. So there was a track record with Capstone.”
In May 2016, STLC engaged Capstone Performance Systems for Core retainer Services and Coding. While the STLC staff largely supported the move, there were some concerns. “The providers wanted to know ‘how will it impact me? Will you help me? Will you give me the tools I need?’ ’’ Kenzig recounts. “Dr. (Mike) Brett and Dr. (Richard) Schamp said, ‘yes, we’ll give you the tools.’
“With David being a nurse and understanding informatics, our providers knew they had an inside go-to guy. And Dr. Clark is a tremendous leader. He said, ‘We’re going to do this, we’re going to be fine,’“ Kenzig says. “And it (the newly-implemented processes) has become normal business.”
Seeing the results
The STLC team saw the results of their effort. “The new risk codes hit, and we saw PMPM results,” says Kenzig. The outcome was not a complete surprise. “Capstone could predict our reconciliation payments, and they spoke to our board to soothe their fears.
“I give kudos to the organization (STLC) in general,” she continues. “We developed a plan, implemented training, and stuck to it.
Dr. Mike was impressed that we did exactly what he told us to do. Now it’s a normal course of business for everyone and they don’t remember the pain. We supported them with training, with food. We pushed forward and did it.”
A smoother process
Capstone risk adjustment and coding specialist Jan Deyber, CRN-C, is impressed by the program’s commitment and follow-through. “They are engaged with monthly audit webinars. They follow through with the audits and show excellent commitment to compliance,” she explains. “We have an open communication system that is prompt and helps resolve issues quickly. We continually find ways to improve reports, assessments, coding and the overall workflow process of all involved.”
Smith appreciates the convenience of Capstone’s services: “I just print, staple and hand the reports to providers,” he says. The HOpp (HCC Opportunity) report, the clinical decision tool, and the monthly reports make the process smoother. “SeniorTLC has a weekly call with Matt Zimmerman to discuss various reports. His knowledge base from a financial and compliance standpoint is helpful.”
Kenzig says providers have benefited from the user-friendly data, which “gives them a place to start when performing their assessments. They can have a better conversation since they can clearly see the participant’s diagnosis history. Their time prepping has been reduced.”
Kenzig credits the experience of the Capstone team with helping STLC to make the transition. “Dr. Mike has brought in the perspective of other PACE programs,” she says. “He validated what we were doing, made us see some of the growing pains were normal. He helped the whole team feel better about what we were doing.”
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