How to Drive Continuous Quality Improvement in Healthcare with Medical Coding Data Analysis

How to Drive Continuous Quality Improvement in Healthcare with Medical Coding Data Analysis

We asked JJ Crumbley, Director, Project Management & Operations, to author this article and share his expertise on how healthcare organizations can continuously drive coding quality improvement with data-driven strategies. Crumbley is a certified Project Management Professional (PMP) with 13+ years of experience integrating project management and client-centered consulting skills to deliver comprehensive solutions specific to our healthcare industry’s needs and challenges.

In my previous article, “Making the Data Work for You: How to Turn Medical Coding Audits into Actionable Insights,” I outlined the benefits of medical coding audits and how organizations can translate the vast amounts of data into strategies. Next, I will dive deeper, illustrating how to drive sustainable, continuous coding quality improvement with such data.

So, how can an organization leverage the analyzed data to sustain continuous quality improvement? First, the organization must have the right foundational approach and understand what the concept of quality improvement means and its benefits.

A key principle to continuous coding quality improvement is the approach of the quality/compliance audit programs. The foundation by which you build and communicate the quality auditing program is key to the long-term success of the continuous coding quality improvement and ROI. Generally, we see quality auditing programs established as either: 1) a Compliance Program or 2) a Continuous Quality Improvement Program.

Generally, when approached as a compliance program, the goal is to check the annual compliance requirements. Although this approach provides insights into the current accuracy levels of your coding staff, it does little to invest in or continually improve the knowledge base of the coding team. In comparison, YES HIM recommends the continuous quality improvement approach as the emphasis is not on compliance but rather on education and continual improvement.

When leadership communicates that the auditing programs are meant to be a tool to aid coders’ development and knowledge base rather than a punitive mechanism to “grade” the coding staff, barriers to entry are lessened, and buy-in, collaboration, and communication between coding staffs and auditors are greatly increased.

Establishing a solid foundation and the right approach to the auditing program is vital to the internal development of coders and the long-term success of continuous improvement efforts.

What Are The Benefits Of Continuous Coding Quality Improvement?

The Centers for Disease Control and Prevention (CDC), the leading national public health institution in the United States that sets the standards for our public health safety and care, describes quality improvement as “one component of the performance management system. It uses data for decisions to improve policies, programs, and outcomes” (Health Catalyst, 2017).

The U.S. Department of Health & Human Services (HHS) identified these direct benefits of continuous coding quality improvement:

By continually striving to improve coding quality, an organization can also expect an increase in productivity. This is a natural – and expected – occurrence from the organization’s drive to achieve its goals and exceed expectations. Of course, another logical – and most obvious – benefit is the improved coding quality and accuracy.

In the example below, a partnership between YES HIM and a large 800-plus-bed healthcare system is highlighted to show the benefits of a quality improvement program approach.

Over a two-year period, all inpatient and outpatient accuracy stats continually improved quarter over quarter.

Exhibit 1: Inpatient Accuracy Stats

inpatient coding accuracy rates

Exhibit 2: Outpatient Accuracy Stats

outpatient coding accuracy rates

In addition to the overall accuracy improvements, the recurrent dialogue, education, and mentoring of the continuous improvement processes also lead to increased productivity across all chart types.

Exhibit 3: Inpatient and Outpatient Productivity Rates

continuous quality improvement in healthcare
continuous quality improvement in healthcare
continuous quality improvement in healthcare
continuous quality improvement in healthcare
continuous quality improvement in healthcare

Highly functioning quality improvement programs and tools, such as collaborative quality audit programs, significantly impact an organization. Increased overall team morale, coding staff knowledge, the identification of potential risks or gaps, as well as many other benefits resulted from the examples above.

How to Drive Quality Improvement Using the PDSA Cycle

The Quality Improvement (QI) PDSA Cycle, developed by the Agency for Healthcare Research and Quality, stands for: “plan, do, study, act.” This cycle is fueled by the actionable insights identified in the previous stages of identifying the organization’s goals, selecting the KPIs for the coding audits, running the audits, cleaning and analyzing the data, and forming recommendations.

Actionable insights are the engine that drives continual, long-term improvement. And continual improvement can only occur when all four phases of the PDSA Cycle are in sync.

  1. Plan strategy: The first phase of the PDSA Cycle requires the organization to develop a quality improvement plan. Those actionable insights from the coding compliance audits will come into play here. Armed with those insights, the organization can create tailored steps to achieve its goals.
  2. Do/Implement strategy: After crafting the quality improvement plan, the next phase is to “do” or implement the strategy. This phase can include additional audits, secondary reviews, one-on-one coaching sessions, tailored educational opportunities, and more to achieve the desired quality improvement goal.
  3. Study/monitor strategy: After the quality improvement strategy is in place, monitor its progress by studying the team’s coding accuracy rates and other quality key performance indicators (KPIs) that were previously selected. Conducting secondary reviews, assessments, and additional coding compliance audits will help monitor the QI plan’s progress. It’s also possible for unforeseen areas of improvement to arise.
  4. Act/re-evaluate strategy and respond: At the final stage in the cycle, use the generated data from the previous stage to evaluate if the quality improvement plan is working. During this stage, the organization may adjust the goals, change assumptions, or even re-evaluate the KPIs and success criteria. Adjust the QI plan as needed to incorporate those unforeseen areas of improvement.

Repeating the PDSA Cycle, fueled by the correctly analyzed and identified actionable insights, will continue to drive quality improvement within the organization. Implementing continual improvement initiatives, like the example above, can help organizations better position themselves for sustainable success and immeasurable benefits, as outlined by HHS.

Lastly, helping healthcare providers translate their audit data into actionable quality improvement plans is one of YES HIM Consulting’s distinguishing services. Contact our team today or review our list of many quality improvement services.

JJ Crumbley

JJ Crumbley, MBA, PMP – Director Project Management & Operations
continuous quality improvement in healthcare

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