Some hospitals have lost millions of dollars in revenue because of falling Medicare reimbursements due to inaccurate clinical documentation. ChartWise:CDI, a new software program created by ChartWise Medical Systems Inc., a Wakefield company founded by Jonathan Elion, was developed to help maximize reimbursements and avoid audits.
Elion a clinical cardiologist and an associate professor of medicine at Brown University, recently spoke with Providence Business News about the new venture.
PBN: What was the inspiration for ChartWise:CDI?
ELION: One day I found myself sitting in an auditorium at Miriam Hospital where a very well-intentioned consultant was talking about how to ensure the hospital receives the full amount for reimbursements. He was wagging his finger and saying, “You doctors have got to do a better job with the terminology in your notes.” He showed us a note that I thought was perfectly fine, and then he said, “In this day and age, this just won’t cut it.” He said we all had to become more conversant in the coding terminology. Well, there are 17,000 diagnostic codes used for Medicare reimbursements. It’s like a whole other language. Then I thought, there has got to be a better way.
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PBN: Aren’t doctors already using those codes?
ELION: Doctors tend to write notes that make sense clinically, and there’s often a huge disconnect between clinical language and the diagnostic codes. An example: A patient comes into the hospital and needs some belly surgery. His doctor already knows he has a history of heart trouble. While in recovery the patient develops a buildup of fluid in his lungs. That’s called congestive heart failure. I’ll be called in. I’ll look at him and see that he’s had this problem before, and maybe I’ll say to give him a diuretic, and the problem will clear up.
PBN: How does your product address this? PBN: You’ve said that your system also provides a defense against audits? PBN: ChartWise:CDI is a Web-based system. How is that advantageous? PBN: There must be some privacy concerns with everything online. PBN: Is the ChartWise:CDI system in use now?
ELION: In response to all this, hospitals have created a new profession, the clinical-documentation specialist, [or] CDS. They go around and read charts, and they’ll leave instructions for the doctors to be more specific. They’re professionals trained to look at charts. They scan for gaps. But they can’t put words in our mouth. They can’t suggest we use the words “acute systolic.” The coder can’t look at the radiologist’s report, or work from the nurse’s notes. It must be in the doctor’s note. If the doctor didn’t say it, it didn’t happen.
Our product, ChartWise:CDI, does much the same thing. We play in the field of clinical- documentation improvement. The ChartWise:CDI program has built into it [more than] 31,000 abnormalities, so you don’t have to be walking around with this big, thick documentation. …
There are three ways for hospitals to make money: Do more work, do a better job collecting on bills you sent out, or do a better job billing for the work that you did. … You have to make sure the doctor’s note lets you get paid for that work.
ELION: Every hospital that takes Medicare payments will be audited. The government hires companies to do it, the recovery-audit contractors, [or] RACs. It’s probably accurate that there are hospitals that are billing incorrectly. It can be hard to do it all correctly. ChartWise:CDI helps you get everything right up front.
ELION: It could be installed at your hospital, if that’s what you want, but hospital computer departments are very busy, so it’s hard for them to find the time to install things. What we’re doing is called “software as a service.” You don’t have to buy any equipment. We take care of all the updates. I could go into a hospital and have them running our system this afternoon. It’s all one database. Right now we’re starting an installation at a hospital chain with [more than] 100 hospitals. They’ll be able to see all that data aggregated together.
ELION: Most hospitals have a CDS using a laptop, carrying it around the hospital. That’s not very secure, because the laptop could end up in the wrong hands. You don’t run this software on your laptop, so you don’t have to worry about the laptop being stolen. And we have state-of-the-art security.
ELION: We’re starting to roll out the full-blown system. The hospital purchasing process can be slow, they’re big bureaucracies, but we are starting to install it at a number of places. •
