The 2016 Speech Industry Implementation Awards: Florida Hospital

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Customer: Florida Hospital

Vendor: Nuance Communications

Product: Nuance CDI

Recent healthcare provider changes made it clear to officials at Florida Hospital that “we’re paid for the services we document, rather than the services we provide,” says Jeff Hurst, senior vice president at the nonprofit healthcare organization, based in Orlando, Fla.

To aid documentation, the nonprofit Florida Hospital launched the Nuance Clinical Documentation Improvement (CDI), which uses the J.A. Thomas Compliant Documentation Management Program. The hospital system phased in the software over a 10-month period, through May 2015.

“We launched CDI because it became clear to us that healthcare is changing from a fee-for-service to a fee-for-value model, from a financial standpoint,” Hurst says.

The hospital system now uses the patient documentation software throughout eight facilities in central Florida metro locations that together comprise 2,600 hospital beds. Florida Hospital/Adventist Health System operates 25 hospitals across Florida.

The hospital system is next phasing in computer-assisted physician documentation technology, also from Nuance, that brings language understanding and voice recognition into CDI software. It calls upon Dragon Naturally Speaking for dictation and for access and clarifications to customized CDI terms.

The current Nuance program used at Florida Hospital is much the same as the language understanding solution in that it marries clinical, documentation, and coding processes. It translates a patient’s clinical status into coded data that is used for quality reporting, physician report cards, reimbursement, public health data, and disease tracking and trending.

With the new system in place, Florida Hospital doctors and nurses document patients’ cases from the moment they enter the hospital until final discharge and even beyond, should they see another Florida Hospital provider or be readmitted.

The system ensures documentation language is compliant with standards and that the complexity and severity of a patient case is properly noted. The latter documentation becomes part of what’s called a case mix index (CMI).

The CMI ensures appropriate reimbursement because the greater the number of complex and severe diagnoses a healthcare system manages and appropriately documents, the higher its CMI. Improved documentation can raise a CMI number and, with it, reimbursement, Hurst says.

The move to CDI has already surpassed expectations, he adds. The hospital system has already seen significant improvements with reported CMI numbers. Since deployment, Florida Hospital has seen a 29 basis point increase to its CMI, from 161 to 189. That improvement translates to a $72.5 million reimbursement increase since implementation.

Documentation has also raised the hospital system’s managed Medicare by 17 basis points—a measurement of Medicare patients seen with complex diagnoses—for another $23 million reimbursement increase, Hurst adds.

“We’ve always provided high-quality care to patients, but we just haven’t always documented that,” Hurst says. “Now we’re getting credit for it.”

Also, the observed-to-expected mortality rate dropped by 48 percent following CDI implementation. That’s a nearly 50 percent decline, not because fewer patients died in the hospitals but because observed mortality rates can be artificially skewed if risk of death isn’t documented or if a patient is readmitted with a life-threatening illness, Hurst says. The new system notes death risks.

With the implementation, Florida Hospital now complies with ICD-10, a clinical cataloging system that went into effect for the U.S. healthcare industry in October 2015.

The savings come with the Nuance system, even though the hospital has brought on 40 registered nurses to help physicians use and get up to speed on the CDI system.

“They’re having real-time discussions with the physicians, saying things like ‘You said this, but did you really mean that?’” Hurst says.

But the nurses do more than clarify physician intent. They also identify gaps in the clinical evidence and documentation and ensure documents are compliant with documentation rules and regulations. Their aid helps maintain timely documentation. The nurses are also familiar with privacy, security, and confidentiality rules that affect clinical document and information sharing.

Florida Hospital plans to next roll out the system to its healthcare clinics.

With those increased reimbursement numbers to back him up, Hurst doesn’t equivocate in his praise for the CDI system.

“CDI was the shining star of 2015 and we expect even greater outcomes as we expand into the patient care and ambulatory settings,” he says. 


After implementing Nuance CDI, Florida Hospital has seen:

• a $72.5 million reimbursement increase;

• a 48 percent drop in the observed-to-expected mortality rate;

• a $23 million managed Medicare reimbursement increase; and

• ICD-10 compliance.

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