Baptist Health improves quality and realizes $45M in appropriate reimbursement.
Nuance’s clinically driven CDI program and a unique staffing model engage physicians and drive results
Baptist Health South Florida is a six-hospital system in
Miami and the Florida Keys with a large international
presence throughout the Caribbean. Its 15,000
employees and 2,200 physicians in virtually all
specialties serve over a million patients a year from
around the world.
Historically, Baptist completed chart reviews after patients had been discharged from the hospital. The retrospective requests to update clinical documentation met with physician resistance, with only a 20% response rate, and missed opportunities to improve quality and receive appropriate reimbursement.
“ Once the clinical documentation programs were up and running, it was amazing how much more documentation we were able to capture and how much more specificity we experienced. ”
Lorena Chicoye, MD
Corporate Medical Director
Administrators understood that this manual, retrospective process resulted in critical data being missed. So Baptist Health, under the leadership of Lorena Chicoye, MD, corporate medical director, engaged Nuance to help change this practice. Baptist Health deployed Nuance’s Clinical Documentation Improvement (CDI) program because of the emphasis on physician engagement and proven results. Unique in its approach to clinical documentation improvement, the Nuance process employs technology and education designed to empower clinically trained CDI specialists to engage in a dialogue with physicians about the quality of patient care and how best to capture those details in their documentation—all while minimizing workflow disruption through a concurrent review process that brings to light care and quality documentation issues while patients are still in the hospital.
Within six months, Baptist Health saw measurable results. The average physician response rate to the CDI team’s concurrent clarifications increased from 10–20 percent to 95 percent. Even more compelling is the 80 percent agreement rate, indicative of physician compliance in capturing the quality details in patient documentation. In the four years since the Nuance CDI implementation, the more accurate severity-based CDI approach has generated a 13 percent average increase in Case Mix Index (CMI) across the system, translating to $45 million in appropriate reimbursement.