MHA Corner Podcast Ep20: Unlocking Documentation Transformation
Author: Maxwell Healthcare Associates
Posted: April 23, 2024
The post-acute industry continues to face turmoil under employment shortages, regulatory scrutiny, and clinician satisfaction within the in-home healthcare setting. Throughout this struggle, agencies find increased compliance, accuracy, and satisfaction through the use of documentation transformation technology. To discuss these possible solutions, we sat down with MHA’s Senior Consultant of Innovation, Desiree Ardoin, alongside Jason Banks, Vice President of Business Development with our partner, nVoq Incorporated. The pair discuss the importance of documentation accuracy, opportunities stemming from technology, and overall best practices for clinician satisfaction and agency success in the industry.
Intro:
Welcome to the MHA Corner Podcast, where we discuss news and developments in the post-acute space. Today, we sit down with MHA Senior Consultant of Innovation, Desiree Ardoin, alongside Jason Banks, Vice President of Business Development with our strategic partner, nVoq Incorporated. The pair discuss the current state of clinician retention and satisfaction in post-acute care, the burden of documentation, and the importance of technology and clarity while navigating change management to improve retention and compliance at the agency level.
What's your experience in the industry? Where do you currently work and what is your job title?
Desiree:
My name is Desiree Ardoin. I am a Senior Consultant of Innovation for Maxwell Healthcare Associates. I have a background in home health and hospice from every different angle of what goes on in home health and hospice. I have been doing this for 15 plus years.
Jason:
And my name is Jason Banks. I'm the Vice President of business development for nVoq Incorporated. nVoq is a documentation transformation company and we're based out of Boulder, Colorado. My background is I have been in in-home healthcare for the better part of 20 years, primarily on the technology side.
So, everything from EHR technology companies to EVV companies to business analytics companies. And I also had the good opportunity, fortune to run a hospice and palliative care organization in the Chicagoland area for a few years as well. So, I have been on both the provider side, but most of my experience has been on the technology or technology enabled services side, and been doing that for, again, the better part of 20 years now.
What is the most pressing trend currently affecting the in-home healthcare industry that can be solved with the implementation of transformative technologies?
Jason:
So, yeah, I can answer this. It's still, what we're seeing in the marketplace is clinician shortage is the primary concern or opportunity for in home healthcare providers. There are not just anecdotally from all the experience that both Des and I have at our respective organizations, but even there have been some more recent studies, one by the Amity group, which was the largest independent study of hospice nurses across the US, that showed that the number one driver of dissatisfaction and those nurses leaving the profession is after hours documentation.
And so, it is really the most pressing trend that we're continuing to see is clinician burnout, and that's caused by all the regulatory compliance. The shortage is sort of a cycle that begets more shortage. In other words, as clinicians leave an organization, the remaining clinicians have to pick up the slack, pick up the caseload, and so that quickly adds to their own workload and continues to burn them out.
So, obviously, there's no panacea to this, but what we're seeing is retention and recruitment. How do we get more clinicians into in-home healthcare is the number one concern that we're seeing across the industry.
Desiree:
It's kind of like a trickling effect. I mean, if you have a clinician that leaves the company and you take their workload and put it on the next clinician, then their burnout comes in faster and quicker than expected. And they start with the, “let me leave”, “this is too much” as well.
How does the documentation transformation platform address compliance challenges that agencies face in the in-home healthcare sector, and how does it contribute to solving these challenges?
Jason:
So today what we see is that clinicians are documenting further and further away from the visit, and it causes a couple of issues. The primary one is clinician burnout. So if you have a clinician that is rushing from visit to visit to visit, because they know they have this pile of documentation that they need to complete at the end of the day, and they're often sitting at their kitchen counter trying to do the documentation, sometimes for two, three hours a night, while they're also trying to feed their family, spend time with their loved ones, get the kids to bed, all the different things that are part of normal life.
It causes clinician burnout, but a secondary effect is that it also causes a ton of quality issues. The more time that goes in between the time that the clinician is with the patient and the time that they're actually doing their documentation, the less accurate that documentation becomes. It's not difficult to imagine that the downstream impact is that you have things that are ultimately being delayed.
So, you have QA, which obviously is a delayed process. And there are more QA issues that coincide with that. But also getting your billing out the door, getting your NOAs NOEs out the door, and making sure that your billing is completely clean is delayed because you have all of this documentation that's outstanding.
And I say hours, but I tell you, in our experience, sometimes organizations have clinicians, not all of them, but a certain percentage of them that are days or even weeks behind in documentation. And so, it's a super scary thing. It has a dramatic impact on the clinician themselves because what we find is clinicians, they want to get the job done quickly and get it done right, but they're just so overwhelmed that they can't do it.
And so not only that, but it's hurting the in-home healthcare organization as well, because they're going to have to spend extra time QAing that documentation, making sure that everything's right to be able to get their billing out the door. So, it has a whole bunch of downstream real impacts on the organization that are sometimes a significant financial hit as well. And we'll talk more about that.
How does nVoq solutions specifically alleviate the burden of overworking clinicians? And what measurable impacts have been observed in terms of reducing burnout?
Jason:
One of the things that we do with our customers is that we start to measure things that really directly tied to burnout. There's a number of studies that show that the number one cause of burnout is after hours documentation. So, the one thing that we do with our customers is we look for a reduction in what we call additional documentation time, which is documentation done outside the home.
We also do short term studies in terms of clinician satisfaction. So, in some recent customers, what we have seen is anywhere between 20% to 40% reduction in after-hours documentation time, as well as clinicians that are reporting that their satisfaction with the work life balance that they have is improving.
For instance, we did a large-scale rollout with a number of home health and hospice clinicians across multiple geographies, and we saw we had a net promoter score of 9.2 out of 10, meaning that these clinicians are reporting that they would really highly promote nVoq as a solution to their after-hours documentation burden.
And so, we're seeing the alleviation of that burden across the board. We had a very prominent customer that did an anecdotal survey of their clinicians, and then did some qualitative analysis and saw that clinicians that were using nVoq’s documentation transformation platform had about a 40% less turnover rate than those clinicians that did not use it.
And we get feedback all the time from clinicians saying, not only is this going to help me sort of stay in the profession, but we have organizations today that are actually using the platform as a recruiting tool, saying to clinicians, hey, we have invested in a technology that really is going to impact your work life balance.
And you hear this from clinicians a lot, which is, we love our patients and families. We absolutely love it. It's all the other stuff that we don't like. And you hear that, too, in the teaching profession a lot, which is, I love the children, I love to teach, and we hear that all the time in home health and hospice is, I love the patients, I love the families. If that was the job, there's no question that I would stay.
And so that's our priority at nVoq and in partnership with MHA, is to get clinicians back to the part that they love, which is the actual bedside care.
Desiree:
Right. And to spin off on you, Jason, I have had several conversations with clinicians stating that, to be exact, their work life balance has tremendously increased with the nVoq product. An amazing outcome for them because they were having those burnouts, and they feel like their patient care is much better and they get to spend time with their family. So, all in all, in the end, nVoq has tremendously helped most of our clinicians that I've been able to speak with.
If we have any specific examples, Jason, if you could discuss a case study or any specific example where the integration of the platform with MHA's expertise and implementations resulted in significant improvements in operations, cost saving, or overall employee satisfaction.
Jason:
Absolutely. So, we have a number of examples. Obviously, we have a recent mutual customer in Graham healthcare that is rolling out nVoq in their environment, but we have a number of mutual customers, and we have a number of published case studies. One of those case studies is with Amedisys and Amedisys saw a significant reduction in those hospice CTIs that were perhaps missing information that would have put them at risk of either an audit or worse, a revenue claw back from CMS.
And so, one of the things that we saw in this published case study that we presented in cooperation with Amedisys, we took them from 15% of their hospice claims being at risk to 3% in nine months. And so that for an organization that size, not only is that a massive QA savings, but it is also protecting their revenue.
And revenue is really reimbursement. Right? So, if you think about it, it really allows the organization to continue their mission within the communities that they serve. And so, it's really important, because a lot of times it's not a care issue. And that's what I found also being on the provider side is the care, many times, is really great.
If you talk to patients and families who have been provided in home health care, they rave about the care, but the documentation sometimes doesn't match that care. And so, again, what our goal is, is to allow and enable that documentation to match the amazing care that's happening in the home, so that they can continue to get reimbursed, get reimbursed quickly, get reimbursed wholly, so that they can continue their mission for the communities that they serve.
How do you ensure a smooth implementation process for agencies adopting new technologies such as the nVoq tool and what steps are taken specifically to maximize ROI and success during an implementation.
Desiree:
So, for us, we actually do a pre-implementation assessment. So, we assess to better understand their current processes and establish some clear objectives for the new technology, such as nVoq. We make sure first and foremost that we have our stakeholder engagement because everything starts from the top and goes all the way down to the bottom.
So, if we don't have our stakeholders involved and completely behind us in the planning process, we, from our assessment, understand that our clinicians kind of drop off. We have to have that background of support from our stakeholders, and we customize our training and our support here. Recently, I assisted nVoq in implementation and training for medical directors and specifically medical directors.
I did 40 to 50 medical directors, and every single one was customized to that specific medical director. So, we notice from the get-go their demeanor, how they're coming across, and we know how much we need to handhold at times. And I do believe that this significantly helped these medical directors feel comfortable with nVoq.
Initially, there were a few of them that said, I don't think this is going to work, but by the end of it, they were doing every single CTI that they had assigned to them and came back and said, oh, my goodness, this is amazing. It's so resourceful.
With the Note Assist, it will help me slide my cue card to show me what I need in that training. We also regularly measure the success. So, I do know that the nVoq background of it, we can go in and check and see how these clinicians are using the tool if they are specifically not getting their wording across correctly. So, we go in, and we do an assessment, look at everything that they're doing, and then send out emails or hot tips on how they can better use the nVoq product.
How does the nVoq platform adapt to unique needs of different in-home healthcare agencies? So, considering variations of size, different locations, or patient demographics.
Jason:
One of the things, Harper, that we see, and one of the nice things about our platform, about the nVoq platform, is that it scales really, really well from a technology perspective. So, we have things like a single sign on and auto provisioning and things that really make it simple.
And Desiree had pointed out earlier that the admin console is one place where you can go in and see who's using the tool, who's not using the tool, what areas need to be addressed, and that really allows an organization to scale. But one thing that we find super helpful in our partnership with MHA is the larger the organization, the more we feel like MHA is a great partner to get involved with because you lose some of that command and control, change management capability, communication with the clinicians.
And so, one of the interesting things is we feel like Maxwell is such a great partner when it comes to those large organizations and implementing true change management within the organization, because it's very difficult. The larger the organization, the less command and control they have at the local level.
And that's really where the rubber hits the road in terms of the ability to impact change or impact adoption of the tool. So again, I think what's really useful and what's nice is that with the technology scales, we have organizations today that have anywhere from 20 clinicians to 20,000 clinicians.
So, from a technology perspective, no problem. But, again, we see that the opportunity lies in that change management. And we're able to work with MHA, with these large organizations to make sure that we have the proper change management and change management protocols in place.
Now, we also have some technical features within the platform that really make it helpful for things like different dialects and accents across the country. Again, we have tools that enable us to scale multiple locations, across various size organizations. So, from that perspective, we have really addressed the scalability of the solution. But everything boils down to how an organization is ready from a change management perspective.
Desiree:
And that truly, truly makes a big difference. I mean, every organization is different, every single region is different. So, when it comes to getting them to adapt to it and utilize the nVoq platform, a different approach is being used at every single angle because no one is the same. I've noticed that from one company to another one, one thing may work for them, but then you go to the next one and it doesn't.
My thing is using a hands-on approach. I want them to be able to see what I'm doing, I want them to be able to not only say, okay, this is what you have to do, log on, do this and do that. I take it on my part to actually get on, share my screen and show them how the nVoq product is beneficial in their everyday life.
In what ways does the MHA partnership with nVoq align with your mission to enhance the quality of care and operational efficiency within the in-home health sector?
Desiree:
We, as a company and with our partnership with nVoq, we push to make sure that our companies are compliant, and for us to make sure that they are compliant, we really and truly push for the Note Assist feature in the nVoq product pushes for better documentation, more complete documentation. It assists our clinicians with actually being able to spend more time with their patients.
If you could discuss the potential long-term benefits of implementing the nVoq platform within in home healthcare agencies. So, both in terms of financial outcomes and patient care quality.
Jason:
So, one of the things that Desiree pointed out, and I think it's just a great point, is we have developed some features inside of the platform that are specifically designed to address everything from the quality of the documentation to patient care quality to financial outcomes. So, one of the things that we have developed is a tool or a feature that we call Note Assist and Note Assist does a couple of different things.
First of all, it allows an agency to understand deficiencies in the documentation in more of a batch mode. So, I can run it and say, hey, here are the charts that are missing some key information that might be either required from a regulatory perspective, required from a payment perspective, or just that organization's best clinical practice.
And so, what this does, the end result of that type of feature, is that it lowers the QA burden and QA cost. The second thing that we do is we actually take that data and we say, which clinicians now need the most help, and we give them a tool that allows them to see what types of information should be put in the chart, to make that chart, regulatory compliance, and we do it in real time.
So, imagine your clinician and you have a cue card of what you should be documenting, and then as you document Note Assist, tells you, hey, you've gotten it 100% correct, this note is good to go, or you're missing something. In order to make sure that the charts complete, that it doesn't come back to you from a QA perspective, you need to go add these things to the chart.
And so that really is our focus at nVoq, is to go back and push these tools up to the original document or the clinician themselves in order to get it right and get it right the first time. And so, again, a lot of the cost that is involved in in-home healthcare is in after the documentation post capture, meaning, once the documentation is done, there's a lot of QA costs.
There's a lot of costs from an operations perspective in getting the reimbursement out the door. But the reality is that a lot of solutions out there aren't addressing the opportunity at the root cause, which is right when that clinician is documenting, give them the tools to be able to get it done quickly, completely correctly the first time.
And so, our focus in our partnership with MHA is to address the root opportunity at its source and allow the clinician to get that documentation done right. And done right the first time.
Desiree:
With the MHA consultants doing all these assessments, we use the nVoq platform on the back end for us to assist these companies and show them their deficiencies and where they need the most help. We will run reports and we will pull their documentation and run it through the system. Then show them, hey, this is what's going on. This is how your documentation is coming across. This is how it needs to be fixed.
You have the availability to purchase the nVoq product, and it will significantly assist your clinicians in their documentation and also your QA department, so they aren't doing as much on the back end.
How does the integration of nVoq's technology with MHA's assessments and strategic offerings create a holistic approach to address the employment crisis and in home care, from both identifying challenges to then implementing effective solutions.
Desiree:
All right, so we identify those challenges. So, we do a comprehensive assessment to pinpoint any type of inefficiencies and areas of the staff’s dissatisfaction. nVoqs technology provides data driven insights into documentation and communication challenges. So, then we strategize a solution based on these assessments. We customize and incorporate nVoqs voice recognition tool to streamline their documentation and mostly reduce administrative burdens.
We use tactics like optimizing workflow design and staffing model adjustments. We've used that on our end a good bit. Also, the implementation phase for MHA has been more so of a hands-on implementation. We feel from the MHA standpoint that the more you show and the more you get these clinicians, or these users involved, the better the outcome is.
And there's less staff turnover, there's documentation efficiency, clinician satisfaction, which is our number one goal, is to get these clinicians satisfied because of the turnover that we're expecting, experiencing in the in-home health sector, and we want their patient care quality to jump as high as possible. And I feel like us doing the hands-on implementation and them seeing hands on how nVoq can assist them, it has been greatly beneficial.
Just one example that I have, I had a clinician who, their patient probably had about 50 diagnoses, and on those diagnoses, she did the dictation, and it came across, and it was 100% correct. So, with the nVoq platform, it is specific to medical terminology. She went from one extreme to the other on all these diagnoses, and it came across 100% correct, including the spelling of most of these diagnoses.
She did send me an email and said, I cannot believe that that just came across like that. She said, "I want you to go listen to it." So, I went back to the nVoq product and listened to her dictation, and I was blown away by it. So, she gave me two thumbs up for the nVoq product.
Jason:
I'll add to that. I mean, we hear that all the time, which is just awesome. You know, as I said, I've been in the industry for the better part of 20 years, and there's not a whole lot of solutions like MHA and like nVoq, that really deal with the root cause at its source.
And a lot of the solutions today are dealing with symptoms of the disease. In other words, you have, for instance, companies that do chart reviews, oasis reviews, things like that, that are sort of after the capture, and those are great, they do a wonderful job, but they're not impacting the source.
And the source is the amount of work and amount of documentation that the clinician has to do. So, they never really touch that, they never really address that. And so, one of the things that we're focused on is how can we again address the root cause of the opportunity at the source?
And that source is really at the clinician level. How can we impact that clinician's life in a positive way and get them back to at least having a high degree of satisfaction with the work that they do, which is taking care of patients and families?
I just want to tailor the last question to talk about both of your experiences within the industry. You definitely would have passion for care and ideal visions of what that future would look like.
What does the future of both documentation and just general operations and care outcomes look like to you? And how would that impact clinicians in the in-home health space in an ideal world?
Desiree:
So, I am actually not a clinician, but I live with a clinician. From experience, he actually did home health and did it for quite some time. And the amount of documentation that he had to do was absolutely insane. He, I can say this, has said several times that he wished that he had this nVoq platform to be able to do all of his documentation.
Because in real time, when you are able to do that documentation in the patient's home or right whenever you walk out, it's like you're doing it right then and there and it's still fresh in your brain. He did state that when he would come home to do that documentation, it was rough for him to be able to remember because he saw so many patients throughout the day that he had to bring himself back to that one patient from his voice.
And him saying, this would have been amazing for me. This was twelve years ago that he was doing hands-on patient care. But I do believe that he would not have gotten out of the in-home health sector as quickly as he did if he would have had this platform and not had to do all of that documentation in the afternoon sitting at his son's baseball game.
Jason:
And I'll just add to that, having also not being a clinician, but really striving to help all of those clinicians. nVoq is super excited about the future. We are working on a number of things to continue to make the clinician experience that much better and impact the overall results of home health and hospice providers.
Some examples of that, we are in the process of doing what is called “form filling”. So, for instance, if I'm a clinician and I'm documenting a narrative, I might be able to automatically check some OASIS questions, some HIS or HOPE questions, or some discrete data elements like vital signs, just as a byproduct of doing my narrative.
And so, there are a number of opportunities to continue to do a totally voice driven documentation record, which is again going to streamline the process, make sure there's higher level of quality, and ultimately give that clinician back their work life balance. We're also working on some things like ambient capture.
This is obviously something that's in nVoqs wheelhouse from an innovation opportunity that we've been exploring and piloting. We have additional AI and predictive analytics. We've been doing AI and machine learning for years to enhance our capture of speech recognition, and we'll continue to make investments in expanding the use of that.
As you can imagine, data is what drives AI, and having the detailed and rich patient narratives to empower even more data is important to our future. And then we also are going to continue to expand upon, and Desiree talked about this earlier, our auditing capabilities and pushing that auditing to the time of capture and the reason that is so important because it becomes a supporting or coaching tool for the clinicians.
And so we're going to continue to expand upon those audit capabilities and we really feel like the future is so bright for us to help these clinicians, these in home healthcare providers achieve very significant outcomes in terms of their retention of clinicians, their ability to recruit new clinicians, and ultimately to lower QA cost, preserve their revenue and make sure that they are focused on a single mission which is serving the communities and providing in home health care and hospice care.
Outro:
Thanks for listening to the MHA Corner Podcast. If you'd like to learn more about Maxwell Healthcare Associates and our tech-enabled solutions, or our strategic partners like nVoq, contact us at [email protected] or visit us at www.maxwellhca.com