Diagnosis for LifePoint Health: Accuracy or Bust

By constantly refining the precision of coding and clinical documentation, LifePoint Health improves both the provider and patient experience

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Richard Flores, VP, Clinical Revenue Integrity, LifePoint Health (Photo: Dean Dixon)

A great deal of attention has focused on consistent, dramatic changes in healthcare delivery and technological breakthroughs in treatments. But hospitals themselves have also been going through substantial changes in response to the new healthcare environment.

Richard Flores, vice president of clinical revenue integrity with LifePoint Health, has witnessed many of his organization’s transformations firsthand. His own position is a case in point. Most hospitals open accounts when patients are present for admission or are seen at the emergency room. They then reconcile charges for all activities and services, billing ,and payments at discharge.

Clinical revenue integrity (and LifePoint’s integrated revenue management department) was created to more accurately track all of the revenue-related activities that occur in between.

“We added clinical revenue integrity to manage the complete revenue cycle,” Flores explains. “My job is to help our hospitals efficiently capture the appropriate charges, ensure proper clinical documentation, and consistently and accurately provide billing codes for all services.”

Improving From the Inside Out

Over the past seventeen years, LifePoint has evolved from a hospital management company to a healthcare company operating hospitals, physician practices, post-acute service providers, and outpatient centers. These changes anticipate the growing prospect of value-based payment reform and a focus on population health. By providing comprehensive services across the care continuum, LifePoint can better control quality, patient outcomes, cost efficiencies, and the patient experience.

To make improvements for patients and providers—and to address shifts in industry standards—Flores has helped lead several coding and documentation initiatives.

In the fall of last year, LifePoint achieved compliance with ICD-10, a nationally mandated expansion of diagnosis and procedure billing codes from approximately 17,000 to 160,000. This required Flores to initiate comprehensive training of thousands of LifePoint physicians, nurses, and coders, which resulted in improved documentation of services and the ability to provide greater detail to payers about care provided.

Over the past two years, Flores also has led the standardization of transcription services and the implementation of new clinical documentation software. The software compares documented medical treatment and outcomes to all patient conditions as they are assessed throughout inpatient admissions.

In addition to workflow monitoring, the system creates a valuable automated system of checks and balances between physicians and nurses.

“The more accurate we can be, the better we can serve our patients,” Flores says. “Standardizing processes like transcription and clinical documentation helps track coding, support appropriate reimbursements, and ensure accurate physician rankings through programs like Healthgrades. All of these elements enhance transparency and help patients make better informed healthcare decisions.”

Aside from his revenue and operational responsibilities, Flores is quick to highlight LifePoint’s quality improvement efforts. The organization is one of only seventeen hospitals and the only investor-owned hospital system to participate in the Center for Medicare and Medicaid Services’ Hospital Engagement Network. The program targets specific safety enhancements and aims to identify leading practices to reduce healtcare-acquired conditions.

In addition, LifePoint has established innovative partnerships, such as its joint venture with Duke University Health System. Duke LifePoint Healthcare owns and operates fourteen hospital campuses in four states. The partnership includes a collaboration to advance quality across all LifePoint hospitals and to identify best practices that will help create safe and highly reliable care nationwide.

As part of its quality initiatives, LifePoint also created its patient and family advisory board in 2015. This group, a combination of former patients and family members, suggests new ways to improve the overall patient experience.

Part of the Fabric of the Community

In many of its markets, LifePoint is one of the largest employers and strives to make itself not only the employer of choice, but also the preferred local healthcare provider. It’s one of the cornerstones of LifePoint’s mission: Making Communities Healthier.

This approach is put into practice by getting involved in the communities it serves. Flores, for example, is vice chair of his local YMCA and has been active, along with his family, in Habitat for Humanity.

An example of the results can be seen in areas where the LifePoint cafeteria has become a favorite spot for holding Rotary Club meetings or for just meeting friends.

“We want to be the first choice for patients, so we reinvest in our communities as constant visible reminders that we’re always here and that no one has to drive forty-five minutes for healthcare.”

After pointing out that this kind of involvement is part of LifePoint’s culture, Flores admits, “We want to be the first choice for patients, so we reinvest in our communities as constant visible reminders that we’re always here and that no one has to drive forty-five minutes for healthcare.”

Even as he does his part to ensure LifePoint’s financial well-being and the accuracy of coding and medical records for patients, providers and payers, Flores sees cost continuing to be healthcare’s biggest challenge.

He says, “Constantly increasing premiums and out-of-pocket expenses will undo improvements that have recently been made in coverage and access. If I can keep improving our operational efficiency, we can pass the savings on to our patients.”