Children’s National Health System, based in Washington, DC, has been serving the nation’s children since 1870. Children’s National hospital is Magnet® designated, and is consistently ranked among the top pediatric hospitals by U.S. News & World Report. Home to the Children’s Research Institute and the Sheikh Zayed Institute for Pediatric Surgical Innovation, Children’s National is one of the nation’s top NIH-funded pediatric institutions.

With a community-based pediatric network, eight regional outpatient centers, an ambulatory surgery center, two emergency rooms, an acute care hospital, and collaborations throughout the region, Children’s National is recognized for its expertise and innovation in pediatric care and as an advocate for all children.

Children’s National embarked upon a search for charge capture technology in 2013 with the goal of converting all of its paper-based processes for both pro fee and facility coding across its 40 sub-specialty clinics, including bone marrow transplant, infectious disease, oncology, ortho, psychiatry, surgery and telemedicine, a digital approach ahead of ICD-10. The organization, which has 450 physicians that practice in nine regional outpatient locations and ten in-hospital clinics, relied on paper charge tickets collected at the end of each day and sent to a business office for data entry. A staff of 15 was responsible for data entry into the appropriate McKesson billing system. Understanding that this process was both imperfect and costly, not to mention driving revenue loss, Children’s National sought SaaS-based, mobile software that would automate both the professional and technical coding process, provide tools for real-time reconciliation and ease the transition to ICD-10.

After completing a comprehensive vendor vetting process, Children’s National selected MedAptus’ Charge suite due to the company’s track record of success with large deployments and experience working with pediatric hospitals. The organization additionally felt that MedAptus was committed to providing the “elbow support” it would need given the number of processes requiring re-engineering.

After a few months of implementation planning, Children’s National was ready to go-live using ICD-10, despite the fact that only one week before deployment was to get underway, Congress voted to delay the ICD-10 transition date one year to October 1, 2015. However, the organization remained committed to its original plan: a four-phase roll-out based on specialty and volume, utilizing MedAptus’ ICD-10 solution.

The cardiology division was chosen as the first group to actually go-live given a high number of tech-savvy doctors; the group however also happened to have the most complicated workflows. While the latter factor slowed down the initial roll-outs, the on-boarding of all other specialties seemed much easier by comparison.

Two MedAptus implementation managers provided all end-user training for the roll-out; training was completed using twenty minute sessions with pairs of providers over the course of a day. It took roughly one week per roll-out wave to complete training. The vast majority of physicians found the MedAptus Pro Charge app highly intuitive to use. And even though ICD-10 was also a new component for many to learn, that aspect of the deployment also went smoothly. In fact, one doctor noted the MedAptus roll-out was the smoothest he’d ever experienced at the hospital.

One unexpected outcome of the MedAptus roll-out to the physicians was that ultimately, providers found that mobility via iPhone devices didn’t fit in their workflow as they had expected. Most found it was preferable to wait until the end of the work day to complete all patient charges at once as opposed to post-encounter. Another interesting and unintended consequence of system installation was the identification of ‘shortcuts’ that some administrative staff had been taking that had downstream impact that — with the new software in place, process deviations could be stemmed.

Children’s National experienced a number of noteworthy results from the adoption of MedAptus. First and foremost, overall turnaround time has been reduced from eight days to less than two days which also led to lower days in AR and a one-time cash flow acceleration. Secondly, the organization was able to realize cost savings largely from two items: a reduction in data entry headcount of nearly 50% and the elimination of paper fee tickets.

As many hospitals and health systems have advanced with EMR usage in the past few years, so has Children’s National, and MedAptus has evolved accordingly. For the professional charge workflow at the hospital, MedAptus now employs its Operational Charge Management offering, whereby charges are derived in the Cerner EMR system which MedAptus now manages downstream, prior to billing, using our robust reconciliation, rules and reporting capabilities. Nurses in the hospital’s infusion clinic utilize MedAptus’ Infusion Charge Capture for direct entry of these complicated encounters to benefit from MedAptus’ ability to map services to the coding hierarchy to ensure full coding compliance.

When it comes to advice for other large organizations looking to automate charge capture, the hospital has a few things to offer:

  1. Meet with all division heads, but start with tech savvy physicians. This is was big component of Children’s National strategy — the project team figured if the first group had a positive experience and told others about it, the good news would spread via word of mouth… which it did. While the project team considered having physician champions in each division, in the end having happy pioneers was the best decision they feel they made.
  2. Consider training on actual coding prior to system go-live. For Children’s National, the appropriate usage of modifiers has been a challenge for some providers to grasp, so this is an area in hindsight the group wishes they had spent more time on prior to actual software training.