Aussie firm makes inroads on Medical Coding market
When Activity Based Funding (ABF) was introduced in 2015, all hospitals in Australia were paid on the number and mix of patients they treat. These activities, or episodes as they are called, are recorded using codes from the ICD-10-AM/ACHI and AR-DRG classifications developed in Australia from the World Health Organization (WHO) classifications.
This process requires the recording of all the disease and intervention (procedure) codes for the patient episode and grouping these codes to produce Diagnosis Related Groups (DRG) codes.
The granular accuracy needed in that reporting might not be obvious. For example, a patient admitted for a dog bite with a history of blood clots and diabetes requires very different treatment in hospital from a patient without blood clots or diabetes. Accurately recording each episode is critical for the patient's medical record, statistical analysis, and it also impacts how much the hospital is paid.
The DRG dictates the value of the episode and is a big deal. It's also big business.
Globally, the provision of the software to support this coding and grouping is dominated by one US-based multinational provider. As in any market 'owned' by a single, dominant monopolist, prices are not kept in check by the norms of healthy competition. Functionality is not advanced in the absence of innovation. And the monopolists fiercely protect their patch. They build firewalls around their monopolies and worry more about preventing competition than advancing outcomes. This is normal in any monopoly.
But the cracks are starting to appear in the global coding and grouping monopoly, and an Aussie battler is making big strides.
Australian company Eurofield Information Solutions has established a strong market position in the digital publication of the ICD-10-AM/ACHI Classifications - used for coding, education and reference purposes - and is now battling the monopolist and the entrenched systems that support that monopoly in the AR-DRG grouping space. However, having superior products and significantly lower costs are usually not enough when dislodging a monopolist.
After strong gains in recent years in the New Zealand and Saudi markets, this Australian company has been building momentum back home with the NSW and Victorian Departments of Health, and now St Vincent's Public and St Vincent's Private Hospitals in Melbourne switching to TurboGrouper for their coding and grouping.
Hospital coding professionals and Health Information Managers insist on highly accurate coding and grouping first and efficiency second. This is especially so for large diverse hospitals, and more recently for hospital-acquired complications (HACs), where more than payment risk is at stake. TurboGrouper is designed to deliver accuracy at speed.
Laura Royce St Vincent's Private Hospital Melbourne HIS Manager - put it very succinctly: "Our coders pride themselves on being accurate and efficient. We don't see those as trade-offs. TurboGrouper allows us to find the right codes quickly, and the HAC flag is crucial to our new HAC management workflow. Having used the sister product TurboCoder for years, we knew that we could rely on TurboGrouper for accuracy and speed, and we were not disappointed."