Becker's CEO+CFO 2024: Fathom panel on autonomous coding

At Becker's CEO+CFO Roundtable in Chicago (Nov. 11-14, 2024), Andrew Lockhart, CEO of Fathom, and Nick Rogers, Head of Revenue Cycle, at Amazon Health Services (formerly One Medical), led a session covering how autonomous coding reduces clinician burdens, improves coding quality, and strengthens operations. This recap synthesizes key takeaways and actionable advice from the discussion.

Key takeaways

1. Relieving clinicians of coding duties through autonomous technology is a tangible way to improve provider satisfaction and retention.
2. Choose true autonomous coding over partial automation and demand concrete service-level agreements (SLAs) with 90%+ automation and 95%+ accuracy.
3. To support growth plans, select vendors whose solutions can scale seamlessly without compromising performance or requiring additional resources.

Summary

1. Case for change

Clinician coding places unnecessary burden on providers. Under clinician coding, primary care providers had to squeeze in time to complete coding for their encounters before moving on to the next patient visit. This responsibility increased the administrative burden on providers, contributing to burnout.

Manual coding inconsistencies impede compliance. While CMS provides detailed coding guidance, there remain considerable gray areas requiring interpretation, leading to inconsistent behavior across providers. In contrast, autonomous coding ensures uniform handling through consistent application of guidelines across all encounters.‍

Projected growth requires new coding approaches. For organizations experiencing or forecasting rapid expansion, traditional coding requires unsustainable staffing levels. One Medical, for example, recognized that steadily increasing coding staff to keep up with annual visit growth would create operational challenges and escalating costs.
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2. Project summary

High automation rates to enable complete shift away from clinician coding. Organizations need high coding automation rates from technology to achieve the desired transformation. For example, One Medical identified 85% as the minimum viable threshold, ultimately achieving over 90% from day one. More generally, only 90%+ automation rates enable complete transition of coding away from clinicians, requiring only a small team to manage exceptions.

True autonomous technology, not partial automation. Given the need for high automation rates, differentiating autonomous coding from computer-assisted coding (CAC) is crucial. CAC tools merely suggest codes that still require human validation, limiting savings, speed, and leverage. In contrast, true autonomous coding can handle all coding on behalf of clinicians.

Aggressive SLAs to ensure performance. Organizations should require specific performance guarantees in their contracts, including SLAs for automation rates, accuracy rates, and turnaround times. Leading vendors will demonstrate the capabilities required to hit these SLAs through a proof of concept, validating the solution's performance before go-live.
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3. ROI and operational impact

Accuracy and acuity improvement exceeded expectations. Before go-live, One Medical evaluated potential E/M leveling impact through high/medium/low scenarios. Several months into full automation, the organization has appropriately experienced a ~7.3% average E/M acuity increase through improved E/M accuracy, delivering substantial ROI for the project.

Heightened quality and compliance standards enterprise-wide. Now, One Medical consistently achieves over 95% E/M accuracy through AI coding, exceeding traditional manual coding benchmarks. This level of accuracy, combined with consistent application of coding rules across the enterprise, has established higher standards for compliance and quality.

Scalable coding approach supporting growth. Organizations can maintain coding quality and speed while growing in volumes, without linearly increasing staffing. This scalability enables predictable operating costs and eliminates coding resourcing as a constraint on growth.
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4. Clinician, patient, and administrator experience

Reduced administrative burden benefits provider satisfaction and retention. Many primary care organizations face persistent recruitment and retention challenges. By relieving coding responsibilities, One Medical has meaningfully reduced provider burnout, freeing up approximately 14,000 hours of clinician capacity per year. The promise of practicing medicine with a lighter administrative load has also become a powerful message for physician recruiting.

Integration with ambient AI for end-to-end impact. As Nick Rogers put it, "one less administrative task is always the goal for [our] providers." To this end, One Medical pursued autonomous coding and HealthScribe ambient documentation in tandem, with the two technologies working together to strengthen both documentation quality and coding accuracy.

Independent audits monitor quality. Third-party audits remain important for monitoring accuracy. As an added benefit, AI's centralized approach makes it easier to systematically identify, investigate, and resolve any coding inaccuracies across the organization.

Real-life impact

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