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Using Data to Recharge Your CDI Program

Using Data to Recharge Your CDI Program. Elizabeth Bonetti, RN, MA, MS. HISTORY. Community hospital Member NYPHCS ADC 300-325 Urban setting. HISTORY. Shared resource model Case managers assumed CDI function Physician and hospital staff education Coding opportunities

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Using Data to Recharge Your CDI Program

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  1. Using Data to Recharge Your CDI Program Elizabeth Bonetti, RN, MA, MS

  2. HISTORY • Community hospital • Member NYPHCS • ADC 300-325 • Urban setting

  3. HISTORY • Shared resource model • Case managers assumed CDI function • Physician and hospital staff education • Coding opportunities • Department development

  4. HISTORY • Physician education • Audits and re-bills • Multiple false starts!!!!

  5. WHY NOW?

  6. REALITY: PAYMENT RESTRUCTURING MS-DRGS • Pay for performance: Direct • Coding/outcomes (P4P) • Pay for performance: Indirect • Consumer choice • Selective contracting • No pay for poor performance: • Adverse events not POA • Recovery Audit Contractors (RAC) 2010: • Readmissions • Bundled $ American Journal of Medical Quality: “Medicare’s Value-Based Payment Initiatives: Impact on and Implications for Improving Physician Documentation and Coding,” by Alan H. Rosenstein, MD, MBA, Michelle O’Daniel, MSG, MBA, Susan White, PhD, Ken Taylor

  7. HOSPITAL DATA REPORTS • MS-DRG coding impact • Coding complexity • Financial impact projections • NYS DRG severity impact • Severity-adjusted LOS report • Opportunity assessment • Adverse event incidence and impact • CMS/JC quality indicator report • HealthGrades report • Actual to expected mortality/complication rates • Patient safety ratings

  8. WHAT IS IMPACTED? • Revenue • ALOS • Patient flow • Medical necessity and DRG denials • Quality data reporting • Risk management

  9. ADMINISTRATIVE SUPPORT • CEO • CMO • CFO • Finance • Clinical chairmen • Nursing leadership • Clinical pharmacy • IT • Compliance • Case management • HIM

  10. PHYSICIAN INCENTIVES • Improves patient outcomes • Emotional: Loyalty/pride/respect • Competitive: Peer pressure • Awareness/accountability: • Reputation • Contracting • OPPE • Financial: • Billing • P4P incentives • Market share American Journal of Medical Quality: “Hospital Report Cards: Intent, Impact, and Illusion,” by Alan H. Rosenstein, MD, MBA Medical Economics: “When Health Plans Don’t Want You Anymore”

  11. PROGRAM PLACEMENT Senior vice president, chief financial officer Executive vice president, chief medical officer Assistant vice president Case management Denials management Health information management Clinical documentation improvement Patient placement Social work Coding

  12. DEVELOPMENT • Opportunity for improvement • Assessment • DRG benchmark report • Business plan • Vendor selection • Physician buy-in • Staffing—type of workers • Collaboration with HIM • Tools • Reporting—monthly benchmarks

  13. PHYSICIAN BUY-IN—WHAT’S IN IT FOR ME? • Salaried vs. voluntary physicians • Education at routine meetings • Tied to professional billing • Meet the physician for 1:1 reviews • Achievement certificates • OPPE reporting

  14. CERTIFICATE OF EXCELLENCE This certificate is awarded to Jennifer Smith, MD in recognition of excellent clinical documentation: “CHF, acute on chronic with systolic dysfunction; respiratory failure secondary to pulmonary edema” Signature Date Signature Date

  15. METHODOLOGY/TOOLS • Work environment • Laptops—concurrent entries • 3M coding software and Sunrise Record Manager • CDI database • EMR • Pocket guides—physician billing guidelines

  16. METHODOLOGY/TOOLS • Physician query sheets/electronic query • Policies/processes • Weekly coding/CDS leadership meetings • Strategic postings • Verbal rewarding and candy • Physician achievement certificates • Validation of $$ reported

  17. A NEW START A branding all its own!

  18. NETPRESENTER • Clinical documentation program • Accurate provider and hospital profiling is now possible • Instant feedback on practitioner documentation to reflect severity of illness • Coming events: Physician/staff education seminars • Documentation team is now in place; contact Jennifer at Ext. xxxx or Brenda at Ext. xxxx for more information

  19. Physician query • Bright color • Inserted in progress notes • CDI contacts • Compliant

  20. METHODOLOGY/TOOLS • Rollout • Physician rounds • Disease based vs. unit based • Emergency department • Coder identified opportunity (retro) • Electronic query solution

  21. COMPLIANCE • Policy review • Process review • Query review • Reports

  22. CD TEAM EDUCATION • Team-building methodology • All attended coding review/updates • Graduation • Celebrations • New staff orientation • Bimonthly education/sharing

  23. EDUCATION • Across all disciplines • Grand rounds • Resident lectures • Strategic postings • 1:1 • Unit-based small conferences • Physician rounds • Discharge summary review • EMR utilization

  24. Reports drive success and improvement

  25. MONTHLY FINANCIAL DASHBOARD • Senior finance leadership dashboard—monthly and annual tracking • Case-specific validation • Annual budgeted revenue expectation • Tracked for attaining annual target

  26. ANNUAL FINANCIAL DASHBOARD

  27. CDI CLINICAL DEPARTMENT DASHBOARD • Clinical department leadership dashboard—monthly and annual tracking • Departmental CMI and revenue impact • Specific physician monitoring included

  28. PHYSICIAN-SPECIFIC DASHBOARD • OPPE indicator • Physician response and agreement rate • Case-specific data available on request

  29. CDI STAFF DASHBOARD • Staff productivity monitoring • Staff QA monitoring • Staff feedback

  30. DASHBOARD—IN DEVELOPMENT • By DRG • Education opportunity by service line • Opportunity for hospital improvement

  31. THE ULTIMATE GOAL • Balance cost and quality QUALITY COST

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