3 rd Annual Association of Clinical Documentation Improvement Specialists Conference

1. 3rd AnnualAssociation of Clinical Documentation Improvement Specialists Conference

2. Understanding the Role ofPerformance Mapping in Clinical Documentation Improvement Darice Grzybowski, MA, RHIA, FAHIMA, HIMentors & John (JT) Trusten, Knowledge Webb Healthcare

3. Agenda • Who are we? • The story/background • What is performance mapping? • Unique approach at client site & best practice lessons learned

4. Background • HIMentors, LLC • Founded in 2004: Best practice in HIM and revenue cycle operations • Assessments, coding/CDI/data integrity audits • Transition to EHR/EDMS from hybrid records • Knowledge Webb Healthcare • Specializing in performance mapping • Project management/healthcare operations

5. The Need for CDI • Most organizations recognize they have a need for CDI • Programs often fail because of: • Lack of dedicated support staff • Lack of adequate education • Lack of adequate measurement • Lack of accountability/discipline • Poor processes & communication

6. A Hospital’s Journey to Improved CDI • Previous program (education only) failed over time due to lack of focus • MS-DRGs provide new opportunity • Sister hospital had a best practice model in place but needed site-specific tweaking • Looking for lower-cost alternative but needed some guidance around best practices • Performance mapping recommended; vendor- neutral approach relative to software

7. Initial Observations • Needed dedicated staff—job description, number of FTEs, skill level & management debates • Need baseline coding audit • Need for PROactive, INTERactive, and REactive balance for querying • Need for up-to-date education for medical staff, coders, administration, and support staff • Need for clear metrics of success

8. Total Solution Implementation Management Business Process Product/ Service Accurate Knowledge Change Management Communications Support

9. Why Performance Map? • Processes run businesses, businesses do NOT run processes • Identify productivity opportunities • Identify best practices • Root cause analysis • Business work flow consistency • Identify ownership and accountability • Consistent education and training

10. Why Improve & Manage Processes? • Processes produce an organization’s products and services • Processes are critical to seizing and maintaining a competitive edge • Processes are the vehicles for meeting customer needs and achieving organization goals • The performance of individuals is only as good as the processes allow it to be • Processes (especially cross-functional processes) are usually • Not documented • Not systematically and continually improved • Not managed

11. ‘CURRENT’ Performance Mapping Steps • “CURRENT” performance map pre-work • Why map? • Scope: How big is the process? • Experts from each key function that touches the process • “Day in the life of” • Develop the “CURRENT” process • Understand opportunities/gaps/constraints

12. Rough CURRENT Performance Map

13. ‘FUTURE’ Performance Mapping Steps • “FUTURE” process map pre-work (with business process owner) • Validate purpose • Develop customized best practice “FUTURE” map • Functional managers

14. Performance ‘Additions’ • Vertical segmentation • Root cause • Integration

15. FUTURE Process Function #1 Action 1 A Function #2 Action 2 Function #3 Action 3 B C Action 4 ? Action 6 Yes Function #4 No D Function #5 Action 7 end 2 hours 2 days 2 weeks 2 hours

16. ‘FUTURE’ Mapping Implementation Approach CDI “CURRENT” Performance Process CDI “FUTURE” Performance Process CDI “Phase 1” Performance Process Closed Loop Process CDI “Phase 2” Performance Process

17. Unique Implementation • Building on existing experience & knowledge • Interviewing • Continued coaching—advocacy • Watching variables • Incorporating change management • One step at a time • Focus on best practices

18. Best Practice Takeaways • Ideally—HIM & clinical skill set combination for CDI specialists • Operationally—HIM accountability • Physician-led education • Ongoing education—others • Physician liaison • Metrics

19. Best Practice Takeaways • Ongoing education (proactive) • Discussion liaisons & process (interactive) • Avoid duplication in coding/abstracting • 2/3 concurrent / 1/3 (retrospective) • 100% response expectation on queries • Connection w/ other PI activities • Focus on the process!

20. Questions? Presenters: Darice Grzybowski, MA, RHIA, FAHIMA President/Founder HIMentors, LLC La Grange, IL 708/352-3507 info@himentors.com www.himentors.com John Trusten Chief Operations Officer The Knowledge Webb Healthcare Stillwater, MN 651/430-9088 jtrusten@knowledgewebb.com Thanks to St. Rita’s Medical Center – Lima, OH