Using Data to Recharge Your CDI Program

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

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

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

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

6. WHY NOW?

7. 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

8. 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

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

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

11. 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”

12. 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

13. 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

14. 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

15. 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

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

17. 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

18. A NEW START A branding all its own!

19. 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

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

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

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

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

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

25. Reports drive success and improvement

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

27. ANNUAL FINANCIAL DASHBOARD

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

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

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

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

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