3 rd Annual Association of Clinical Documentation Improvement Specialists Conference

1. 3rd AnnualAssociation of Clinical Documentation Improvement Specialists Conference

2. Data Mining and Reports:Using Data to Drive your CDI Program Provena Covenant Medical Center Maureen Baxley, RRT, RN, BSN,Clinical Documentation Nurse Carla Henderson, RRT, RN, BSN, Clinical Documentation Nurse Provena Health Nancy R. Ignatowicz, RN, MBA, CCDS, System Manager Clinical Documentation

3. Provena Health • 6 hospitals; separated by 210 miles • 12.4 CDI FTEs (14 nurses) + System Manager Clinical Documentation + System Director Coding & Documentation • 1,538 licensed beds • 65,530 reviews in 2009 (7% post-discharge) • 10,938 queries in 2009 (16% post-discharge) • 27% SOI/ROM/POA • 27% MCC • 26% PDx • 19% CC • 1% Procedural

4. How do you get from Here to Here Are you sure you want to?

5. Compelling issue and questions • It is a waste of time to collect data and create reports ~ and do nothing with it • How do you decide what to collect? • What do you do with the data once you collect it?

6. Pertinent topics • Productivity • Financial • Audits • Education • Profiling

7. Productivity

8. Measuring productivity

9. Adjusted productivity

10. Financial data

11. Measuring financial impact • Reproducible • Able to correlate with census; vacations (staff and provider); etc. • Ensure that without the CDI query, benefit would not have occurred • Audit to ensure consistency in data entry and post-discharge reconciliation to ensure creditable outcome data

12. Financial variance

13. “I guess canceling all remaining vacations is a little too much to ask, huh?” Advice from the consultant

14. DNFC • What portion of unanswered queries contribute to DNFC? • What effect do vacations have? • Post-discharge follow-up process • 0.5 FTEs job shared

15. Reconciliation audits • Systemwide staff mismatches in assigning benefit (both negative and positive mismatches) • Computer issues • Isolated discrepancies; individualized mentoring • No unexplainable issues; reduce monitoring to sampling

16. Show teamwork; multidisciplinary communication and collaboration has led to improved capture in clarity and specificity of diagnoses This leads to more timelysubmissions for coding/billing Forum: Clinical documentation

17. Using these economic times to illustrate CDI to all disciplines • Patient care techs • Height and weight • Dietitian • BMI • Physicians • Order diet or supplements • Nurses • Document supplement intake

18. Don’t take your data at face value, get down to the details

19. Identify improvement opportunities • Audit • Charts • Data entry into tracking tool • Tracking tool data reconciliation • Factor in your variables • Analyze your results • Analyze outcomes pre- and post-intervention Remember, it is not just about the financial opportunity.

20. Inter-rater reliability; consistency and credibility • Charts • Each hospital’s audit may have a unique target • Queries • Were they needed • Were they non-leading • Tracking tool • Currently using Midas 7.2.4 with PH developed focus note screens to track our data within the Midas CM module

21. Audit:‘My doctors document well’ • Productivity measures below target • Pattern: case reviewed only once, no follow-up review • Finding: • Documentation changed after initial review; if case would have had follow-up reviews, it was likely that 64% would have been asked a query for clarification • Conclusion: • Mentor staff to continue to follow cases rather than try to see all cases • Findings used to write for an increased staffing proposal

22. Audit:‘Our doctors document poorly’ • Cost per case higher than Medicare base rate • Average LOS greater than GM-LOS • Finding: Queries were written and answered in H&P (Get down to the details: H&P dictated days after query was written) • Conclusion: Seek administrative assistance

23. Audit:Performance • Productivity measures below target • Finding: Get down to the details, don’t just look at productivity number as the census was low • Incidental finding: patient expired; few diagnoses documented; SOI~2; ROM~2 • Conclusions: collaborate with quality to perform review of death charts for documentation opportunities; expand target to all payer, all ages

24. Justify increasing your FTEs • Audit to verify opportunity is being missed (remember to include SOI/ROM cases) • Use audits from other ministries to support calculation justifications • Project increased caseload volume that would be seen with increased FTE • Mentor current staff to optimize productivity measures before requesting increase in FTEs Remember T~3

25. Discover the hidden benefit

26. CDI staff education • Reconciliation is a teaching tool • CDI education/HIM education • Is education/mentoring needed • Is it isolated or systemwide • Is it a process improvement opportunity • Is it one ministry or a system opportunity • Agree to disagree

27. MIDAS Reconciliation as a teaching tool • CDI nurse performs own reconciliation • Manager initially performed 100% reviews of queries then decreased to sampling Conclusions: Able to gain objective data; opportunity to learn mentoring opportunities for individuals and for systemwide; opportunity to identify concurrent versus post-discharge interventions; opportunity to identify provider opportunities; opportunity to identify best practices and share with others and improve performance …

28. Don’t just analyze, do something

29. Data-driven education • What are your most frequent queries? • Physicians: Do they not answer any query or just certain queries? • Evaluation: What is the pre- and post-effect of your physician documentation CME?

30. Query frequency

31. Heart failure documentation

32. Physician responses This can be hospital- or physician-specific. We can also stratify by query topic.

33. Physician CME 3 months before versus 3 months after CME

34. HOLY COW: Someone is looking • Is cost per case higher than expected? • Is LOS higher than expected? • Is SOI and ROM low?

35. Why profile? • Credentialing (quality and economic) • Excluded from insurance network • Marketing/competition • Medicare P4P and VBP • Patient insurance copays • Personal salary • Profiles/report cards • Third-party contractual

36. Physician profiles • Average age • Avoidable days • CMI • Cost • LOS • SOI • ROM

37. Physician-specific example National avg. Medicare payment for FY 2010 is $5,223.14

38. The epiphany Oh my ____ What are we going to do?

39. Physicians in private practice • Clinic physician serving as CDI physician liaison for own group • Clinic partnering with hospital to work on documentation • Requesting CME at their offices • Utilizing profiling data in peer evaluations • Utilizing query response rate in annual physician appraisals

40. Wrap-up

41. You too can be data-driven with your limited resources • Audit to identify opportunities • Create automated data reports that measure and promote accountability • Apply the lessons learned (across the system) • Physicians want data • Use data to direct physician CME education COMMUNICATE and EDUCATE

42. Managing your resources:Being data-driven NOT data rich • Partner with IT/DS: Automate reports • Partner with your multidisciplinary steering committee: Limit data collection to what you are going to use ~ actionable data • Make sure your data is objective and reproducible • Educate: • Deliver key points • Bullet-point it

43. Using data to promote change in your organization • Doing more without increasing staffing or changing productivity or financial targets • Learn from others; make knowledge transferable: extrapolate what you learn where applicable • Address shortages of time and staff

44. Using data to drive your CDI Program

45. Questions ? ? ? ? ? ? ? ? ? ? Thank You