CDI Professionals And The Highway Patrol

1. CDI Professionals And The Highway Patrol

3. Safe Care?

5. HCAHPS Core measures CMS Readmissions Mortality Bundled Payments HACs MSPB

6. Pay for Performance

7. Hospital Reimbursement Penalties Over Time 2% 3.25% 5.5% 5.75% 6% A hospital’s payment reduction applies to EVERY Medicare patient for one year

8. Value-based Purchasing

12. Value-based Purchasing

15. 2016 CMH MSPB

16. 2016 CMH MSPB

17. 2016 CMH MSPB

18. 2016 CMH MSPB

19. 2016 CMH MSPB

22. FY 2018 Results • 1597 hospitals to see bonuses, slightly less than last year • Amounts to $ 1.9 billion • 1211 hospitals will see payment reduction • For half of hospitals, changes are only from -0.5% to +0.5% • Highest performing hospital received slightly more than 3% bonus • Lowest performing hospital received cut of 1.65%

23. Value-based Purchasing

24. Readmission Reduction

26. Readmissions

28. FY 2018 Results • 80% of hospitals will be penalized, 24 fewer hospitals than last year • All but 174 hospitals were also penalized last year • Average penalty held steady at 0.73% • 48 hospitals received maximum 3% penalty • CMS estimates penalties are $564 million compared to $528 million in FY 2016

29. Starting with FY 2017, PN measure expanded to include sepsis with secondary pneumonia dx.

30. Readmission Reduction

31. Hospital-acquired Conditions

32. MS-DRG Payment Suppression for Hospital Acquired Conditions and InfectionsPayment implications since Oct. 1, 2008 1 • Foreign Object Retained After Surgery • Air Embolism • Blood Incompatibility • Stage III and IV Pressure Ulcers • Falls and Trauma • Fractures, Dislocations, Intracranial Injuries, Crushing Injuries, Burn • Other Injuries • Catheter-Associated Urinary Tract Infection (UTI) • Vascular Catheter-Associated Infection • Surgical Site Infection, Mediastinitis, Following Coronary Artery Bypass Graft • Surgical Site Infection Following Certain Orthopedic Procedures • Spine, Neck, Shoulder, Elbow • Surgical Site Infection Following Bariatric Surgery for Obesity • Laparoscopic Gastric Bypass, Gastroenterostomy, Laparoscopic Gastric Restrictive Surgery • Surgical Site Infection Following Cardiac Implantable Electronic Device (CIED) • Deep Vein Thrombosis or Pulmonary Embolism Following Certain Orthopedic Procedures: • Total Knee and Hip Replacement • Iatrogenic Pneumothorax with Venous Catheterization • Manifestations of Poor Glycemic Control • Diabetic Ketoacidosis • Nonketotic Hyperosmolar Coma • Hypoglycemic Coma • Secondary Diabetes with Ketoacidosis • Secondary Diabetes with Hyperosmolarity

33. Hospital-acquired Conditions

36. Patient Safety Indicator 90 (PSI 90)Domain 1 Removed Modified Added

37. PSI 90 Composite Weight- HACRP

38. 2

40. FFY 2018 • 751 of 3313 hospitals to have Medicare payments reduced by 1% , including 115 teaching hospitals • These hospitals performed in the worst quartile • Estimated losses to hospitals of $ 430 million • Hospitals that serve poorer and sicker patient populations were fined more than hospitals with a more affluent patient base

42. Hospital-acquired Conditions

44. VBP + Readmissions + HACs

45. CDI Improves LOS Small improvements in diagnosis specificity and accuracy allow physicians more days to safely discharge their patients Less physician stress if they do not feel forced to discharge patients too early Meeting GMLOS goals improves publicly reported data which may lead to increased patient volume Balancing act between optimizing LOS and reducing readmissions

46. CDI Helps E&M Compliance H&Ps, consultations, progress notes and discharge summaries in a facility need to satisfy CMS requirements for E&M level billed CMS and other payers will eventually target physicians as they do hospitals now for denials, improper payments and over-payments

47. CDI Improves Communication Healthcare professionals convey information via HER The more specific and accurate the medical record, the better the clinical decisions made by the next provider of care Long progress notes have a downside- they must tell a story about the patient “The chart was surprised the patient died” Missing information/poor documentation is a quality of care issue Majority of TJC sentinel events are due to poor communication

48. CDI Solidifies Medical Necessity CMS and other payers are aggressively scrutinizing “Inpatient” versus “Observation Status” through RAC and other auditing methods Also scrutinizing procedural medical necessity If outpatient procedure is denied, payer may deny physician professional fee as well Be very familiar with LCDs and NCDs

49. Hospital Benefits Physicians Should Understand • “No margin, no mission” • More available revenue for: • Employee recruitment and retention • Capital improvements • Surgeon/proceduralist equipment

50. Physicians Nearly 50% report frequent or constant feelings of professional burnout in the past year Spend an average of 50% of their work day entering data into EHRs and completing clerical work versus 27% of work hours spent interacting with patients Internal Medicine residents spend 5 hours a day entering data for 10 patient records More than 80% say it is disruptive and time-consuming when queries occur after they entered the note or after the patient is discharged