Hitting a Home Run: How Conway Regional Medical Center Transformed Mortality Deficiencies to Become the Best in League Thursday, September 24, 2015 Marion Kruse, RN, BSN, MBA Senior Managing Director, Clinical Services Precyse

© 2015 Precyse Solutions, LLC. All rights reserved.22 A Tale of One Hospital (Part One) What is CDI? Key CDI Impacts and Challenges Effective CDI Program Approaches CDI Key Performance Indicators Physician Engagement Adding CDI Technology A Tale of One Hospital (Continued) Q&A Agenda

© 2015 Precyse Solutions, LLC. All rights reserved.33 What is your organization’s status in regards to CDI programs? a.Never implemented CDI program and none planned b.Never implemented CDI program but planning one c.Implemented CDI program(s) with poor results d.Implemented CDI program with positive results e.Don’t Know Poll Question #1

© 2015 Precyse Solutions, LLC. All rights reserved.44 Complete health care services to the growing communities of North Central Arkansas Centered on a 154-bed acute care medical center 26 Bed Rehabilitation Hospital In 2014 the Conway Regional staff and area physicians: Delivered 1,828 babies Assisted 42,128 people in the Emergency Department Provided care for 8,128 patients admitted to the medical center Cared for 32,297 patients through the primary care network About Conway Regional Health System

© 2015 Precyse Solutions, LLC. All rights reserved.55 Conway Regional Medical Center A Tale of One Hospital

© 2015 Precyse Solutions, LLC. All rights reserved.66 Clinical Documentation Integrity/Improvement (CDI) is the process of preventing and reconciling inconsistent, imprecise, incomplete, conflicting, and/or illegible provider documentation. Definition of CDI

© 2015 Precyse Solutions, LLC. All rights reserved.77 What is your biggest problem associated with Clinical Documentation? a.Physician indifference b.Missed opportunity to maximize reimbursement c.Poor public quality measures d.Low Case Mix Index (CMI) e.Not sure Poll Question #2

© 2015 Precyse Solutions, LLC. All rights reserved.88 CDI Program Goals Not Just a Business Office Issue CDI programs are designed to create precision in clinical documentation in order to: Improve the accuracy of coding Optimize reimbursement Ensure the accuracy of reported outcomes

© 2015 Precyse Solutions, LLC. All rights reserved.99 CDI – A Golden Opportunity Source: “Clinical Documentation Meets Financial Performance”, HFMA

© 2015 Precyse Solutions, LLC. All rights reserved.10 Good Physician Documentation Key to Accurate Reporting Non-specific documentation = Non-specific codes Non-specific codes = Inaccurate code assignment

© 2015 Precyse Solutions, LLC. All rights reserved.11 CDI Helps Maximize Revenue Capture Source: “Best in Class Clinical Documentation Improvement Programs”, The Advisory Board Company, 2010 Accurate Documentation Ensures Appropriate Reimbursement $3.7 M

© 2015 Precyse Solutions, LLC. All rights reserved.12 Value Based Purchasing Program (VBPP) Hospital Readmission Reduction Program (HRRP) Hospital Acquired Conditions (HAC) Public Quality Reporting Transition to ICD-10 CDI Impact Reaches Beyond CMI

© 2015 Precyse Solutions, LLC. All rights reserved.13 Insufficient Staff Poorly Defined Scope Low Accountability for Program Staff Inadequate Tracking Mechanisms Physician Indifference Lack of Oversight from Finance (buy-in) Common Shortfalls of CDI programs* *”Best in Class CDI Programs”, The Advisory Board Company, 2010

© 2015 Precyse Solutions, LLC. All rights reserved.14 Effective CDI Program Phases

© 2015 Precyse Solutions, LLC. All rights reserved.15 A Change of Focus CC/MCC Capture and CMI focus Align CDI with Changing Healthcare Delivery Model

© 2015 Precyse Solutions, LLC. All rights reserved.16 Metrics to measure outcomes/success: Volume of reviews by CDIS Provider query rate Provider concurrence rate Number of Clarifying (Quality) queries Query impact Key pairings (simple versus complex pneumonia) CC/MCC capture rate Case Mix Index - overall, medical, surgical Excluding trachs and vents Public Quality Reporting Indices Key Performance Indicators

© 2015 Precyse Solutions, LLC. All rights reserved.17 Physician Engagement - Education Make it practical Make education convenient and mobile Use a Myriad of Education Methods: Supplemental eLearning Peer-to-peer Internal programs Communicate the ‘What’s In It For Me’ effectively

© 2015 Precyse Solutions, LLC. All rights reserved.18 Get to know your physician culture Minimize impact on their daily routine Outline how data will be presented back to them so they can follow their progress Give them a glimpse of the future Stress that CDI is painless and the benefits outweigh any effort Appeal to their competitive nature by showing them how they compare to their peers Engaging Physicians in Education

© 2015 Precyse Solutions, LLC. All rights reserved.19 Technology Enabled CDI *Natural Language Processing **Computer-Assisted Coding Maximize CDI Specialist’s efficiency Improve workflow and automate processes Enable greater communication between CDIS, Clinicians, Coders, and Management Greater accountability for physician queries Ensure documentation is completed and accurate prior to coding (NLP*- enabled) Integrated CDI/Coding (CAC**) Solution is Optimal

© 2015 Precyse Solutions, LLC. All rights reserved.20 Conway Regional Medical Center’s Challenges Poor mortality rate results in public reporting Not a care issue – a documentation issue Physicians unaware of their impact Previous CDI efforts losing effectiveness A Tale of One Hospital (Continued)

© 2015 Precyse Solutions, LLC. All rights reserved.21 Quality Process improvement project was implemented by hospital leadership. As part of this program: A CDI Program was instituted Precyse provided physician education on the importance of quality documentation and value based purchasing CDS staff participated in mortality rounds to assure the full severity of illness was appropriately documented Conway Regional Medical Center A Tale of One Hospital

© 2015 Precyse Solutions, LLC. All rights reserved.22 Rapid Response Team reinforced Each member has a specific job at each and every code Debriefing after codes to identify opportunities Dissect the event Analyze what worked, what didn’t work, what needs improvement Create strategies to move forward Reinstituted purposeful hourly nursing rounding Focus: patient safety Implementation of TeamSTEPPS® Training Teamwork system Conway Regional Medical Center Non-CDI Activities

© 2015 Precyse Solutions, LLC. All rights reserved.23 Documentation Improves Mortality Index Improved Documentation = Improved Mortality Index Source: American Data Network

© 2015 Precyse Solutions, LLC. All rights reserved.24 Pneumonia #1 Query

© 2015 Precyse Solutions, LLC. All rights reserved.25 Their reputations are at stake Performance is publicly reported Patients choose the best doctors Physician Champions identified Education ICD-10 ready queries Queries made easy for responses Conway Regional Medical Center Physician Engagement “Buy-in”

© 2015 Precyse Solutions, LLC. All rights reserved.26 How prepared is your CDI Program for ICD-10? a.CDS staff is trained in ICD-10, queries templates contain ICD-10 language, and physician education is being provided based on the results of dual coding b.CDS staff has completed ICD-10 training and is working on updating templates and physician education c.CDS staff is scheduled or has started ICD-10 training d.Not far along at all or no CDI program Poll Question #3

© 2015 Precyse Solutions, LLC. All rights reserved.27 A Tale of One Hospital Conway Regional Medical Center

© 2015 Precyse Solutions, LLC. All rights reserved.28 CDI Strategies for Success Maximize efficiency of CDI Specialists Streamline workflow and automate processes Enable communication: CDIS, Clinicians, Coders and Management Engage Physicians and lead to improved documentation Ensure complete and accurate documentation before downstream coding Utilize CDI Technology for efficiency and accountability

© 2015 Precyse Solutions, LLC. All rights reserved.29 Q&A