3rd Annual Association of Clinical Documentation Improvement Specialists Conference

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

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

Background HIMentors, LLC Knowledge Webb Healthcare 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

Most organizations recognize they have a need for CDI 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

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

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

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

Processes run businesses, businesses do NOT run processes 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

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 Note from Editorial Services: Last bullet point seems to be missing text / incomplete sentence.

‘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

Rough CURRENT Performance Map

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

Performance ‘Additions’ Vertical segmentation Root cause Integration

FUTURE Process Function #1 Function #2 Function #3 Function #4 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

‘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

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

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

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! Note from Editorial Services: 4th bullet doesn’t make sense as written. Should be: 2/3 concurrent; 1/3 retrospective?

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 Note from Ed Services: Changed to “Presenters” (plural), okay?