Pediatric CDI Program Dr. Vijeta Salunkhe, MBBS, MHA, MBA, CCDS, CCS 10/21/2017

Dr. Vijeta Salunkhe, MHA, MBA, CCS, CCDS Currently Clinical Documentation Improvement Manager and physician advisor for clinical documentation accuracy program at Baylor Scott and White McLane Children’s, Temple Texas. Holds extensive health care experience as a manager, CDI reviewer, and physician. Completed medical school at Grant Medical College, Mumbai and graduated with a dual master’s degree in healthcare administration and business administration from University of Houston Clear Lake with Beta Gamma Sigma International Honorary membership. Is CCS and CCDS certified by AHIMA and ACDIS respectively. Led ICD-10 physician education efforts across the system, designed queries and EHR templates for the system Is very proud to serve as a leader for Texas ACDIS Chapter with the leadership team and help ACDIS committee to expand the chapter. Currently selected by the US News and World Report representing Baylor Scott and White McLane Children's Medical Center as an expert on the panel to develop recommendations for refinements of the 2018-2019 Best Children's Hospital rankings!

Objectives of the presentation APR DRGs Vs. MS DRGs Pillars of Pediatric CDI program Impact of physician engagement Pediatric Educational resources

Baylor Scott & White - McLane Children’s Medical Center HIMSS certified level 7 Medical/surgical rooms, Pediatric ICU & NICU at McLane Children's Hospital Scott & White - Temple 24-hour pediatric emergency department and verified trauma center emergency department

Baylor Scott & White - McLane Children’s Quality Awards and Recognition Only Level II Pediatric Trauma Center between Dallas-Austin ELSO certified Extra Corporeal Membrane program College of American Pathologists CAP Accredited Lab Only Gold Certified Safe Sleep Center in Texas by Cribs for Kids Pending Level IV NICU Designation by TDHS Application in for Pathways to Excellence Designation

APR DRG Vs. MS DRG The Journey Begins!

Common Terminologies

APR DRG Vs. MS DRG MS-DRG APR-DRG Relative weight will increase with secondary diagnoses that are considered MCC/CC’s MCC: Major complication and comorbidity CC: Complication and Comorbidity Relative weight will increase with Severity of Illness (SOI), SOI increases with secondary diagnoses that are considered MCC/CC’s MCC: Major complication and comorbidity CC: Complication and Comorbidity

Major Diagnostic Category 15 MS DRG APR DRG Number of DRGs 7 28 Severity levels None 4 levels within each DRG Recognition of Birth weight in DRGs 7 Birth weight ranges Separate Surgical DRGs No Yes

MS DRG – One or Two possibilities Depends on capture rate – one MCC and one CC MS DRG MCC CC

APR DRG – Hundreds of possibilities! MCC CC CC APR DRG CC MCC MCC CC CC

CORES OF PEDIATRIC CDI PROGRAM

Cores of CDI Program

Physician & Leadership Engagement Listen To What The Leaders In Your Organization Want Find a physician Champion Ask Questions Make Your Case Listen To The Response Report

CDI Professional - a Leader Put YOURSELF in the Driver’s Seat Effective Communication CDI Mission and Vision Statement

Technology Electronic Health Records CDI Tools Worklist management Increased efficiency CDI Tools Transition from paper records Electronic Query System Leverage technology to improve CDI efforts Accurate data

Chart Reviews APR DRG chart reviews within 24 – 48 hours of admission Conduct root cause analysis Find the hidden gems in the chart reviews Send quality queries Review the charts before it is final billed

Coding Reconciliation

Impact of Engagement Reduction in Query Rates Increase in Query Responses (Quality Responses) Accurate physician profiles Quality of patient care

PEDIATRIC EDUCATION EXAMPLE

Root Operations – For Surgery

Build Case Studies

Newborn Respiratory Distress Respiratory Distress Syndrome Transient Tachypnea of Newborn Bronchopulmonary Dysplasia Respiratory Failure in Newborn

Pediatric Respiratory Failure Respiratory Distress Respiratory Failure Acute Respiratory Failure with hypoxia or hypercapnia

Table for McLane Children’s Neonatologist   In preterm infants, Respiratory Distress Syndrome (first 1 week) Respiratory Failure in newborn  (1 week to 28 days) BPD (after 28 days) In term infants, who do not have RDS but have TTN Transient Tachypnea of Newborn Respiratory Failure of newborn In children, who has no TTN and no RDS Respiratory Failure in newborn All of the above should be supported with the treatment/assessment and plan.

Pediatric Malnutrition Issues – Failure to thrive/severe weight loss/severe malnutrition Description of the problem Common issues identified at the institution Benefit of implementing a uniform definition

Pediatric Malnutrition

References Source – AHIMA and CMS website ww.cms.gov/Medicare/Coding/ICD10/downloads/pcs_refman.pdf] Baylor Scott and White McLane Children's Medical Center clinical definitions ACDIS CDI leadership white paper www.cms.gov/Medicare/Coding/ICD10/downloads/pcs_refman.pdf https://elearningindustry.com/7-steps-leadership-buy-in Journal of AHIMA July 2017 edition

Questions/Discussion Dr. Vijeta Salunkhe, MBBS, MHA, MBA, CCDS, CCS Baylor Scott and White McLane Children's Medical Center Vijeta.Salunkhe@bswhealth.org 254-935-5014