Value and Benefits to share with multidisciplinary teams Working DRG Value and Benefits to share with multidisciplinary teams Jennifer Cavagnac , CCDS Dr. Vishal Tiwari MD FACP Christine Scibelli MS, RN

Communicate to key parties the Working DRG GLOS Goals Communicate to key parties the Working DRG GLOS Physicians :Anticipated DC order Case management: Appreciation of LOS data for DC planning

Benefits Improved patient progress Patient satisfaction Identifying early morning discharges Opening beds for ED boarding Patient satisfaction Timely communication of patient needs Robust provider handover Accuracy for CMI, O/E, reduced LOS

Communication Process IPOC rounds/Standard roundtable with teams Triad meetings (case management, attending and CDI, UM) Face to Face Electronic accessibility Ensure patient awareness of plan – patient satisfaction

ACDIS Forums – what can we learn? Daily lists w DRG/GLOS and if there is Query to case managers Meet with Physician Champion to discuss outliers weekly (whether it is medical, family, social, etc.). Track and present at UR meetings/hospitalists meetings “Always be sure to note the DRG is subject to change” “We have Meditech and we set it up to pull that information from abstracting onto the physician's rounding report…. It is updated to match most recent documentation of conditions and procedures.”

Technical Potentials MPage – CIS Wish: Worklist – patient list Concept Challenge – users must go in each case Workaround – static reports and distribution. Wish: Worklist – patient list Interface to teletracking

Survey How many of you are sharing a working DRG? How many plan to? How do you share this information?

S2 pilot

Exhibit “13a” Advantages to electronic formats – Automated! Accurate! Financial Class Med Rec Number Name Visit Number Admit Dt Attend MD Reviewer W DRG W APR SOI W APR ROM W DRG Est Reimb W DRG GLOS LOS LOS Variance Current Room Transfer MSDRG Advantages to electronic formats – Automated! Accurate! Available! …..But is it integrated??

Important to know Data (DRG) is subject to change… Interpretation can be dangerous without knowledge and education Communication is the key Appreciate: Observation to INPT Any status changes

Barriers to Discharge (but the DRG is right) Insurance Social determinants of health Substance , housing, financial, transportation Community resources Patient support – family, VNA Healthcare proxy, guardianship Behavioral health/Geriatric health

Case study Working DRG info LOS management Query management –Timeliness of response Clear integration of patient awareness for discharge plan.

Case example After Pt ID Admit LOS GLOS DRG MD Q? Notes J.Doe 2/1 4 3.4 179 W.Smith Yes Pt needs arrangements for renal specialist follow up After 4.5 178 DONE Pt needs arrangements for renal specialist follow up – completed. Discharge planned tomorrow am J.Doe has Aspiration PNA and CKD noted a query is out for the CKD stage (clinical indicators support stage 4) DRG could move to 178 and result in GLOS of 4.5

Questions/ Thoughts?