Jean S. Clark RHIA

Roper St. Francis Healthcare Private, not-for-profit community health system in Charleston, SC Two acute care hospitals, a third on the way Rehabilitation hospital 50% Medicare Very traditional medical staff

Our journey to improve documentation at the bedside Go-live—September 2005 Started “thinking” about a clinical documentation program 3 years prior Coding was good Stable coding work force SO WHY CDI? Last frontier External demands for data increasing Patient care and safety—THE primary reason!

Our journey to improve documentation at the bedside January 2005: Started the journey Decided not to do this on our own Interviewed consulting firms that specialized in CDI programs Criteria for selection Provided education Software Quarterly educational/assessments of the program Monthly reports Experienced in CDI implementations

Our journey to improve documentation at the bedside Consultants –Pros –Cons

Our journey to improve documentation at the bedside Structure of the program Research Contacted other hospitals Read the literature Surveyed hospitals in our state

Our journey to improve documentation at the bedside Structure of the program Reports to HIM service line director CDI specialists are all RNs— “documentation detectives” Varied experience Internal and external candidates selected All but one RN is still with the program, and they love what they do!

Our journey to improve documentation at the bedside Structure of the program What about the coders? Acceptance vs. issues Part of training and teams Coding data quality specialist—a key player! Coding manager’s role

Our journey to improve documentation at the bedside Structure of the program 4 CDI specialists at Roper 2 CDI specialists at STF 1 manager

CDI and coding Strong managers Coding data quality specialist Process for resolving disputes CDI for clinical expertise Coders for coding expertise

Our journey to improve documentation at the bedside Physician education and acceptance Did not use consultants to educate physicians Focused on improving documentation for patient care and safety Did not focus on reimbursement MDs part of the team What’s in it for you Non-threatening approach Education is ongoing The CDI team—RN, coders, physicians

Our journey to improve documentation at the bedside First-year program exceeded our expectations and projected ROI Improved our CC capture rate Improved our case mix Reduced number of symptom codes used as principal diagnoses Paved the way for MS-DRGs and POA

Process CDI specialists have cell phones and laptops Assigned to specific nursing units Spend majority of the day on the units New admissions, re-reviews Enter data into Midas Serve as educators Attend meetings on a regular basis

Query forms Used consultant’s query at first Now tailored for specific DRGs Used while the patient is in the hospital and not after discharge Coders query after discharge Goal to reduce queries

Communication tools Query forms, for example: circulatory system disorders, sepsis, pneumonia, debridement Pocket cards, for example: department of orthopedics, major GI diagnoses, circulatory system MCCs, UHDDS guidelines for reporting secondary diagnoses Intranet site SC CDI cooperative

Key partners Case management VP, medical affairs Performance improvement Medical staff Emergency department Hospitalists Pharmacist Anesthesiologists

Reports CMI Overall system CMI (no exclusions) Medicare CMI Medicare medical CMI Medicare medical CMI, less vents Medicare surgical CMI Surgical CMI, excluding trachs and transplants Overall CMI, excluding trachs and transplants

Reports CC capture rates Overall CC capture rate as a % of total CC DRGs Overall cases w/o CC Overall cases with CC Medical CC capture rate as a % of total CC DRGs Medical cases w/o CC Medical cases with CC Surgical CC capture rates as a % of total CC DRGs Surgical cases w/o CC Surgical cases with CC

Format Current month compared to same month a year ago Percentage difference YTD post go-live YTD pre go-live Percentage difference MedPAR compared to MedPAR national 80th percentile Medical opportunity achieved (in $$$) Surgical opportunity achieved (in $$$)

Other reports MDC reports DRG pair capture rates Physician reports Working DRG vs. final DRG

Added benefits Integral part of physician profile meetings Collect data for focused reviews (for example timeliness of H&Ps) Worked with one department to improve H&Ps Easy transition to POA and MS-DRGs

Lesson learned Need a manager from the beginning Make sure your vendor has had “enough” experience and staff It has far exceeded our expectations!

Questions For additional materials, please see resources - exhibit C.