The Health Roundtable COPD: Cost of Precise Diagnosis and Documentation Presenter: Liz Pardede & Kathryn Arnett The Prince Charles Hospital Innovation Poster Session HRT1215 – Innovation Awards Sydney 11 th and 12 th Oct c_HRT1215-Sessio_ARNETT_TPCH_QLD

The Health Roundtable KEY PROBLEMS  Revenue v Cost review: $1.2 million loss on E65(COPD)  Led to coding and documentation review  Clinician anecdotal thought – patient complexity not reflected in documentation  Previous project key focus was LOS - reduced COPD LOS from 7.7 to 5.2 days  Large COPD patient cohort at TPCH (~680 patients) with ~ 20% Bronchiectatic cohort  Comparison with HRT data showed we were not as complex as peer facilities 2

The Health Roundtable AIM OF THIS INNOVATION  Review patients coded with E65B to ensure documentation and coding accurately reflects care requirements  Receive adequate reimbursement in ABF environment for complexity and use of resources  Identify inconsistencies, errors, omissions and influencing factors  Develop strategies to address these issues and improve the integrity, quality and capture of documentation  If successful, target other DRGs that are known to have lower than expected complexity splits and high revenue losses 3

The Health Roundtable BASELINE DATA  431 E65B episodes from July-March FY 2012: 95% audited (409)  Of the 409 – 102 (25%) were found to have significant co- morbidities and/or complications not documented in a codeable form.  $1.2 million loss based on revenue v cost  Main documentation issues: respiratory failure, hypo/hyperkalemia, hypo/hypernatremia, nicotine dependence, renal insufficiency and malnutrition.  High Bronchiectatic cohort (20%) 4

The Health Roundtable KEY CHANGES IMPLEMENTED  Established Thoracic Data Management Taskforce  Coding DRG summary sheet  Enhanced orientation program for RMOs  Development of Clinical Coding and Audit Education Process for implementation throughout the organization  Revision of eDS (electronic Discharge Summary) to better reflect terminology  Improved communications – clinical engagement 5

The Health Roundtable OUTCOMES SO FAR  Coding DRG summary sheet:  Integration into Medical Record  Use on medical ward rounds  Enhancement of medical orientation program:  Education for Resident Medical Officers (RMOs) and Registrars – case study  Program specific orientation by HIM  Continued improvement in documentation and coding outcomes  Cost retrieval of ~$550K 6

The Health Roundtable LESSONS LEARNED  Clinician interaction with HIMs is crucial  Medical nomenclature v classification terminology  Increased awareness for clinicians  Insight into model of care and impact on LOS  Accurate specificity of conditions and co-morbidities = true complexity of the patient and resources consumed = improved outcomes and accurate ABF reimbursement  Integrity of data for research and planning  Need for Bronchiectatic DRG  Money talks with clinicians  Many more DRGs to review 7

The Health Roundtable Project Team  Liz Pardede – Clinical Nurse – Thoracic Medicine  Lisa McCarthy –Thoracic Clinical Nurse Consultant  Alex Meredith – Health Information Manager - Thoracic Program  Kathryn Arnett – Clinical and Business Analyst  Dr Philip Masel – Respiratory Physician  Dr Pat Aldons – Respiratory Physician  Dr Scott Bell – Medical Director, Thoracic Program 8