1. / ©2015 NAVIGANT CONSULTING, INC. ALL RIGHTS RESERVED 1 TERRANCE GOVENDER MD CLINICAL DOCUMENTATION INTEGRITY

2. / ©2015 NAVIGANT CONSULTING, INC. ALL RIGHTS RESERVED 2 OBJECTIVES Understand the role of clinical documentation in a value-based purchasing model Learn the role of ICD-10 in the VBP model Explain the core fundamental documentation concepts applicable to ICD-10 Have tips on engaging physicians in ICD-10 and specific documentation

3. / ©2015 NAVIGANT CONSULTING, INC. ALL RIGHTS RESERVED 3 VALUE BASED HEALTHCARE

4. / ©2015 NAVIGANT CONSULTING, INC. ALL RIGHTS RESERVED 4 4 VALUE BASED HEALTHCARE Rapid transition from Fee-for-service to value based payments VALUE = QUALITY COST Quality: Safety Time to be seen Time spent with patient Evidence based care Outcomes CMS defined measures Cost: Cost to treat a patient Cost to the patient Optimizing margins Eliminating waste

5. / ©2015 NAVIGANT CONSULTING, INC. ALL RIGHTS RESERVED 5 5 SHIFTING PAYER MIX: MEDICARE ENROLLMENTS

6. / ©2015 NAVIGANT CONSULTING, INC. ALL RIGHTS RESERVED 6 6 SHIFTING PAYER MIX: MEDICAID ENROLLMENTS

7. / ©2015 NAVIGANT CONSULTING, INC. ALL RIGHTS RESERVED 7 7 DISTRIBUTION OF NATIONAL HEALTH EXPENDITURES BY SOURCE OF PAYMENT

8. / ©2015 NAVIGANT CONSULTING, INC. ALL RIGHTS RESERVED 8 8 IMPACT Bottom line affected Profitability Quality and cost as independent variables Measure financial and quality performance

9. / ©2015 NAVIGANT CONSULTING, INC. ALL RIGHTS RESERVED 9 9 QUALITY: CMS DEFINED MEASURES Tools that measure or quantify -Healthcare processes -Outcomes -Patient perceptions -Organizational structure Collected and reported -Claims -Assessment instruments -Chart abstraction -Registries Purpose -Quality improvement programs -Public Reporting -Reimbursement (incentives and penalties)

10. / ©2015 NAVIGANT CONSULTING, INC. ALL RIGHTS RESERVED 10 / ©2015 NAVIGANT CONSULTING, INC. ALL RIGHTS RESERVED 10 QUALITY OCCURS AT THE BEDSIDE 30-90 day readmission rates Hospitalization rates Length of stay Rates of discharges to skilled nursing facilities Mortality rates AHRQ Patient Safety Indicators

11. / ©2015 NAVIGANT CONSULTING, INC. ALL RIGHTS RESERVED 11 / ©2015 NAVIGANT CONSULTING, INC. ALL RIGHTS RESERVED 11 COMMUNICATION TO ACCOUNTABILITY Documentation habits bolster communication amongst clinicians Data extracted in the form of “codes” and risk adjusted Accountability to metrics that don’t support VBP

12. / ©2015 NAVIGANT CONSULTING, INC. ALL RIGHTS RESERVED 12 Observed Severity of Pt OBSERVED SEVERITY VS. EXPECTED UTILIZATION Page 12 Navigant CDI Program Manuals™ are licensed to specific Navigant client-users and may not be reproduced for any reason without express written permission of Navigant. Navigant logos, trademarks and marks may not be removed or altered. Pneumonia population RW PneumoniaAspiration Pneumonia Sepsis due to Aspiration Pneumonia Coded & (Thereby) Expected Severity12 Discordance

13. / ©2015 NAVIGANT CONSULTING, INC. ALL RIGHTS RESERVED 13 / ©2015 NAVIGANT CONSULTING, INC. ALL RIGHTS RESERVED 13 QUALITY AND COST IMPLICATIONS

14. / ©2015 NAVIGANT CONSULTING, INC. ALL RIGHTS RESERVED 14 ICD-10: DYNAMIC CHANGE ICD-9 F Expected Relative Weight Case Mix Index 3 2 1 Expected Relative Weight 3 2 1 ICD-10 14

15. / ©2015 NAVIGANT CONSULTING, INC. ALL RIGHTS RESERVED 15 / ©2015 NAVIGANT CONSULTING, INC. ALL RIGHTS RESERVED 15 LEVERAGING ICD-10 Documentation specificity to support population severity of illness Optimizing EMR to capture information at the point of care Skilled documentation specialists and coders to support the clinical team Practice of core fundamental universal documentation concepts: Acuity Comorbid and secondary diagnoses Specification of types of diagnoses Possible diagnoses versus symptoms as reason for admission Etiologies of diagnoses if known or suspected

16. / ©2015 NAVIGANT CONSULTING, INC. ALL RIGHTS RESERVED 16 / ©2015 NAVIGANT CONSULTING, INC. ALL RIGHTS RESERVED 16 DOCUMENTATION CULTURE IS IMPERATIVE

17. / ©2015 NAVIGANT CONSULTING, INC. ALL RIGHTS RESERVED 17 / ©2015 NAVIGANT CONSULTING, INC. ALL RIGHTS RESERVED 17 PHYSICIAN ENGAGEMENT Start with WHY! Collaborate and partner Leverage -Internal resources -Clinical and financial teams -Reliable clinical and financial data -Physician input -Accountability -Physician contracts Organizational culture

18. / ©2015 NAVIGANT CONSULTING, INC. ALL RIGHTS RESERVED 18 / ©2015 NAVIGANT CONSULTING, INC. ALL RIGHTS RESERVED 18 KEY POINTS Plan for the change in the current fee-for-service reimbursement model Value takes precedence Financial success equals value demonstrated and measured Quality (clinical) and costs (financial) should not be separated Data dependent on documentation -Focus on core fundamental concepts Collaborate and partner with physicians in all things “quality” and “finance” Organizational culture: -Supports value -Supports the clinical team -Supports administration -Working towards interrelated goals

19. / ©2015 NAVIGANT CONSULTING, INC. ALL RIGHTS RESERVED 19 terrance.govender@navigant.com QUESTIONS