1. CDI/MD Collaboration Lisa Didion, MD
Section Chief - Pediatric Hospital Medicine
Associate CMO – Children’s of Mississippi

2. Children’s of Mississippi
By the numbers
8,300 inpatient admissions/year
8,500 surgeries/year
44,500 ER visits/year
112,000 clinic visits/year
30+ specialists
250+ faculty

3. Children’s of Mississippi
230 inpatient beds
Batson Children’s Hospital
Only children’s hospital in state
30 Critical Care beds
100 Med/Surg beds
Wiser Hospital
100 bed NICU
Only level 4 NICU in the state

4. CDI at Children’s Overall goal Improve documentation Consistently
Accurately
Improve Documentation
Increase CMI
Increase Reimbursement

5. Road to Towards the Goal
Collaboration!
Many providers don’t know whose looking at their documentation
Providers don’t know all the “buzz words”
Key players
CDI
Coding
Providers
Residents
Nurse Practitioners
Faculty

6. Collaboration at Children’s
Clinical Documentation Excellence Teams
Length of Stay Teams

7. Clinical Documentation Excellence Teams
“Big Picture”
Multidisciplinary
CDI
Coding
Billing
Providers
Informatics

8. Clinical Documentation Excellence Teams
Department of Pediatrics
NICU specific
Review:
Professional billing
Hospital billing
Unspecified code usage
Query response rate
CMI
Denials
ICD-10 transition

9. Clinical Documentation Excellence Teams
Keys to success
Education, education, education
Departmental Performance Improvement Conference
Resident Orientation
Departmental faculty meetings
Divisional meetings
One-on-one
Tip cards – unspecified code usage
Query process
Within EHR
Response rates

10. Query Response Rate

11. Improving Query Response Rates
Education & Availability
Data
Departmental
Division
Provider

12. Unspecified Code Usage – Dept of Pediatrics

13. CMI – Children’s of Mississippi

14. LOS – Children’s of Mississippi

15. CMI - Hospitalist

16. Length of Stay Teams APR-DRG based Team Encounters LOS variance
New pathways/guidelines
Team
Physician Champion
CDI *
Coding *
Leadership

17. Length of Stay Teams Goals Education & data sharing Standardize care
“My patients are much sicker than this”
Standardize care
Identify barriers to discharge
Improve documentation

18. Length of Stay Teams Asthma (141) Bronchiolitis (138)
Sickle Cell Pain Crisis (662)
Diabetes (420)
Childhood Behavioral Disorders (758)
Appendectomy (225)
NICU
g (591), g (593), >2499 with major procedure (631)

19. Data Example– LOS Team
Children's of Mississippi LOS Committee Diabetes Dashboard - APRDRG September 2015
Sep-15
Sep-14
# of Encounters
Severity
ALOS
Expected LOS 2 1
2.36
2.61
2.07 8
1.81
2.75 9
2.54 3
0.00
4.27
3.56 4
9.35
Aug-15
Rolling 12 Months 5
2.22 46
2.04 10
2.79
116
2.69 19
2.91
4.26
8.87

20. CMI - Appendectomy

21. CMI - Bronchiolitis

22. CMI - Diabetes

23. CMI - Sickle Cell Pain Crisis

24. Lesson’s Learned Names and faces Education & Availability Data
CDI team
Physician Champions
Education & Availability
Data
Feedback

25. Thank You Children’s CDI Team Shelia Bullock Laura Collins
Maury Sherman