2. Eric Ryland, RHIA, CHDA, CCS, CPC Manager of Coding Denver Health Medical Center Denver, CO Metrics: Measuring the Impact of CDI and Coder Contributions

3. Our Facility Denver Health is a level one trauma center Located in downtown Denver 477 beds Multiple hospital-based specialty clinics Multiple community healthcare centers Medicaid & uninsured are our largest payer groups Medicare is our third largest payer Teaching facility utilizing residents

4. Coding Area One coding manager and two assistant managers 25 coders – inpatient & outpatient Two outsourcing companies providing additional coverage for staff vacations and training time We code for inpatient DRG accounts, observations, ambulatory surgeries, emergency department account, and for the specialty clinics 5-day turnaround time for coding

5. CDI Area One CDI nurse manger Three CDI nurses working part time for an equivalent of 2 FTEs Primary focus is our Medicare & Medicaid patients CDI staff report to the HIM director CDI staff attend the monthly coding meetings and maintain a high level of communication with the coding staff

6. Core Measures & PSI Staff Core measures & PSI staff are located in the quality department and report up to the CQO One nurse reviews core measures data One nurse reviews accounts for PSI, HAC, SOI, and ROM The quality department nurses frequently attend coding meetings

7. Goal We want to be able to demonstrate the success of the efforts made by the CDI and the coding staff. This helps: – Justify the funding for the CDI program – Support the argument for highly trained coders – Identify areas of improvement within the CDI or coding teams – Create a feedback loop between the CDI staff, the coding staff, and the downstream users of the coded data

8. Who Are the Interested Parties? CDI manager Coding manager HIM director Utilization management CFO Others

9. What Are the Areas We Are Looking At? DRGDiagnosis-related groups MCCMajor comorbid condition CCComorbid condition SOISeverity of illness ROMRisk of mortality HACHospital-acquired condition PSIPatient safety indicator Core measuresQuality of care Other areasUM, discharge disposition

10. How Do We Go About Measuring for So Many Areas? We must determine what area we wish to measure from – CDI staff, coders, quality staff, etc. We must select a metric to quantify our results – Number of changes, $$$, CMI, etc. We must determine the point in the process to measure at and how to capture that data – Manually collect data or capture data from systems reports

11. Who? How? When? Who? – The areas measured for effectiveness Chosen by need to demonstrate effectiveness How? – Using metrics Chosen by usefulness and an ability to calculate When? – At valued-added points Determined by reviewing process flow charts

12. CDI Committee Physician advisor CDI manager CDI nurses Coding manager Inpatient coding educator HIM director Utilization management director Quality measures nurses

13. Flow Chart Process Flow-chart from the beginning with CDI to final data item Create a master flow chart that incorporates the flows of all endpoint data items This allows you to identify the points along the way where each area plays a role With the flow chart you can then visualize how to begin measuring the successful efforts of the people involved in the process

14. CDI Flow Chart

15. CDI & Coding Flow Chart

16. HAC Flow Chart

17. PSI & Core Measures Flow Chart

18. Identifying the Points of Measurement

19. How to Quantify the Measurements? Numerical count – A simple count of the number of changes – Can also be expressed as a percentage Dollar increase/decrease – Revenue increase or decrease resulting from a DRG change Change in CMI, SOI, ROM, core measures – Showing initial and final aggregate scores

20. Revenue Increase

21. DRG Relative Weight Changes

22. Calculating Aggregate CMI Change

23. Metrics for Measurement

24. Methods of Metrics Gathering Manual – Spreadsheets Time-consuming with potential for data entry errors Software – Run reports May be limited to a single software system A data warehouse can consolidate systems data Combination – Software-generated reports integrated with spreadsheet data Most prevalent situation

25. Our Model for Data Collection

26. Our CDI Results

27. CDI Query Results 4th Qtr. 2011 Query rate – 26% Physician response rate – 78.2% Physician agrees with query – 82% Financial impact rate – 6.8%

28. Our Coding Results 2011

29. Our HAC Results

30. Our PSI Results

31. Our Core Measures Results 2011

32. # of Visits Reviewed

33. Total # of Reviews

34. Total # of Queries

35. Reimbursement Impact

36. MCC/CC Capture Rate

37. Query Rate

38. Physician Response Rate

39. Agreement Rate

40. Reporting Frequency Monthly reports are created and reviewed by the coding manager, CDI manager, HIM director, and the quality department nurses Quarterly & annual reports are created and prepared for presentation to the CFO, CQO, and CIO Weekly reports are generated on accounts with outstanding queries, missing dictations, and disparities between the CDI DRG and the coding DRG

41. Lessons Learned Capturing metrics through software saves time and resources Developing our metrics helped us streamline both the CDI and the coding work flows Our CDI metrics gave us insights into where we could look to improve our efforts The metrics gave us support for additional training of our coders Developing metrics has helped create a more cooperative environment between the areas involved

42. What to Look for in Choosing Software Know what data you want to capture and how you want to report it Look for software that has the reporting capabilities you are looking for Determine whether you are looking for a database to enter your data or a more dynamic system that interacts with other areas like coding If the software allows you to create your own reports, consider a system that doesn’t use a proprietary report writing language

43. Resources MS-DRG weights from 2012 IPPS Final Rule – https://www.cms.gov/AcuteInpatientPPS/FR20 12/list.asp#TopOfPage HACs – https://www.cms.gov/HospitalAcqCond/downlo ads/HACFactsheet.pdf SOI overview – http://www.ahrq.gov/qual/mortality/Hughessu mm.htm

44. Contact Information Eric Ryland, RHIA, CHDA, CCS, CPC eric.ryland@dhha.org

45. In order to receive your continuing education certificate for this program, you must complete the online evaluation which can be found in the continuing education section at the front of the workbook. Questions?