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Using Data to Recharge Your CDI Program

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Presentation on theme: "Using Data to Recharge Your CDI Program"— Presentation transcript:

1

2 Using Data to Recharge Your CDI Program
Elizabeth Bonetti, RN, MA, MS

3 HISTORY Community hospital Member NYPHCS ADC Urban setting

4 HISTORY Shared resource model Coding opportunities
Case managers assumed CDI function Physician and hospital staff education Coding opportunities Department development

5 HISTORY Physician education Audits and re-bills
Multiple false starts!!!!

6 WHY NOW?

7 REALITY: PAYMENT RESTRUCTURING MS-DRGS
Pay for performance: Direct Coding/outcomes (P4P) Pay for performance: Indirect Consumer choice Selective contracting No pay for poor performance: Adverse events not POA Recovery Audit Contractors (RAC) 2010: Readmissions Bundled $ American Journal of Medical Quality: “Medicare’s Value-Based Payment Initiatives: Impact on and Implications for Improving Physician Documentation and Coding,” by Alan H. Rosenstein, MD, MBA, Michelle O’Daniel, MSG, MBA, Susan White, PhD, Ken Taylor

8 HOSPITAL DATA REPORTS MS-DRG coding impact NYS DRG severity impact
Coding complexity Financial impact projections NYS DRG severity impact Severity-adjusted LOS report Opportunity assessment Adverse event incidence and impact CMS/JC quality indicator report HealthGrades report Actual to expected mortality/complication rates Patient safety ratings

9 WHAT IS IMPACTED? Revenue ALOS Patient flow
Medical necessity and DRG denials Quality data reporting Risk management

10 ADMINISTRATIVE SUPPORT
CEO CMO CFO Finance Clinical chairmen Nursing leadership Clinical pharmacy IT Compliance Case management HIM

11 PHYSICIAN INCENTIVES Improves patient outcomes
Emotional: Loyalty/pride/respect Competitive: Peer pressure Awareness/accountability: Reputation Contracting OPPE Financial: Billing P4P incentives Market share American Journal of Medical Quality: “Hospital Report Cards: Intent, Impact, and Illusion,” by Alan H. Rosenstein, MD, MBA Medical Economics: “When Health Plans Don’t Want You Anymore”

12 PROGRAM PLACEMENT Senior vice president, chief financial officer
Executive vice president, chief medical officer Assistant vice president Case management Denials management Clinical documentation improvement Health information management Patient placement Social work Coding

13 DEVELOPMENT Opportunity for improvement Business plan Vendor selection
Assessment DRG benchmark report Business plan Vendor selection Physician buy-in Staffing—type of workers Collaboration with HIM Tools Reporting—monthly benchmarks

14 PHYSICIAN BUY-IN—WHAT’S IN IT FOR ME?
Salaried vs. voluntary physicians Education at routine meetings Tied to professional billing Meet the physician for 1:1 reviews Achievement certificates OPPE reporting

15 CERTIFICATE OF EXCELLENCE
This certificate is awarded to Jennifer Smith, MD in recognition of excellent clinical documentation: “CHF, acute on chronic with systolic dysfunction; respiratory failure secondary to pulmonary edema” Note from Editorial Services: Signature and date lines at bottom right will need to be moved so they don’t run into the footer. DONE BY WENDY Signature Date Signature Date

16 METHODOLOGY/TOOLS Work environment Laptops—concurrent entries
3M coding software and Sunrise Record Manager CDI database EMR Pocket guides—physician billing guidelines

17 METHODOLOGY/TOOLS Physician query sheets/ electronic query
Policies/processes Weekly coding/CDS leadership meetings Strategic postings Verbal rewarding and candy Physician achievement certificates Validation of $$ reported

18 A NEW START A branding all its own!

19 NETPRESENTER Clinical documentation program
Accurate provider and hospital profiling is now possible Instant feedback on practitioner documentation to reflect severity of illness Coming events: Physician/staff education seminars Documentation team is now in place; contact Jennifer at Ext. xxxx or Brenda at Ext. xxxx for more information

20 Physician query Bright color Inserted in progress notes CDI contacts Compliant

21 METHODOLOGY/TOOLS Rollout Coder identified opportunity (retro)
Physician rounds Disease based vs. unit based Emergency department Coder identified opportunity (retro) Electronic query solution

22 COMPLIANCE Policy review Process review Query review Reports

23 CD TEAM EDUCATION Team-building methodology
All attended coding review/ updates Graduation Celebrations New staff orientation Bimonthly education/sharing

24 EDUCATION Across all disciplines Grand rounds Resident lectures
Strategic postings 1:1 Unit-based small conferences Physician rounds Discharge summary review EMR utilization

25 Reports drive success and improvement

26 MONTHLY FINANCIAL DASHBOARD
 Month/year Reviews MD queries (+) DRG changes Variance Type of reviews # % Concurrent opportunities Retrospective opportunities Re-bill records Severity of illness (SOI) No opportunity TOTAL Senior finance leadership dashboard—monthly and annual tracking Case-specific validation Annual budgeted revenue expectation Tracked for attaining annual target

27 ANNUAL FINANCIAL DASHBOARD

28 CDI CLINICAL DEPARTMENT DASHBOARD
Apr May June 2nd Q Clinical department # reviews % DRG change Variance Family medicine 27 82% $39,940 24 50% $14,657 29 100% $ 38,316 80 77% $92,913 Internal medicine 137 68% $192,698 91 57% $96,846 140 94% $ 245,572 368 73% $535,116 OB/GYN 3 $10,887 0% $0 $ 6 33% Pediatrics $6,072 1 $7,911 4 67% $13,983 Surgery 8 62% $10,049 2 $3,970 $ 8,126 13 87% $22,145 TOTAL 178 69% $259,646 118 55% $123,384 175 83% $ 292,014 471 $675,044 Clinical department leadership dashboard—monthly and annual tracking Departmental CMI and revenue impact Specific physician monitoring included

29 PHYSICIAN-SPECIFIC DASHBOARD
September 2010 Family medicine attending MD Cases reviewed Queries MD response MD agreement $$ variance Yes No John McParland 10 2 1 ($4,277) Mary Eagan 12 $8,524 Steve Seifried 22 4 3 $24,123 Andrew Smith 15 $2,100 Total 59 9 8 7 $30,470 OPPE indicator Physician response and agreement rate Case-specific data available on request

30 CDI STAFF DASHBOARD Staff productivity monitoring Staff QA monitoring
October 2010 Family medicine attending MD Cases reviewed Queries MD response MD agreement $$ variance Yes No Jennifer Smith, RN 325 45 42 3 40 2 $77,240 Annaliza Gonzales, RN 375 66 60 6 59 1 $107,830 Elizabeth Jones, RN 280 38 $52,231 Sally Jones, RN 288 35 32 $45,455 Total 1268 191 177 14 169 8 $282,756 Staff productivity monitoring Staff QA monitoring Staff feedback

31 DASHBOARD—IN DEVELOPMENT
By DRG Education opportunity by service line Opportunity for hospital improvement

32 THE ULTIMATE GOAL Balance cost and quality QUALITY COST

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