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Using Data to Recharge Your CDI Program. Elizabeth Bonetti, RN, MA, MS. HISTORY. Community hospital Member NYPHCS ADC 300-325 Urban setting. HISTORY. Shared resource model Case managers assumed CDI function Physician and hospital staff education Coding opportunities

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using data to recharge your cdi program
Using Data to Recharge Your CDI Program

Elizabeth Bonetti, RN, MA, MS

history
HISTORY
  • Community hospital
  • Member NYPHCS
  • ADC 300-325
  • Urban setting
history1
HISTORY
  • Shared resource model
    • Case managers assumed CDI function
    • Physician and hospital staff education
  • Coding opportunities
    • Department development
history2
HISTORY
  • Physician education
  • Audits and re-bills
  • Multiple false starts!!!!
reality payment restructuring ms drgs
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

hospital data reports
HOSPITAL DATA REPORTS
  • MS-DRG coding 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
what is impacted
WHAT IS IMPACTED?
  • Revenue
  • ALOS
  • Patient flow
  • Medical necessity and DRG denials
  • Quality data reporting
  • Risk management
administrative support
ADMINISTRATIVE SUPPORT
  • CEO
  • CMO
  • CFO
  • Finance
  • Clinical chairmen
  • Nursing leadership
  • Clinical pharmacy
  • IT
  • Compliance
  • Case management
  • HIM
physician incentives
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”

program placement
PROGRAM PLACEMENT

Senior vice president, chief financial officer

Executive vice president, chief medical officer

Assistant vice president

Case management

Denials management

Health information management

Clinical documentation improvement

Patient placement

Social work

Coding

development
DEVELOPMENT
  • Opportunity for improvement
    • Assessment
    • DRG benchmark report
  • Business plan
  • Vendor selection
  • Physician buy-in
  • Staffing—type of workers
  • Collaboration with HIM
  • Tools
  • Reporting—monthly benchmarks
physician buy in what s in it for me
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
slide15

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”

Signature

Date

Signature

Date

methodology tools
METHODOLOGY/TOOLS
  • Work environment
  • Laptops—concurrent entries
    • 3M coding software and Sunrise Record Manager
    • CDI database
    • EMR
  • Pocket guides—physician billing guidelines
methodology tools1
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
a new start
A NEW START

A branding all its own!

netpresenter
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
slide20

Physician query

  • Bright color
  • Inserted in progress notes
  • CDI contacts
  • Compliant
methodology tools2
METHODOLOGY/TOOLS
  • Rollout
    • Physician rounds
    • Disease based vs. unit based
    • Emergency department
  • Coder identified opportunity (retro)
  • Electronic query solution
compliance
COMPLIANCE
  • Policy review
  • Process review
  • Query review
  • Reports
cd team education
CD TEAM EDUCATION
  • Team-building methodology
    • All attended coding review/updates
    • Graduation
    • Celebrations
    • New staff orientation
    • Bimonthly education/sharing
education
EDUCATION
  • Across all disciplines
  • Grand rounds
  • Resident lectures
  • Strategic postings
  • 1:1
  • Unit-based small conferences
  • Physician rounds
  • Discharge summary review
  • EMR utilization
monthly financial dashboard
MONTHLY FINANCIAL DASHBOARD
  • Senior finance leadership dashboard—monthly and annual tracking
  • Case-specific validation
  • Annual budgeted revenue expectation
  • Tracked for attaining annual target
cdi clinical department dashboard
CDI CLINICAL DEPARTMENT DASHBOARD
  • Clinical department leadership dashboard—monthly and annual tracking
  • Departmental CMI and revenue impact
  • Specific physician monitoring included
physician specific dashboard
PHYSICIAN-SPECIFIC DASHBOARD
  • OPPE indicator
  • Physician response and agreement rate
  • Case-specific data available on request
cdi staff dashboard
CDI STAFF DASHBOARD
  • Staff productivity monitoring
  • Staff QA monitoring
  • Staff feedback
dashboard in development
DASHBOARD—IN DEVELOPMENT
  • By DRG
    • Education opportunity by service line
    • Opportunity for hospital improvement
the ultimate goal
THE ULTIMATE GOAL
  • Balance cost and quality

QUALITY

COST