Using Data to Recharge Your CDI Program Elizabeth

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 – Department development

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

WHY NOW?

REALITY: PAYMENT RESTRUCTURING MS-DRGS • Pay for performance: Direct – Coding/outcomes (P 4 P) • Pay for performance: Indirect – Consumer choice – Selective contracting • No pay for poor performance: American Journal of Medical Quality: “Medicare’s Value-Based Payment – Adverse events not POA Initiatives: Impact on and Implications for Improving Physician Documentation and • Recovery Audit Coding, ” by Alan H. Rosenstein, MD, MBA, Contractors (RAC) 2010: Michelle O’Daniel, MSG, MBA, Susan White, Ph. D, – Readmissions Ken Taylor – Bundled $

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 Health. Grades report – Actual to expected mortality/complication rates – Patient safety ratings

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

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

PHYSICIAN INCENTIVES • • Improves patient outcomes Emotional: Loyalty/pride/respect Competitive: Peer pressure Awareness/accountability: – Reputation American Journal of Medical Quality: – Contracting “Hospital Report Cards: Intent, Impact, and Illusion, ” by Alan H. Rosenstein, MD, MBA – OPPE Medical Economics: • Financial: “When Health Plans Don’t Want You Anymore” – Billing – P 4 P incentives – Market share

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

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? • Salaried vs. voluntary • • • physicians Education at routine meetings Tied to professional billing Meet the physician for 1: 1 reviews Achievement certificates OPPE reporting

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

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

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 branding all its own!

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

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

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

COMPLIANCE • Policy review • Process review • Query review • Reports

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

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

Reports drive success and improvement

MONTHLY FINANCIAL DASHBOARD Month/year Type of reviews Re views # MD queries % # % (+) DRG changes # Variance % 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

ANNUAL FINANCIAL DASHBOARD

CDI CLINICAL DEPARTMENT DASHBOARD Clinical department Apr May June 2 nd Q # 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 3 100% $10, 887 0 0% $0 3 0% $ - 6 33% $10, 887 Pediatrics 3 100% $6, 072 1 100% $7, 911 0 0% $ - 4 67% $13, 983 Surgery 8 62% $10, 049 2 100% $3, 970 3 100% $ 8, 126 13 87% $22, 145 TOTAL 178 69% $259, 646 118 55% $123, 384 175 83% $ 292, 014 471 69% $675, 044 • Clinical department leadership dashboard—monthly and annual tracking • Departmental CMI and revenue impact • Specific physician monitoring included

PHYSICIAN-SPECIFIC DASHBOARD September 2010 Family medicine attending MD Cases reviewed Queries John Mc. Parland 10 2 Mary Eagan 12 Steve Seifried MD response MD agreement Yes No 2 0 1 1 ($4, 277) 2 2 0 $8, 524 22 4 3 1 3 0 $24, 123 Andrew Smith 15 1 1 0 $2, 100 Total 59 9 8 1 7 1 $30, 470 • OPPE indicator • Physician response and agreement rate • Case-specific data available on request $$ variance

CDI STAFF DASHBOARD October 2010 Family medicine attending MD Cases reviewed Queries 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 42 40 2 38 2 $52, 231 Sally Jones, RN 288 38 35 3 32 3 $45, 455 Total 1268 191 177 14 169 8 $282, 756 • Staff productivity monitoring • Staff QA monitoring • Staff feedback MD response MD agreement $$ variance

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

THE ULTIMATE GOAL • Balance cost and quality QUALITY COST