© Copyright 2009 American Health Information Management Association. All rights reserved.
How CDI Programs Result in Quality Coded Data
Audio Seminar/Webinar February 19, 2009
Practical Tools for Seminar Learning
Disclaimer
AHIMA 2009 Audio Seminar Series • http://campus.ahima.org/audio American Health Information Management Association • 233 N. Michigan Ave., 21st Floor, Chicago, Illinois
i
The American Health Information Management Association makes no representation or guarantee with respect to the contents herein and specifically disclaims any implied guarantee of suitability for any specific purpose. AHIMA has no liability or responsibility to any person or entity with respect to any loss or damage caused by the use of this audio seminar, including but not limited to any loss of revenue, interruption of service, loss of business, or indirect damages resulting from the use of this program. AHIMA makes no guarantee that the use of this program will prevent differences of opinion or disputes with Medicare or other third party payers as to the amount that will be paid to providers of service. As a provider of continuing education the American Health Information Management Association (AHIMA) must assure balance, independence, objectivity and scientific rigor in all of its endeavors. AHIMA is solely responsible for control of program objectives and content and the selection of presenters. All speakers and planning committee members are expected to disclose to the audience: (1) any significant financial interest or other relationships with the manufacturer(s) or provider(s) of any commercial product(s) or services(s) discussed in an educational presentation; (2) any significant financial interest or other relationship with any companies providing commercial support for the activity; and (3) if the presentation will include discussion of investigational or unlabeled uses of a product. The intent of this requirement is not to prevent a speaker with commercial affiliations from presenting, but rather to provide the participants with information from which they may make their own judgments.
Faculty
AHIMA 2009 Audio Seminar Series ii
Amy Gardner, RHIT
Amy Gardner, RHIT, is a cardiovascular services documentation specialist with Deaconess Medical Center in Spokane, WA. Ms. Gardner has over 16 years of experience in the HIM profession, with an emphasis on coding in all areas. She has also written courses for AHIMA.
Contact info: [email protected]
Marilyn Jones, MBA, MN, RN, CCS
Marilyn Jones, MBA, MN, RN, CCS, is a manager with KPMG’s Healthcare Forensic group in Atlanta, GA. Ms. Jones has over 25 years of nursing and healthcare consulting experience, including documentation improvement and compliance in the acute healthcare setting. Prior to consulting she was a nursing director at a university teaching hospital and practiced as a legal nurse consultant at a major law firm.
Contact info: [email protected]
Table of Contents
AHIMA 2009 Audio Seminar Series
Disclaimer ..................................................................................................................... i Faculty ......................................................................................................................... ii Objectives ..................................................................................................................... 1 What is a CDIP? ............................................................................................................. 1 Who Participates? .......................................................................................................... 2 Documentation Specialists .............................................................................................. 2 Necessary Skills for DS (Documentation Specialists) .......................................................... 3 Physician Participation .................................................................................................... 3 Other Participants: ......................................................................................................... 4 Potential “Types” of CDIPs ........................................................................................... 4-5 Is one program type better than another? ........................................................................ 5 Communicating Documentation Needs ............................................................................. 6 Education of Physicians ............................................................................................... 6-7 Changes to DRGs ........................................................................................................... 7 How have MS-DRGs affected documentation? ................................................................... 8 Examples of MCCs .......................................................................................................... 8 ESRD…Implications ........................................................................................................ 9 Quality Measures ........................................................................................................... 9 Vaccination Standards ................................................................................................... 10 RACs and CDIPs ............................................................................................................ 10 POA and HACs .............................................................................................................. 11 HACs ....................................................................................................................... 11 Queries ....................................................................................................................... 12 Expansion Opportunities ................................................................................................ 13 Benefits of CDIP ............................................................................................................ 13 How Current Healthcare Initiatives and Economic Events
Are Impacting Hospitals and the Need for CDI Programs ...................................... 14 The Economic Crisis: Impact on Hospitals................................................................... 14-15 Healthcare Reform ................................................................................................... 15-18 Medicare Reform Initiatives ....................................................................................... 19-23 Medicaid Reform Initiatives ............................................................................................ 24 Value-based Purchasing (VBP) ................................................................................... 25-30 Hospital and Physician Profiling ................................................................................. 30-31 Clinical Documentation Improvement Programs ............................................................... 32 Resource/Reference List ................................................................................................ 33
Audio Seminar Discussion and Audio Seminar Information Online ................................. 33-34 Upcoming Audio Seminars ............................................................................................ 34 Thank You/Evaluation Form and CE Certificate (Web Address) .......................................... 35
Appendix .................................................................................................................. 36 Resource/Reference List ....................................................................................... 37 Resources CE Certificate Instructions
How CDI Programs Result in Quality Coded Data
AHIMA 2009 Audio Seminar Series 1
Notes/Comments/Questions
Objectives
Review how clinical documentation improvement programs (CDIP) result in accurate and complete coded dataSummarize how accurate coded data is critical to healthcare delivery, research, public reporting, reimbursement, and policy-makingReview effective CDI methods that ensures complete, clear, and accurate health record documentation for complete and accurate coding
1
What is a CDIP?
Definition of CDIP:• Clinical Documentation Improvement
Program• Importance of a CDIP
2
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Notes/Comments/Questions
Who Participates?
Documentation SpecialistsPhysicians, Mid-Levels (ARNPs, PAs)Nursing Staff• Other Ancillary Staff
3
Documentation Specialists
Who are they?• RHITs, RHIAs, CCSs
• Education in coding and HIM skills– Ability to learn clinical knowledge
• RNs• Clinical Knowledge
– Ability to learn coding skills
4
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Notes/Comments/Questions
Necessary Skills for DS (Documentation Specialists)
Understanding of Clinical Disease processes• Anatomy and Physiology• Coding Skills• Ability to communicate effectively
• Verbal and Written
• Confidence
5
Physician Participation
Why do we need their support?• Creating Credibility • Improvement in Documentation• Better Profiles• Achieving results in CMS requirements
6
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Notes/Comments/Questions
Other Participants:
Nursing staff• Other Ancillary Patient Care Staff
• PT• OT• Dietary
– Assist with BMI documentation
7
Potential “Types” of CDIPs
Case Management Program• Typically RN only focus
• Relies on Case Managers to perform concurrent medical record review
• Incorporates concurrent DRG assignment with daily duties of discharge planning for patients
8
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Notes/Comments/Questions
Potential “Types of CDIPs” (Cont.)
HIM Programs• Utilizes RHITs/RHIAs/CCSs with strong
emphasis on coding background• Also utilizes RNs
9
Is one program type better than another?
Choose what works best for your facility…• Both “types” of programs utilize
Inpatient Coders
Decide how to approach your medical staff • Define your mission and goals
10
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Notes/Comments/Questions
Communicating DocumentationNeeds
How to communicate with physicians• Creating a level of physician “buy-in”
• Specificity needs
11
Education of Physicians
Best Method of Education• Written• Verbal • Group Presentations
• Show results/outcomes• Encourage participation and question and
answer sessions
12
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Notes/Comments/Questions
Education of Physicians (Cont.)
Say it once, say it twice…• Is one conversation enough to help
physician to understand?• Remember to present hard facts
• Coding Clinics• Fliers with information
– Education for documentation specificity requirements
13
Changes to DRGs
October 1, 2008• DRGs to MS-DRGs• Most expansive change since original
inception of DRGs
14
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Notes/Comments/Questions
How have MS-DRGs affected documentation?
MCCs• Major Complications/Co-morbidities
• What is the importance?– Why CCs vs. MCCs?
15
Examples of MCCs
Acute or Acute on Chronic CHF• Systolic vs. Diastolic
Renal Failure• Acute Renal Failure• Chronic Kidney Disease
– Stages 1-5
Decubitus Ulcers– Importance of clear documentation of the stages
16
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Notes/Comments/Questions
ESRD…Implications
ESRD benefits provided under Medicare RulesImportance of documentation/acknowledgement of this disease
17
Quality Measures
How can DS’s help meet standards?• Heart Failure Measures• Myocardial Infarction Measures• Pneumonia• SCIP
• Concurrent Review to meet standards– Models for concurrent review:
– Who performs this review
18
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Notes/Comments/Questions
Vaccination Standards
Meeting Pneumonia and Flu Vaccination Requirements • Who requires this vaccination standard?
• Methods for achieving these standards
19
RACs and CDIPs
How can a CDIP help with RACs?• Considerations
• Players involved
20
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Notes/Comments/Questions
POA and HACs
Improving documentation for POAImproving documentation for HACs• Defining the need for specificity to
physicians • Importance of clarity in record for coding
staff
21
HACs
Importance in UTI clarification• Foley vs. UTI
• Pressure Ulcers• Diabetic Ketoacidosis
22
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Notes/Comments/Questions
Queries
AHIMA Practice Brief on Queries• Reason for queries• Should the DS( Documentation
Specialist) query for everything• Pick and choose when to query
23
Queries (Cont.)
Written queries• Concurrent vs. Post discharge
• What information to include• To lead or not to lead or just the facts…
24
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Notes/Comments/Questions
Expansion Opportunities
Potential for Documentation Specialists:• Growth• Education• Membership in Associations
25
Benefits of CDIP
Specificity in DocumentationBetter ProfilesCMS CORE measure standards metImproved Physician/Mid-Level communicationImproved ability to code/bill more efficiently
26
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Notes/Comments/Questions
How Current Healthcare Initiatives and Economic Events Are Impacting Hospitals and the Need for CDI Programs
Economic Crisis Impact on HospitalsHealthcare ReformMedicare Reform InitiativesMedicaid Reform InitiativesValue-based PurchasingHospital and Physician ProfilingClinical Documentation Improvement Programs (CDIP) – The Need Continues
27
The Economic Crisis: Impact on Hospitals
Bad Debt and Charity Care• Rising unemployment• Loss of medical coverage• Slowdown in payment by patients
Access to Credit and Capital Resources• Difficulty in obtaining capital resources• Decreased days cash on hand• Increased cost of borrowing
Negative Investment Income 28
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Notes/Comments/Questions
The Economic Crisis: Impact on Hospitals (Cont.)
Housing CrisisDecreased Demand for Hospital and Physician Services• Decline in elective procedures• Decline in admissions
Possible Cuts to Medicaid and Medicare Provider Payments
29
Healthcare Reform
Why is Healthcare Reform Needed?• Healthcare spending in the United States
is 2.3 times higher than in other developed nations1
• Healthcare expenses are projected to increase 83 percent in the next 10 years2
30
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Notes/Comments/Questions
Healthcare Reform (Cont.)
• Quality Concerns• Medical Errors
– Approximately 48,000 to 98,000 patient deaths each year3
• Medication Errors– $3.5 billion annually4
• Access Issues • Uninsured Americans5 – 47.0 million • Uninsured for catastrophic healthcare
expenses6 –15.6 million
31
Healthcare Reform (Cont.)
• Medicare Solvency and Beneficiary Impact• Expenditures up from $219 billion in 2000 to
an estimated $486 billion in 2009• Medicare premiums, deductibles, and cost-
sharing are forecasted to consume 28 percent of the average beneficiaries’ Social Security check in 20107
32
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Notes/Comments/Questions
Healthcare Reform (Cont.)
What’s New on Capital Hill• President Barack Obama’s selection of
healthcare team• Secretary of Department of Health and Human
Services and Director of a new White House Office on Health Care Reform?
• Jeanne Lambrew, a former aide to President Bill Clinton and a senior fellow at the Center for American Progress – Deputy Director of White House Office of Health Reform
• Director of Centers for Medicare and Medicaid Services (CMS)?
• U.S. Surgeon General?33
Healthcare Reform (Cont.)
Summary of President Obama’s Plan • Estimated cost to implement is significant • Affordable health insurance• Universal coverage is not mandated• Healthcare coverage for all children• Competitive and regulated private system• Establish a National Health Insurance Exchange• Establish a new health insurance plan that would
be available to uninsured as well as small businesses8
34
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Notes/Comments/Questions
Healthcare Reform (Cont.)
• Large employer mandate – two options• Contribute to employee health coverage • Contribute to the cost of the public plan
• Expand public payer system• Establish a Small Business Health Tax
Credit • Individual tax credit for premiums• Expand eligibility of Medicaid and the
State Children's Health Insurance Program9
35
Healthcare Reform (Cont.)
Other Healthcare Reform Plans• Senator Edward Kennedy• Senate Finance Chairman Max Baucus • Special Interest Groups are introducing
plans• American Medical Association• American’s Health Insurance Plans• Federation of American Hospitals• American Academy of Family Physicians
36
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Notes/Comments/Questions
Medicare Reform Initiatives
Medicare Fee-for-Service Program • Administrative Functional Environment
• Medicare Administrative Contractors (MACs)– Established under the Medicare Prescription Drug
Improvement and Modernization Act of 2003– Focus: customer service, operational excellence, and
financial management– By 2010 to become the central point in CMS’s fee-for-
service program– Replace fiscal intermediaries (FI) and carriers– Nineteen MACs with 15 A/B MACs to process both Part A &
Part B core claims processing operations
37
Medicare Reform Initiatives (Cont.)
MedicareAdministrative
Contractors (MACs)
QualifiedIndependent
Contractors (QICs)
QualityImprovementOrganization
(QIO)
EnterpriseData
Centers (EDCs)
AdministrativeQualified
IndependentContractors(Ad QICs)
Zone ProgramIntegrity Contractors
(ZPICs)
RecoveryAudit
Contractors (RACs)
MedicareSecondary Payer
Recovery Contractor(MSPRC)
Healthcare IntegratedGeneral Ledger
Accounting System(HIGLAS)
BeneficiaryContact
Center (BCC)
38
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Notes/Comments/Questions
Medicare Reform Initiatives (Cont.)
Functional Contractors• Purpose: To monitor the relationships within the
MAC program• Zone Program Integrity Contractors (ZPICs)
– Find, prevent, and deter waste, fraud, and abuse in Medicare – Seven (7) zones that interacts with a MAC jurisdiction– Perform program integrity functions for Medicare A-D, Durable
Medical Equipment, home health, hospice, and the Medi-Medi program
• Quality Improvement Organization (QIO)– Group of practicing doctors and other health care professionals– Hired to review and improve the care of Medicare beneficiaries– Review complaints regarding quality of health care services
provided to Medicare patients10
39
Medicare Reform Initiatives (Cont.)
• Recovery Audit Contractors(RACs)• Demonstration project created by the
Medicare Prescription Drug, Improvement, and Modernization Act of 2003. The Tax Relief and Health Care Act of 2006 made the RAC Program permanent
• Purpose– Find and correct improper Medicare payments paid to
health care providers participating in fee-for-service Medicare
– “Provide information to CMS and Medicare contractors that could help protect the Medicare Trust Funds by preventing future improver payments thereby lowering the Medicare FFS claim payment error rate”11
40
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Notes/Comments/Questions
Medicare Reform Initiatives (Cont.)
• RACs are paid a contingency fee based on the amount of the overpayments and underpayments that they detect and correct
• California, Florida, and New York were selected as the demonstration states because of there high per capita Medicare consumption
• In 2007, Massachusetts, South Carolina, and Arizona were included in the demonstration project
• RAC demonstration ended March 2008• Goal is to have RACs fully in place by 201012
41
Medicare Reform Initiatives (Cont.)
• Four RACs were announced on October 6, 2008 • Diversified Collection Services, Inc. of Livermore,
California, in Region A, initially working in Maine, New Hampshire, Vermont, Massachusetts, Rhode Island, and New York
• CGI Technologies and Solutions, Inc. of Fairfax, Virginia, in Region B, initially working in Michigan, Indiana, and Minnesota
• Connolly Consulting Associates, Inc. of Wilton, Connecticut, in Region C, initially working in South Carolina, Florida, Colorado, and New Mexico
• HealthDataInsights, Inc. of Las Vegas, Nevada, in Region D, initially working in Montana, Wyoming, North Dakota, South Dakota, Utah, and Arizona
42
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Notes/Comments/Questions
Medicare Reform Initiatives (Cont.)
• November 4, 2008 Press Release – CMS imposed an automatic stay on the contract work of the four RACs due to a protest filed by two unsuccessful bidders with the Government Accountability Office (GAO). 13
• Protest Resolved • PRG-Schultz, Inc. – subcontractor to HDI,
DCS and CGI in Regions A, B & D• Viant Payment Systems, Inc – subcontractor
to Connolly Consulting in Region C
43
Medicare Reform Initiatives (Cont.)
• Results of RAC Demonstration: Cumulative through March 27, 2008• > $1.03 billion of “improper payments” - 96 percent
collected from providers; 4 percent repaid to providers14
44
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Notes/Comments/Questions
Medicare Reform Initiatives (Cont.)
• Top Overpayment Items for Inpatient Hospitals• Excisional Debridement• Inpatient Rehabilitation Facility (IRF)
services following joint replacement surgery• Heart Failure and Shock• Surgical Procedures in Wrong Setting• Respiratory System Diagnoses with
Ventilator Support• Extensive OR Procedures Unrelated to
Principal Diagnosis15
45
Medicare Reform Initiatives (Cont.)
RAC Expansion Schedule
D A
B
Oct. 1,2008
March 1,2009
August 1, 2009 or laterC
16
March 1, 2009
46
*VT, NH, ME, MA, RI, CT (J14) Part A claims (including PartB of A) will not be available for RAC review until August
2009 due to the MAC transition. Part B claims in RI will notbe available for RAC review until August 2009 due to theMAC transition. All other Part B claims are available for
RAC review beginning March 1, 2009.*
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Notes/Comments/Questions
Medicaid Reform Initiatives
Medicaid Integrity Program (MIP)• States have the chief responsibility of
controlling fraud in the Medicaid program
• CMS provides oversight, technical assistance, and direction
• Deficit Reduction Act of 2005 established the MIP• Goal: To fight fraud, waste, and abuse in the
Medicaid Program47
Medicaid Reform Initiatives (Cont.)
Medicaid Integrity Group (MIG)• Responsible for implementing and managing the
MIP
• Goals of the MIG• Promote the proper expenditure of MIP funds• Improve program integrity performance nationally• Ensure the operational and administrative excellence of
the MIP• Demonstrate effective use of MIP funds• Foster collaboration with internal and external
stakeholders of the MIP17
48
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Notes/Comments/Questions
Value-based Purchasing (VBP)
CMS initiative to align payment policy with the delivery of high quality and efficient care.
49
Value-based Purchasing (Cont.)
Quality Reporting for 2009• To avoid the two percent reduction in the
payment update, hospitals must submit/allow CMS to report quality data
• Thirty quality measures are included in the FY 2009 payment. Topics covered are Acute Myocardial Infarction, Heart Failure, Pneumonia, Surgical Care Improvement Project (SCIP), Mortality & Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS)
50
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Notes/Comments/Questions
Value-based Purchasing (Cont.)
Quality Reporting for 2010 • To avoid the two percent reduction in the
payment update, hospitals must submit/allow CMS to report quality data
• Forty-two quality measures are included in the FY 2010 payment
51
Value-based Purchasing (Cont.)
New Metrics for 2010• Surgical Care Improvement Project (SCIP)
• SCIP Cardiovascular 2 Surgery – Beta Blocker• Nursing Sensitive Measures – Failure to Rescue• Readmission Measures – Heart Failure Readmission
(Medicare only)• Agency for Healthcare Research and Quality (AHRQ)
Quality Indicators: Inpatient Quality Indicators and Patient Safety Indicators – 9 measures
• Cardiac Surgery Measures – Participation in systematic database for cardiac surgery
• One measure from 2009, PN measure – Oxygenation Assessment, will be retired and not reported by hospitals
52
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Notes/Comments/Questions
Value-based Purchasing (Cont.)
Quality Reporting for 2011 and Subsequent Years • COPD• Complications of Vascular Surgery – AAA,
Carotid Endarterectomy and Lower Extremity Bypass
• Inpatient Diabetes Care Measures• Healthcare-associated Infections (Central
Line-associated Bloodstream Infections and Surgical Site Infections)
53
Value-based Purchasing (Cont.)
• Timeliness of Emergency Care Measures• SCIP Cardiovascular 3 – Beta Blockers• Complications Measures (Medicare
patients) – Healthcare-acquired Conditions (HACs)
• Hospital Inpatient Cancer Care Measures
54
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Notes/Comments/Questions
Value-based Purchasing (Cont.)
• Serious Reportable Events in Healthcare (“Never Events”)
• Average Length of Stay Coupled with Global Readmission Measure
• Preventable HACs18
55
Value-based Purchasing (Cont.)
HACs• Hospital-acquired infections add nearly $5
billion per year to U.S. healthcare costs19
• In 2002, 1.7 million hospital-acquired infections were associated with 99,000 deaths20
• A survey by Leapfrog Group® determined that 85 percent of hospitals did not always follow guidelines to prevent many of the hospital acquired infections21
56
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Notes/Comments/Questions
Value-based Purchasing (Cont.)
Selection of HACs• High cost• High volume• Results in a higher-paying DRG when existing as
a secondary diagnosis• Condition could reasonably be avoided through
the application of evidence-based guidelines
• Effective October 1, 2008, the higher-weighted DRG is not assigned when a secondary diagnosis listed as a HAC was not present on admission
57
Value-based Purchasing (Cont.)
Foreign Object Retained after SurgeryAir EmbolismBlood IncompatibilityCatheter-associated UTIsVascular Catheter-associated InfectionsPressure Ulcers – (Stages III and IV)Falls (complications from)
• Fractures• Dislocations• Intracranial Injury• Crushing Injury• Burns• Electric Shock
Surgical Site Infection, Mediastinitis following CABG
Manifestations of Poor Glycemic Control
• Diabetic Ketoacidosis• Nonketotic Hyperosmolar Coma• Hypoglycemic Coma• Secondary Diabetes with
Ketoacidosis• Secondary Diabetes with
HyperosmolaritySurgical Site Infection following Certain Orthopedic Procedures (Spine, neck, shoulder, elbow)Surgical Site Infection following Bariatric Surgery for Obesity (Laparoscopic gastric bypass, Gastroenterostomy, Laparoscopic gastric-restrictive surgery)Deep-vein Thrombosis and Pulmonary Embolism following Certain Orthopedic Procedures (Total Knee Replacement, Hip Replacement)
HACs Selected – Effective October 1, 2008
58
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Notes/Comments/Questions
Value-based Purchasing (Cont.)
Candidate HACs• Surgical site infection following device
procedures• Failure to rescue• Death or disability associated with drugs,
devices, or biologics• Dehydration• Malnutrition• Water-borne pathogens• Surgical site infections following procedures –
orthopedic and other• Ventilator-associated pneumonia• Clostridium difficile-associated disease22
59
What is profiling?• Extrapolation of information about hospitals
and/or physicians, based on known dataWhat is being profiled?• Severity of Illness• Expected Risk of Mortality vs. Actual• Quality of Care Measures• Cost Efficiency/Effectiveness• Length of Stay• Readmission Rate• Complication of Medical Care
Hospital and Physician Profiling
60
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Notes/Comments/Questions
Hospital and Physician Profiling (Cont.)
Who is Profiling Hospitals and Physicians?• CMS
• VBP Demonstrations and Pilots• VBP Programs• HACs and Present on Admission Indicator
Reporting• Physician Quality Reporting Initiative• Medicare and Medicaid Contractors/Auditors
• State Agencies• The Joint Commission
61
Hospital and Physician Profiling (Cont.)
• Internet profiling sites• HealthGrades®• Leapfrog Group®
• Trade magazines and newspapers• U.S. News & World Report’s Best 100 Hospitals
• Consumers• Employers• Commercial Payers• Managed Care Organizations• Physician Practice Groups• Hospitals
62
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Notes/Comments/Questions
Clinical DocumentationImprovement Programs
The need for CDIP continues• Accurate and complete physician documentation
is critical to accurate profiling and appropriate reimbursement in an ever-changing healthcare environment• Implement or revitalize CDIP• Utilize a multidisciplinary approach with your CDIP.
Involve Hospital Administrators, Compliance Directors, Revenue Cycle Managers, Physician Leaders, Health Information Management, Nursing, Case Management and Clinical Documentation Specialists in navigating through healthcare initiatives
63
Clinical Documentation Improvement Programs (Cont.)
• Educate physicians regarding the importance of accurate documentation on public profiling and appropriate reimbursement
• Educate physicians and staff on regulatory reform/initiatives
• Educate coding staff and Clinical Documentation Specialists on new coding guidelines, clinical topics, and medical technology
• Do a risk assessment to determine key areas of vulnerability and determine action steps to correct
• Provide ongoing monitoring, maintenance, and corrective action of your CDIP
64
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Notes/Comments/Questions
Resource/Reference List
Kennedy MD, James S., “A Minute for the Medical Staff”, Medical Records Briefing, February 2009: “Define and document acute Kidney injury and chronic kidney disease”Bryant BS, RHIA, RHIT, CCS, Gloryanne, Hirschl BS, CCS, Nancy. “Improve Documentation and coding now, before recovery audit contractors go national in 2010”, Briefings on Coding Compliance Strategies, April 2008Bowman RHIA, CCs, Sue et al., AHIMA, HIM Body of Knowledge, “Managing an Effective Query Process”. Pages 1-9
65
Audio Seminar Discussion
Following today’s live seminarAvailable to AHIMA members at
www.AHIMA.orgClick on Communities of Practice (CoP) – icon on top right
AHIMA Member ID number and password required – for members only
Join the Coding Community from your Personal Page under Community Discussions, choose the Audio Seminar Forum
You will be able to:• Discuss seminar topics • Network with other AHIMA members • Enhance your learning experience
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Notes/Comments/Questions
AHIMA Audio Seminars
Visit our Web site http://campus.AHIMA.orgfor information on the 2009 seminar schedule. While online, you can also register for seminars or order CDs, pre-recorded Webcasts, and *MP3s of past seminars.
*Select audio seminars only
Upcoming Seminars/Webinars
Managing the Clinical Documentation Improvement Program (CDIP)March 5, 2009
Coding for HematologyApril 2, 2009
Coding for Multi-System Trauma PatientsApril 9, 2009
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Notes/Comments/Questions
Thank you for joining us today!Remember − sign on to the
AHIMA Audio Seminars Web site to complete your evaluation form
and receive your CE Certificate online at:
http://campus.ahima.org/audio/2009seminars.html
Each person seeking CE credit must complete the sign-in form and evaluation in order to view and
print their CE certificate
Certificates will be awarded forAHIMA Continuing Education Credit
Appendix
AHIMA 2009 Audio Seminar Series 36
Resource/Reference List ....................................................................................... 37 Resources CE Certificate Instructions
Appendix
AHIMA 2009 Audio Seminar Series 37
Resource/Reference List
http://www.census.gov/prod/2007 pubs/p60-233.pdf
http://www.cms.hhs.gov/HospitalAcqCond/07_EducationalResources.asp#TopOfPage
http://www.reformplans.com/HCR/Comparison-Grid.html
www.cms.hhs.gov/MedicareContractingReform/Downloads/FunctionalEnvironment.pdf - 2008-10-28
http://www.cms.hhs.gov/RAC/01_Overview.asp#TopOfPage
http://www.cms.hhs.gov/RAC/Downloads/AppealUpdatethrough83108ofRACEvalReport.pdf - 2008-12-31
http://http://www.cms.hhs.gov/RAC/Downloads/2007%20RAC%20Status%20Document%20vs1.pdf
http://www.cms.hhs.gov/RAC/Downloads/RAC%20Expansion%20Schedule%20Web.pdf
http://www.cms.hhs.gov/DeficitReductionAct/Downloads/fy08cmip.pdf
http://edocket.access.gpo.gov/2008/pdf/E8-17914.pdf
http://www.cdc.gov/od/oc/media/pressrel/r2k0306b.htm
http://www.leapfroggroup.org/media/file/Leapfrog_hospital_acquired_infections_release.pdf
http://www.cms.hhs.gov/HospitalAcqCond/07_EducationalResources.asp#TopOfPage
Resources
1 OECD health data 2007: Statistics and indicators for 30 countries.” Organization for Economic Co-operation and Development. July 18, 2007
2 Poisal, John A., Christopher Truffer, Sheila Smith, Andrea Sisko, Cathy Cowan, Sean Keehan and Bridget Dickensheets. “Health spending projections through 2016: Modest changes obscure Part D’s impact.” Health Affairs. February 21, 2007
3 Kohm, Linda T., Janet M. Corrigan and Molla S. Donaldson. To Err is Human: Building a Safer Health System. Washington DC: National Academy of Sciences. 2007
Resources
4 Aspden, Philip, Julie A. Wolcott, J. Lyle Bootman and Linda R. Cronenwett. Preventing Medication Errors. Committee on Identifying and Preventing Medication Errors, Board on Health Care Services. Washington, DC: National Academy of Sciences. 2006
5 “Income, poverty, and health insurance coverage in the United States: 2006.” U.S. Census Bureau. August 2007. Available at: http://www.census.gov/prod/2007 pubs/p60-233.pdf
6 Schoen, Cathy, Michelle M. Doty, Sara R. Collins and Alyssa L. Holmgren. “Insured but not protected: How many adults are underinsured?” Health Affairs. June 14, 2005
Resources
7 CMS, CDC, & Prevention Agency for Healthcare Research and Quality. Transcript of “Hospital-Acquired Conditions & Hospital Outpatient Healthcare-Associated Condition Listening Session.” Thursday, December 18, 2008. Available at: http://www.cms.hhs.gov/HospitalAcqCond/07_EducationalResources.asp#TopOfPage
8 World Health Care Congress’ Forum on the Changes Ahead. Available at: http://www.reformplans.com/HCR/Comparison-Grid.html
9 Ibid10 CMS’s publication: Functional Contractors Overview
Available at: www.cms.hhs.gov/MedicareContractingReform/Downloads/FunctionalEnvironment.pdf - 2008-10-28
Resources
11 RAC Permanent Program. Available at: http://www.cms.hhs.gov/RAC/01_Overview.asp#TopOfPage
12 Ibid13 Ibid14 The Medicare Recovery Audit Contractor (RAC)
Program: Update to the Evaluation of the 3-Year Demonstration. January 2009. Available at: http://www.cms.hhs.gov/RAC/Downloads/AppealUpdatethrough83108ofRACEvalReport.pdf - 2008-12-31
15 CMS RAC Status Document FY 2007: Status Report on the Use of Recovery Audit Contractors (RACs) in the Medicare Program. February 2008. Available at: http://http://www.cms.hhs.gov/RAC/Downloads/2007%20RAC%20Status%20Document%20vs1.pdf
Resources
16 RAC Expansion Schedule March 1, 2009. Available at: http://www.cms.hhs.gov/RAC/Downloads/RAC%20Expansion%20Schedule%20Web.pdf
17 Comprehensive Medicaid Integrity Plan of the Medicaid Integrity Program: FYs 2008-2012. June 2008. Available at: http://www.cms.hhs.gov/DeficitReductionAct/Downloads/fy08cmip.pdf
18 2009 Hospital Inpatient Prospective Payment System Final Rule. Available at: http://edocket.access.gpo.gov/2008/pdf/E8-17914.pdf
19 Centers for Disease Control and Prevention: Press Release, March 2000. Available at: http://www.cdc.gov/od/oc/media/pressrel/r2k0306b.htm
20 Klevens et al. Estimating Health Care-Associated Infections and Deaths in U.S. Hospitals, 2002. Public Health Reports March-April 2007. Volume 122
Resources
21 2007 Leapfrog Group Hospital Survey. The Leapfrog Group 2007. Available at: http://www.leapfroggroup.org/media/file/Leapfrog_hospital_acquired_infections_release.pdf
22 CMS, CDC, & Prevention Agency for Healthcare Research and Quality. Transcript of “Hospital-Acquired Conditions & Hospital Outpatient Healthcare-Associated Condition Listening Session.” Thursday, December 18, 2008.Available at: http://www.cms.hhs.gov/HospitalAcqCond/07_EducationalResources.asp#TopOfPage
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