jean s. clark rhia. roper st. francis healthcare private, not-for-profit community health system in...
TRANSCRIPT
Roper St. Francis Healthcare
• Private, not-for-profit community health system in Charleston, SC
• Two acute care hospitals, a third on the way• Rehabilitation hospital• 50% Medicare• Very traditional medical staff
Our journey to improve documentation at the bedside
• Go-live—September 2005• Started “thinking” about a clinical documentation
program 3 years prior• Coding was good• Stable coding work force • SO WHY CDI?• Last frontier• External demands for data increasing• Patient care and safety—THE primary reason!
Our journey to improve documentation at the bedside
• January 2005: Started the journey• Decided not to do this on our own• Interviewed consulting firms that specialized in
CDI programs• Criteria for selection• Provided education• Software• Quarterly educational/assessments of the
program• Monthly reports• Experienced in CDI implementations
Our journey to improve documentation at the bedside
• Structure of the program
• Research
• Contacted other hospitals
• Read the literature
• Surveyed hospitals in our state
Our journey to improve documentation at the bedside
• Structure of the program• Reports to HIM service line director• CDI specialists are all RNs
—“documentation detectives” • Varied experience• Internal and external candidates selected• All but one RN is still with the program,
and they love what they do!
Our journey to improve documentation at the bedside
• Structure of the program
• What about the coders?
• Acceptance vs. issues
• Part of training and teams
• Coding data quality specialist—a key player!
• Coding manager’s role
Our journey to improve documentation at the bedside
• Structure of the program
• 4 CDI specialists at Roper
• 2 CDI specialists at STF
• 1 manager
CDI and coding
• Strong managers
• Coding data quality specialist
• Process for resolving disputes
• CDI for clinical expertise
• Coders for coding expertise
Our journey to improve documentation at the bedside
• Physician education and acceptance• Did not use consultants to educate physicians• Focused on improving documentation for patient
care and safety• Did not focus on reimbursement• MDs part of the team• What’s in it for you• Non-threatening approach• Education is ongoing• The CDI team—RN, coders, physicians
Our journey to improve documentation at the bedside
• First-year program exceeded our expectations and projected ROI
• Improved our CC capture rate• Improved our case mix• Reduced number of symptom codes used
as principal diagnoses• Paved the way for MS-DRGs and POA
Process
• CDI specialists have cell phones and laptops
• Assigned to specific nursing units• Spend majority of the day on the units• New admissions, re-reviews• Enter data into Midas• Serve as educators• Attend meetings on a regular basis
Query forms
• Used consultant’s query at first
• Now tailored for specific DRGs
• Used while the patient is in the hospital and not after discharge
• Coders query after discharge
• Goal to reduce queries
Communication tools
• Query forms, for example: circulatory system disorders, sepsis, pneumonia, debridement
• Pocket cards, for example: department of orthopedics, major GI diagnoses, circulatory system MCCs, UHDDS guidelines for reporting secondary diagnoses
• Intranet site• SC CDI cooperative
Key partners
• Case management• VP, medical affairs• Performance improvement• Medical staff• Emergency department• Hospitalists• Pharmacist• Anesthesiologists
ReportsCMI
• Overall system CMI (no exclusions)• Medicare CMI• Medicare medical CMI • Medicare medical CMI, less vents• Medicare surgical CMI• Surgical CMI, excluding trachs and transplants• Overall CMI, excluding trachs and transplants
ReportsCC capture rates
• Overall CC capture rate as a % of total CC DRGs• Overall cases w/o CC• Overall cases with CC• Medical CC capture rate as a % of total CC DRGs• Medical cases w/o CC• Medical cases with CC• Surgical CC capture rates as a % of total CC DRGs• Surgical cases w/o CC• Surgical cases with CC
Format
• Current month compared to same month a year ago
• Percentage difference• YTD post go-live• YTD pre go-live• Percentage difference• MedPAR compared to MedPAR national 80th
percentile• Medical opportunity achieved (in $$$)• Surgical opportunity achieved (in $$$)
Other reports
• MDC reports
• DRG pair capture rates
• Physician reports
• Working DRG vs. final DRG
Added benefits
• Integral part of physician profile meetings
• Collect data for focused reviews (for example timeliness of H&Ps)
• Worked with one department to improve H&Ps
• Easy transition to POA and MS-DRGs
Lesson learned
• Need a manager from the beginning
• Make sure your vendor has had “enough” experience and staff
• It has far exceeded our expectations!