Using $ in Physician Education

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in CDI Talk Archive
Clearly it is not compliant to discuss financial gain or loss within queries. But, when doing physician education to achieve a greater understanding and engagement from them, is it acceptable to talk about the difference in dollar amounts and relative weights of various DRGs? Or should I steer away from this?

Comments

  • mdomineseymdominesey
    edited May 2016
    The general rule is that money is not appropriate when discussing a particular case, but I see nothing wrong in discussing impacts in $$ when doing presentations about appropriate documentation.

    I use the PEPPR to great advantage that way. :)


    Mark N. Dominesey, RN, BSN, MBA, CCDS, CDIP
    Sr. Clinical Documentation Improvement Specialist
    Sibley Memorial Hospital

    Information Technology
    5255 Loughboro Rd NW
    Washington DC, 20016-2695

    W: 202.660.6782
    F: 202.537.4477


    http://www.sibley.org


  • evanspx@sutterhealth.orgevanspx@sutterhealth.org
    edited May 2016
    A better alternative may be to discuss the proper stratification of
    cases to the ROM/SOI assigned via the APR-DRG system. Our general
    policy is not to discuss the financials and to confine discussions to
    the impact of documentation upon quality measures, such as Core
    Measures and Observed/Expected Mortality.

    Our grouper calculates impact on SOI/ROM automatically.

    Paul Evans


    Paul Evans, RHIA, CCS, CCS-P, CCDS

    Supervisor, Clinical Documentation Integrity, Quality Department
    California Pacific Medical Center
    2351 Clay #243
    San Francisco, CA 94115
    Cell: 415.637.9002
    Fax: 415.600.1325
    Ofc: 415.600.3739
    evanspx@sutterhealth.org
  • katysuegood@gmail.comkatysuegood@gmail.com
    edited May 2016
    I find that for the most part, MD's are very turned off by discussing financial impact. If the MD is employed by the hospital, they may care slightly. We spend a lot of time reassuring MD's that money is NOT the motivating factor, so I try not to mention money unless I am talking to leadership/administration.
    I focus on severity of illness, risk of mortality and accurate capture of patient condition.

    Katy Good, RN, BSN, CCDS, CCS
    Clinical Documentation Program Coordinator
    AHIMA Approved ICD-10CM/PCS Trainer
    Flagstaff Medical Center
    Kathryn.Good@nahealth.com
    Office: 928.214.3864
    Cell: 928.814.9404

  • sharon.colesharon.cole
    edited May 2016
    I was first told many years ago to show the money. BUT, I have since learned from all the education I have done that the physicians respond MUCH better to discussions of SOI/ROM (severity of illness and risk of mortality) and quality care. They will also occasionally ask me about the length of stay since this is something they hear about from the case managers/discharge planners. I don't think telling them about the financial impact is a good idea. Seems it could be perceived as leading to me.

    Sharon Cole, RN, CCDS
    Providence Health Center
    Case Management Dept
    254.751.4256
    srcole@phn-waco.org


  • donna.kentdonna.kent
    edited May 2016
    What Katy said.

    Donna Kent, RN, BSN, CCDS
    Manager, Clinical Documentation Integrity Program
    Clinical Quality and Accreditation
    Torrance Memorial Medical Center
    ph.:310 784-6884 fax:310 784-6899
    donna.kent@tmmc.com

  • mdomineseymdominesey
    edited May 2016
    The only time I discuss money is on general terms with physicians who are in administration or in other leadership posts. Example: VPMA/CMO, CMIO, President of Medical Affairs, etc. The physician on the floor generally will not care about the impacts to the *hospital's* bottom line, but I *always* make a point to chat with them about how documentation affects *their* bottom line, like with E/M billing, denials based on insufficient documentation to establish medical necessity, etc. But at query time, is not appropriate to discuss the financial impact even with a verbal query.

    Mark



    Mark N. Dominesey, RN, BSN, MBA, CCDS, CDIP
    Sr. Clinical Documentation Improvement Specialist
    Sibley Memorial Hospital

    Information Technology
    5255 Loughboro Rd NW
    Washington DC, 20016-2695

    W: 202.660.6782
    F: 202.537.4477


    http://www.sibley.org


  • robert.hodges2robert.hodges2
    edited May 2016
    As long as it's education only, such as group education why not? I know I do it when talking about finances and the impact documentation has.

    Robert

    Robert S. Hodges, BSN, MSN, RN, CCDS
    Clinical Documentation Improvement Specialist
    Aleda E. Lutz VAMC
    Mail Code 136
    1500 Weiss Street
    Saginaw MI 48602
     
    P: 989-497-2500 x13101
    F: 989-321-4912
    E: Robert.Hodges2@va.gov
     
    "We are dealing with Veterans, not procedures; With their problems, not ours." --General Omar Bradley

  • robert.hodges2robert.hodges2
    edited May 2016
    And going back, to the other posts, I also focus on SOI and ROM in my education along with continuity of care. Talking about finances makes the admin group happy.

    Robert
     
    VA Core Values:  Integrity, Commitment, Advocacy, Respect, Excellence (“I CARE”)
    VA Core Characteristics:  Trustworthy, Accessible, Quality, Innovative, Agile, Integrated

    "The difference between the right word and the almost right word is the difference between lightning and the lightning bug." Samuel "Mark Twain" Clemens
     
  • cynthia.a.goeweycynthia.a.goewey
    edited May 2016
    We discuss financial impact at our group education presentations. Our physicians are often times amazed at the financial impact that the change in documentation makes. I believe, in our institution, this makes a greater impact on the physicians then discussing SOI/ROM (which we do discuss). I think the economic climate we are in, and the emphasis of our organization to maintain a sustainable environment, has forced all of us to be fiscally aware of our actions.
    Cindy

  • jamiedugan2012jamiedugan2012
    edited May 2016
    I think both are relevant and you have to temper your education to the
    audience you are addressing. What I have found is that the Doctors want
    to do the right thing, but unfortunately documentation as it related to
    reimbursement is now just getting taught in schools. Of course, they
    have no idea the dollar amount tied to any documentation and when they
    do find out my providers have been astonished. What they thought they
    said and what it codes out to are worlds apart usually. Have a great
    day!
    Jamie Dugan RN
    Clinical Documentation Improvement Specialist
    Jacksonville, Florida Baptist Health System

  • sabullocksabullock
    edited May 2016
    I teach all aspects. Severity of Illness, Risk of Mortality, HACs, PSIs, Length of Stay Impact, public reported data, helps suppport E/M (their $s) and hospital reimbursement. That way you are not dwelling on just hospital reimbursement. Most physicians are much more savy than sometimes we give them credit for being. They do understand if the hospital does not get reimbursed this impacts patient care in the long run. Decreased reimbursement means issues with equipment aquisition and expansion of servces. This applies to private and public facilities regardless of size.

    Shelia Bullock, RN, BSN, MBA, CCM, CCDS
    Director, Clinical Documentation Services
    University of Mississippi Health Care
    2500 North State Street
    Room S 336
    Jackson, MS 39216
    T: 601-815-3079 F: 601-815-9505
    sabulllock@umc.edu
    umhc.com
  • evanspx@sutterhealth.orgevanspx@sutterhealth.org
    edited May 2016
    We will speak about the $$ dollar aspect, but only if we are providing a
    'high level' overview to a group of the medical staff. The Chair of
    Medicine co-presents with me and I will code and group scenarios 'live'
    in order to illustrate the impact of documentation upon various metrics.

    We don't discuss the $$$ impact of documentation upon individual
    accounts as we perform concurrent CDI reviews.



    Paul Evans, RHIA, CCS, CCS-P, CCDS

    Supervisor, Clinical Documentation Integrity, Quality Department
    California Pacific Medical Center
    2351 Clay #243
    San Francisco, CA 94115
    Cell: 415.637.9002
    Fax: 415.600.1325
    Ofc: 415.600.3739
    evanspx@sutterhealth.org
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