multi-hospital system model
What are the "best practice" models for a multi-hospital CDI program? We are moving from a hybrid EMR to a fully electronic state and hope to reduce CDI process variation across the facilities. Specific questions:
1. CDI credentials
2. Ratio of CDI to discharge charts
3. CDI focus: all, Medicare only, DRG based payors, other
4. Remote review only or some variation
5. Electronic query only or some other variation
6. Reporting structure: Finance, HIM, Quality, Case Management, other
All input is welcome!
Thanks in advance for your assistance.
Clare
Clare Garrard, R.N., D.S.N., CCDS
Health Management Services
Morton Plant Mease Healthcare
300 Pinellas St., MS 42
Clearwater, FL 33756
727.298.6336
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1. CDI credentials
2. Ratio of CDI to discharge charts
3. CDI focus: all, Medicare only, DRG based payors, other
4. Remote review only or some variation
5. Electronic query only or some other variation
6. Reporting structure: Finance, HIM, Quality, Case Management, other
All input is welcome!
Thanks in advance for your assistance.
Clare
Clare Garrard, R.N., D.S.N., CCDS
Health Management Services
Morton Plant Mease Healthcare
300 Pinellas St., MS 42
Clearwater, FL 33756
727.298.6336
Confidential: This electronic message and all contents contain information
from BayCare Health System which may be privileged, confidential or otherwise
protected from disclosure. The information is intended to be for the addressee
only. If you are not the addressee, any disclosure, copy, distribution or use
of the contents of this message is prohibited. If you have received this
electronic message in error, please notify the sender and destroy the original
message and all copies.
Comments
in the July CDI Journal on multihospital system CDI programs. I'd also
recommend looking at the new "road map" on the ACDIS site for some of
your other questions.
The VA is facing this same challenge right now and currently working on
standards which will be implemented at all 157 VA Medical Centers. But
as we do this we must keep in mind that a "one size fits all" will not
work because of the variations in size and focus of the different
medical centers. What will be common is the provider query process,
that existing standard VHA query forms be used, and metrics which will
be captured at the national level. Other items, such as what payers,
how queries are sent to providers, and what services/payers to cover
will have to be determined locally. This is definitely a work in
progress.
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
"Patriotism is easy to understand in America; it means looking out for
yourself by looking out for your country" Calvin Coolidge
I know there are several members that are part of a multi-hospital model. A current board member Lena Wilson is HIM operations manager for Clarian Health in Indianapolis with I believe 6 locations.
What are the "best practice" models for a multi-hospital CDI program?
1. CDI credentials
-- tough issue. I do think credentials are desirable, for us however there is no direct impact for a CDI to obtain (clinical nurses have clinical ladder), and I don't have the employment market that would enable to build as a requirement or as a premium attractant.
2. Ratio of CDI to discharge charts
-- We model to approximately 150 discharges / CDS / month to estimate staffing needs and expected productivity.
see http://blogs.hcpro.com/acdis/2011/11/cdi-productivity-benchmarks-a-cdi-talk-topic/
3. CDI focus: all, Medicare only, DRG based payors, other
-- consider factors: where is the most ROI (& I don't just mean $ -- whatever your organization is looking for as a return); available staffing; what are the priorities -- is there a particular service line that is high visibility? an area that needs particular help with mortality profiling? etc.; consider using age as a basic guideline if not able to cover all -- that way not 'treating' medicare differently & broadly speaking there are more opportunities with documentation improvement with more medically complex patients (and I'm suggesting that correlates roughly with age).
4. Remote review only or some variation
-- great presentation during the National conference -- take a look at the posted ppt in Forms & Tools (2012 Conference: Track 3. CDI from home?); personally feel need to make sure there are solid avenues incorporated for building and maintaining relationships (part of which is face to face), so would be considering more of a variation or blend.
5. Electronic query only or some other variation
-- electronic query as primary avenue. Follow up any way possible to resolve (page, phone, email, chase down hallway...).
6. Reporting structure: Finance, HIM, Quality, Case Management, other
-- we report through HIMS to Finance. Strong cross link with aspects of quality shop with collaborative projects, focus, etc. with CDI, Coding & Quality. No matter the reporting structure, there needs to be strong connection and team work among those areas.
Don