Financial projection

renmeyer@sbcglobal.netrenmeyer@sbcglobal.net
in CDI Talk Archive
We are a 170 bed rural hospital with 3 CDI's. We just recently started our CDI program. Our target financial benefit through the CDI program was set at $2 million for the year. I think that is an unrealistic expectation.
Does anybody have some thoughts on this.
Also, if anybody would be willing to share what their financial target is, including hospital size and number of CDI's I would really appreciate your input.

Thank You
Renee

Comments

  • sharon.cooper@owensborohealth.orgsharon.cooper@owensborohealth.org
    edited May 2016
    I think 2M is certainly doable - you can capture a lot with just a cc or mcc, esp on a surgical case - just with a query clarifying dx they are actually treating & just not documenting clearly or In the appropriate coding terminogy.

    Sharon Cooper, RN-BC, CCS, CDIP, CCDS
    AHIMA-Approved ICD-10-CM/PCS Trainer
  • fentona@bronsonhg.orgfentona@bronsonhg.org
    edited May 2016
    I think it really depends on your pt. population. We are a 400+ bed hospital. We have 2 CDI's and see only Medicare patients. We are told we generate around 1.7M+

    Amy Fenton, R.N.
    Clinical Documentation Specialist
    Bronson Hospital
    Quality and Safety
    601 John Street
    Box 59
    Kalamazoo, MI 49007
    Phone 269-341-8442
    Fax 269-341-8330
    E mail fentona@bronsonhg.org

    every 6 months....
  • katysuegood@gmail.comkatysuegood@gmail.com
    edited May 2016
    We don’t have a financial target. I’m not saying that we don’t look at what we bring in, our consulting group does provide that information. But honestly, we just received our biannual report and I hadn’t even thought to look at that piece. In fact, I can only remember looking at it once, when we were first starting our program 2 years ago. I am sure hospital leadership DOES look at it though and I know my director has used it as a way to get support for additional FTE’s. Although we all know that our hope is to have a financial benefit for the hospital, we have tried to move away from the concept of “maximize reimbursement” towards “ensure a complete record”. I remember reading something recently (maybe from ACDIS?) about what the financial impact of a CDI may be depending on how effective they are, but for some reason I cannot find it now. I believe 2million would fall into the realm though, on the higher end. Maybe unrealistic for a new program. I would imagine a lot would also depend on what CDI in your facility is doing. Are you querying only for DRG impact, quality indicators, data necessary for coding that does not impact the DRG? Are you involved in other areas in the hospital, RAC, ICD-10? Many of these things may in fact be revenue generating (or at least save the hospital some money), but it may be difficult to calculate what kind of impact is being had. I admit, I don’t love the idea of a financial goal. Call me naive, but I like to think (or at least pretend) that this isn’t all about money. I worry about how a financial goal might impact how a CDS reviews records and their decision to query.

    Katy Good, RN, BSN, CCDS, CCS
    Clinical Documentation Program Coordinator
    AHIMA Approved ICD-10CM/PCS Trainer
    Flagstaff Medical Center
    Kathryn.Good@nahealth.com
    Cell: 928.814.9404
  • mdomineseymdominesey
    edited May 2016
    Renee,

    The Advisory Board has a great presentation that they use to try and drum up business for their CDI services. In it they state that for a 200 bed hospital, a great performing program (experienced CDI, admin support, electronic management application) that each CDI Specialist can generate $1.2 million due to improvements in the documentation. They state an average person and program is about $750k each.

    $2mil does sound reasonable for 3 CDI's in the second year in a rural hospital. Strive for it, but be able to explain why you didn't reach it. Cover your costs - salary + 30% and your electronic system - keep track of that. Show a positive cash flow to make the accountants happy, then reach for the stars!

    I beat the drum continuously that it is not about the money. I was trained in reaching for Severity and Risk using APRs. The money will follow the comprehensive documentation of severity and risk. With ~3hrs each day last month, I showed over $55k due to my efforts!

    Kindest Regards,

    Mark



    Mark N. Dominesey, RN, BSN, MBA, CCDS, CDIP
    Clinical Documentation Excellence
    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
    mdominesey@sibley.org
    http://www.sibley.org
  • katysuegood@gmail.comkatysuegood@gmail.com
    edited May 2016
    You're right Mark, It WAS Advisory Board material that I looked at that stated what an "average" and "superior" CDI will generate. Thanks for the reminder!

    I have a copy of their "Best in Class Clinical Documentation Improvement Programs" book. It provides good, basic info, I believe.


    Katy Good, RN, BSN, CCDS, CCS
    Clinical Documentation Program Coordinator
    AHIMA Approved ICD-10CM/PCS Trainer
    Flagstaff Medical Center
    Kathryn.Good@nahealth.com
    Cell: 928.814.9404
  • Unknown
    edited May 2016
    How do I get a copy of the book mentioned here? thanks

    Jamie Dugan RN
    Clinical Documentation Improvement Specialist
    Baptist Health System
    office:904-202-4345
    cellular: 904-237-7253
    Business Email-jamie.dugan@bmcjax.com
    cdis.icd10@bmcjax.com
  • katysuegood@gmail.comkatysuegood@gmail.com
    edited May 2016
    Hmmm.... I got it from an Advisory Board Summit I attended in the spring. Does your hospital purchase products from the Advisory Board?
    I would contact them directly and ask. I am not sure whether these materials are something they give out or if it is just for Advisory Board customers.

    I will be attending their next summit next week, I can see if they have some there.

    Katy Good, RN, BSN, CCDS, CCS
    Clinical Documentation Program Coordinator
    AHIMA Approved ICD-10CM/PCS Trainer
    Flagstaff Medical Center
    Kathryn.Good@nahealth.com
    Cell: 928.814.9404
  • Unknown
    edited May 2016
    Thanks Kathy! Do they have a web site?

    Jamie Dugan RN
    Clinical Documentation Improvement Specialist
    Baptist Health System
    office:904-202-4345
    cellular: 904-237-7253
    Business Email-jamie.dugan@bmcjax.com
    cdis.icd10@bmcjax.com
  • katysuegood@gmail.comkatysuegood@gmail.com
    edited May 2016
    I believe it is Advisory.com

    Katy Good, RN, BSN, CCDS, CCS
    Clinical Documentation Program Coordinator
    AHIMA Approved ICD-10CM/PCS Trainer
    Flagstaff Medical Center
    Kathryn.Good@nahealth.com
    Cell: 928.814.9404
  • Unknown
    edited May 2016
    Thanks!

    Jamie Dugan RN
    Clinical Documentation Improvement Specialist
    Baptist Health System
    office:904-202-4345
    cellular: 904-237-7253
    Business Email-jamie.dugan@bmcjax.com
    cdis.icd10@bmcjax.com
  • sharon.colesharon.cole
    edited May 2016
    Katy,
    Where can I get information on the Advisory Board Summit next week? We do not have a contract with them, can anyone go?

    Sharon Cole, RN, CCDS
    Providence Health Center
    Case Management Dept
    254.751.4256
    Sharon.cole@phn-waco.org
  • evanspx@sutterhealth.orgevanspx@sutterhealth.org
    edited May 2016
    Renee: In order to answer with any accuracy, one would need to compute a number of factors, to include, but not limited to, your CC/MCC capture rate prior to and post CDI implementation, and your 'effective' Base Rate.

    For instance, in San Francisco, many of 'my' hospitals have an effective (Blended) Base Rate of $10,000 - which is high. This is because our Disproportionate Share (DSH) Factor is high and also because we have teaching hospitals. (What this means is that if I find a 'cc' and increase the R.W. by .5, I increase the reimbursement for that case by $5,000.)

    So, do you know your effective (blended) Facility Base Rate for your Medicare Cases?

    In our facility, we increased the average CMI by about 8% over a 20 month period - I can't post the exact $$ amounts publicly, but this was a substantial increase. If you can obtain your TRUE blended Base Rate for a fiscal year, you could project the % increase you believe you could obtain via your program and then multiply this by your Base Rate.

    Another important factor is the 'quality ' of the documentation - if your staff documented nicely prior to any CDI intervention, your gains could be modest.

    You can call me for a private discussion about finances, if you wish.

    Paul Evans, RHIA, CCS, CCS-P, CCDS
     
    Manager, Regional Clinical Documentation & Coding Integrity
    633 Folsom St., 7th Floor, Office 7-044
    San Francisco, CA 94107
    Cell:  415.637.9002
    Fax:  415.600.1325
    Ofc:  415.600.3739
    evanspx@sutterhealth.org
  • evanspx@sutterhealth.orgevanspx@sutterhealth.org
    edited May 2016
    I think we should consider the realistic expectation from Senior Leaders that CDI can compliantly and positively affect finances - but, I would also track and correlate Quality Measures, such as Observed/Expected Mortality Ration that are a direct product of our efforts. (We do not discuss financial implication with our staff, but the CEO, CMO, and so forth, do track the CMI with me and they expect me to explain significant positive and negative changes).

    Paul Evans, RHIA, CCS, CCS-P, CCDS
     
    Manager, Regional Clinical Documentation & Coding Integrity
    633 Folsom St., 7th Floor, Office 7-044
    San Francisco, CA 94107
    Cell:  415.637.9002
    Fax:  415.600.1325
    Ofc:  415.600.3739
    evanspx@sutterhealth.org
  • ssalinasssalinas
    edited May 2016
    I was just about to send an email echoing what Paul says below.

    To determine financial impact, you have to look at where the facility was prior to the CDI program. If your percentage of accts with CC/MCCs is high to start with, the financial impact may be relatively low. Your CMI may not be observed to increase significantly.

    In these facilities, the value of CDI programs may well be the better and stronger documentation achieved which will meet RAC/QIO/MAC and other review organizations increasingly stringent documentation demands.

    Sharon Salinas, CCS
    Barlow Respiratory Hospital
    213-250-4200 Extension 3336
  • katysuegood@gmail.comkatysuegood@gmail.com
    edited May 2016
    This stuff is so complicated. Our consulting group gives us the data regarding our financial impact but I'll be honest and say that I'm not 100% sure what all is considered in that calculation. I also don’t 100% "buy it" but the hospital wants that data and at least this way I am not the one trying to calculate it.
    CMI is such a tough indicator because it is not solely impacted by CDI. I guess if we are sure that we didn’t have any major variables change from year to year, it would work but in our case, this is unlikely. If we take on another CT surgeon, our CMI will change. We just recently had one of our (2 total) neurosurgeons die suddenly. We have no idea when his position will be filled permanently. Our CMI may drop without the 2nd surgeon. We added a bariactric program a few years ago, revamped our joint program, etc.
    Then there are other factors on top of this. For example, We went live with EHR (Executive health resources, not an electronic medical record) last year. Accordingly, we now have a FAR lower OBS rate (meaning, they are now moving into Inpatient status but have a low RW, SOI/ROM, etc). We expect this to have a significant impact on our CMI.
    So far, we have focused on CC/MCC capture rate and SOI/ROM data. We look at our place within our state cohort of similar hospitals, etc...


    Katy Good, RN, BSN, CCDS, CCS
    Clinical Documentation Program Coordinator
    AHIMA Approved ICD-10CM/PCS Trainer
    Flagstaff Medical Center
    Kathryn.Good@nahealth.com
    Cell: 928.814.9404
  • evanspx@sutterhealth.orgevanspx@sutterhealth.org
    edited May 2016
    Katy: Agree, it is very complicated and also 100% agree the factors that move CMI are multi-variable and not limited to CDI and/or coding functions. What one 'can' do is track case-by-case the financial impact CDI has upon individual cases and then report the impact as ONE of the metrics for the CDI program. However, we should obviously also address the CDI impact upon Quality Measures. I think this is compliant if a program:

    * Reviews all payers - not just Medicare
    * Performs query function for educational reviews and issues queries that do not impact the DRG
    * Performs queries solely for the sake of compliantly and correctly reporting the ROM/SOI

    IMO, positively impacting the ROM/SOI will also positively impact the CMI because a documentation program that compliantly increase the specificity of documentation in regards to acuity and types of diseases will improve coding under the APR/DRG and MS-DRG systems.

    I am working currently to establish the metrics below:

    Purpose: Establish a Basic Dashboard for Clinical Documentation Activities with defined operational and outcome measurements

    Outcome Measures - Include volumes for each metric

    • Overall CMI
    • Medical CMI
    • Medical CC/MCC capture rates
    • Medical CMI without mechanical ventilation DRGs
    • Surgical CMI
    • Surgical CC/MCC capture rates
    • Surgical CMI excluding tracheostomy and transplants
    • Surgical CMI by service line
    • CC/MCC capture rates for specific DRG pairs and triplets (comparative data)
    (Compare target areas at regular intervals to Medicare Provider Analysis and Review Data, PEPPER data, and/or a benchmarked peer group available via MIDAS+)
    • Financial Impact based on changes in the CMI

    Paul Evans, RHIA, CCS, CCS-P, CCDS
     
    Manager, Regional Clinical Documentation & Coding Integrity
    633 Folsom St., 7th Floor, Office 7-044
    San Francisco, CA 94107
    Cell:  415.637.9002
    Fax:  415.600.1325
    Ofc:  415.600.3739
    evanspx@sutterhealth.org
  • evanspx@sutterhealth.orgevanspx@sutterhealth.org
    edited May 2016
    Good point, Sharon

    One more point - we should bear in mind that the stated position of CMS is revenue neutrality - does this mean CMS designs to keep our overall CMI flat for upcoming years by keeping relative weights unchanged? I don't know? If so, 'treading water' in regards to our CMI may truly be a CDI success? Something to consider?

    Paul Evans, RHIA, CCS, CCS-P, CCDS
     
    Manager, Regional Clinical Documentation & Coding Integrity
    633 Folsom St., 7th Floor, Office 7-044
    San Francisco, CA 94107
    Cell:  415.637.9002
    Fax:  415.600.1325
    Ofc:  415.600.3739
    evanspx@sutterhealth.org
  • katysuegood@gmail.comkatysuegood@gmail.com
    edited May 2016
    Exactly! Also, I really try to keep the money talk to a minimum. In my experience, even the mention of reimbursement kills physician buy in. I try to focus on SOI/ROM as this is where the MD's can get on board. We emphasize that we want them to "get credit" for all the care they provide and this is how we do that. This all will impact their future "physician report cards", etc. So whether they like it or not, they can at least identify with the importance. Besides, and increased SOI/ROM should impact reimbursement down the road.

    It's not that different than the conversations I have with coders. It is not enough anymore to just assure that they have the highest DRG possible. Multiple CC/MCCs offer DRG denial protection, individual SOI/ROM impacts our institutional Mortality Rate (huge issue for us right now). The days where coding was just tied to reimbursement are over. It seems like every department is looking back at coded data for information ranging from quality data to justification of FTE's. And that’s WITHIN the institution, not all the organizations outside the hospital that use this data.

    It is imperative that we remain diligent about ensuring a accurate and complete record. From the documentation and coding standpoint. And honestly, financial impact is only a small part of it.

    Katy Good, RN, BSN, CCDS, CCS
    Clinical Documentation Program Coordinator
    AHIMA Approved ICD-10CM/PCS Trainer
    Flagstaff Medical Center
    Kathryn.Good@nahealth.com
    Cell: 928.814.9404
  • evanspx@sutterhealth.orgevanspx@sutterhealth.org
    edited May 2016
    Katy: Excellent philosophy - we never discuss the $$ implications with the treating staff and we never should. We DO discuss the 'score card', ROM, Quality, so forth, as per your response. I DO discuss the $$ in closed doors with the C-Suite, and they expect answers and rightly so, in my opinion. However, these same executives ALSO are concerned about our publicly reported outcomes data, much of which is based on coded data.



    Paul Evans, RHIA, CCS, CCS-P, CCDS
     
    Manager, Regional Clinical Documentation & Coding Integrity
    633 Folsom St., 7th Floor, Office 7-044
    San Francisco, CA 94107
    Cell:  415.637.9002
    Fax:  415.600.1325
    Ofc:  415.600.3739
    evanspx@sutterhealth.org
  • renmeyer@sbcglobal.netrenmeyer@sbcglobal.net
    Thanks to everybody for your input and comments. Lots of interesting information. Again, thanks a lot!
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