ROM/SOI Review Methodology

evanspx@sutterhealth.org

I have a complicated question and will try to brief.

I need to conduct a systematic review of documenation and coding at a site with a climbing O/E score. I would like some input regarding sampling methodology.
Also, would it be valuable to review the APR-DRGs at this site that have generated 'low' SOI/ROM scores, taking into account volume? I am trying to devise a samping methodlogy that will help strategically identify potential documentation and coding opporutnities that may compliantly help the site generate accurate, and hopefully "BETTER" outcomes for the O/E via improved ROM/SOI scores. But, I can't revew every chart and I need to ensure any sample is valid. Ideally, I could obtain data to include account numbers of the targeted cases so that I could audit and recode each case.

Any help appreciated.
Paul Evans, RHIA, CCS, CCS-P, CCDS
I believe I should reivew these types of cases:

A focused record review of high risk cases (e.g. those with a death with an APRDRG risk of mortality of 2 or less or with charges that exceed 300% of the expected DRG payment)

evanspx@sutterhealth.org

Formatting errors - please allow me to resend for the sake of clarity:


I have a complicated question and will try to brief.

I need to conduct a systematic review of documentation and coding at a site with a climbing O/E score. I would like some input regarding sampling methodology.
Would it be valuable to review the APR-DRGs at this site that have generated 'low' SOI/ROM scores, taking into account volume? I am trying to devise a sampling methodology that will help strategically identify potential documentation and coding opportunities that may compliantly help the site generate accurate, and hopefully "BETTER" outcomes for the O/E via improved ROM/SOI scores.

But, I can't review every chart and I need to ensure any sample is valid. Ideally, I could obtain data to include account numbers of the targeted cases so that I could audit and recode each case. Should I perform a focused record review of high risk cases (e.g. those with a death with an APR‐DRG risk of mortality of 2 or less or with charges that exceed 300% of the expected DRG payment or cases that exceed GMLOS?

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

sabullock

If you only focus on mortality, I would eliminate the palliative care ones and those that die on the same day of admission. Often it is difficult to get the ROM up on those.
Cases that exceed GMLOS and are not 4/4 (if that is your goal) would probably give you more information.

Shelia

katysuegood@gmail.com

Paul,

Our O:E ratio was why I was tasked with review mortality records. Though all records impact O:E, this is what they wanted reviewed so that’s my sample. We have had significant impact on E:O with this process. We are still not where we want to be though so I'll be curious what you decide and how it works out.
If you want to know any more about our process, let me know. I also am presenting a poster on it at the ACDIS conference.

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.org

Thanks, Katy and Shelia.

Katy - I would like to know anything you wish to share and you have my e-mail. To summarize, you had significant impact at your site by focusing only on Expired Cases - is that correct?

I also believe a recent change in APR/DRG methodology that took effect with Grouper V30.0 may be a factor - see message from a vendor.

"On Wednesday, January 23, 2013, we will update the DataVision and CPMS web applications to use the logic of the 3M All Patient Refined Diagnostic Related Groups (APR DRG) Grouper, version 30.0. In this version, 3M has significantly changed the risk-of-mortality (ROM) and severity-of-illness (SOI) ICD-9-CM assignments, as well as the APR DRG routing logic. To maintain continuity for APR DRG expected and predicted values in the web application, we will use version 30.0 to process all data in the Midas+ Comparative Database.

The changes in APR DRG version 30.0 might affect your facility's APR DRG data. Midas+ reviewed the data and noted a 10% to 17% decrease in the number of encounters in SOI Level 3 (major) and Level 4 (extreme). Although these groups had a smaller number of patients, their length of stay (LOS) and mortality tended to be higher than in version 29.0. These results correlate with 3M findings. "


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

vivian.gannon

Katy,

I am excited to hear you will be at the conference! Looking forward to meeting you and hearing about your poster presentation. I am just now beginning to formulate a process to begin Mortality Reviews here, so any words of wisdom you can offer will be much appreciated!

Vivian

Vivian E. Gannon RN,CCM,CCDS
Clinical Documentation  Improvement Coordinator
Chesapeake Regional Medical Center
vivian.gannon@chesapeakeregional.com

katysuegood@gmail.com

Sorry for the delayed response. We are mid-move and life is a little hectic

We initiated mortality reviews 2 years ago due to a poor O:E ratio. We have had significant improvement in the O:E ratio since then which I attribute to both the CDI program itself and the mortality reviews (they both started at roughly the same time). The impact we have had due to mortality reviews likely could have been attained by reviewing any similar subset of patients but the decision was made to focus on mortalities mainly because this is where a lot of other focus lies. MD's tend to hone in on their death records. Our MD's are becoming more aware of their quality data and therefore scrutinize the coding of death records. We want to ensure that these records are highly accurate and my review helps with this.
We started this process when was new to CDI. It started out as a joint effort between our coding manager and I. We literally sat side-by-side and reviewed each record for both coding and documentation opportunities. About a year in, after I had more experience and had achieved my CCS, I took over completely (except when I still call her with questions). We review every death chart regardless of SOI/ROM. I focus on Pdx and SOI/ROM but I also provide feedback with additions/deletions of diagnoses regardless of impact. I only query when it will impact Pdx, SOI/ROM, or to clarify complications. Additionally, any charts that after my review will have a lower SOI/ROM than 3/3 get sent to our MD advisor.
I can go into further detail about how the technical side of how our system works if you want that type of info. Just let me know


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.org

Helpful information, Katy. Thank you for your assistance.

Paul

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