IMPORTANT!!!!
This is lengthy so I apologize in advance, but our CDI group is so frusterated and don't know where to turn.
I have a very important question, and don't know where to turn. Our 4 person CDI group has been told that the "goals" for our program for the upcoming year are to 1.) increase reimbursement by $1,000,000.00 and 2.) to DECREASED THE O/E MORTALITY TO BELOW 1%. While I understand the o/e ration, WE DON'T understand how to improve it without knowing how it is calculated. Yes, I understand it is based on the observed vs expected deaths, but WHAT AND HOW DO WE IMPROVED THAT? Through documentation yes, but It is more than that, and here-in lies the question.
I will tell you initially our group figured out, on our own- that we thought by adding MORE MCC's and CC's- and thus RAISING THE SOI AND ROM TO THE HIGHEST LEVELS OF 4, THAT this WOULD HELP SHOW A MORE TRUE PICTURE AND THUS INCREASE THE EXPECTATION OF DEATH. We did this for a month, and spent a lot time on the death reviews daily capturing all MCC, CC and general diagnosis. (we currently only see about 60% of Medicare patients, but are tasked with death reviews). So, after a month of this, we had a conference call with our Consultant Group who told us basically that all we needed to do was to worry about the National Mortality Rate of a DRG/Diagnosis (for instance, DRG 871 is Nat mortality of 18.5% ...HOWEVER, the ROM for that DRG Is only a 3, and SOI is only a 3. Wouldn't I want to continue to capture every diagnosis that may raise this to SOI 4 and ROM 4? Wouldn't that then help the O/E ration more than just assigning the highest weighted DRG. When we asked this (of several people) we were told that by seeing 100% of our census of Medicare patients, that would help the O/E ration-HOW IS SEEING 100% OF THE PATIENT POPLUATION HELPING AND O/E RATION? Wouldn't it be by reviewing 100% of the DEATHS that we affect that. How would reviewing 100% of the population of medicare-MOST of whom leave ALIVE affect the o/e ratio? AS long as we review 100% of deaths, it seems to me we would be affecting the o/e ratio!
So, is it based on national mortality or based on the SOI, ROM levels? One of our CDI just returned from the ACDIS boot camp and was told to us the highest SOI and ROM and that is what impacts it, but with so much conflicting info, we want to ensure we put the process in place that is going to help us reach our goals. HELP!!!!! And thanks in advance! SOOOOO frusterated......
Juli Bovard RN CCDS
Certified Clinical Documentation Specialist
Clinical Effectiveness/Clinical Quality
Rapid City Regional Hospital
719-4390 (work)
786-2677 (cell)
"No Limit to Better......"
[CCDS_pin_1inch]
"The difference between the right word and the almost right word is the difference between lightning and the lightning bug."- Samuel "Mark Twain" Clemens
I have a very important question, and don't know where to turn. Our 4 person CDI group has been told that the "goals" for our program for the upcoming year are to 1.) increase reimbursement by $1,000,000.00 and 2.) to DECREASED THE O/E MORTALITY TO BELOW 1%. While I understand the o/e ration, WE DON'T understand how to improve it without knowing how it is calculated. Yes, I understand it is based on the observed vs expected deaths, but WHAT AND HOW DO WE IMPROVED THAT? Through documentation yes, but It is more than that, and here-in lies the question.
I will tell you initially our group figured out, on our own- that we thought by adding MORE MCC's and CC's- and thus RAISING THE SOI AND ROM TO THE HIGHEST LEVELS OF 4, THAT this WOULD HELP SHOW A MORE TRUE PICTURE AND THUS INCREASE THE EXPECTATION OF DEATH. We did this for a month, and spent a lot time on the death reviews daily capturing all MCC, CC and general diagnosis. (we currently only see about 60% of Medicare patients, but are tasked with death reviews). So, after a month of this, we had a conference call with our Consultant Group who told us basically that all we needed to do was to worry about the National Mortality Rate of a DRG/Diagnosis (for instance, DRG 871 is Nat mortality of 18.5% ...HOWEVER, the ROM for that DRG Is only a 3, and SOI is only a 3. Wouldn't I want to continue to capture every diagnosis that may raise this to SOI 4 and ROM 4? Wouldn't that then help the O/E ration more than just assigning the highest weighted DRG. When we asked this (of several people) we were told that by seeing 100% of our census of Medicare patients, that would help the O/E ration-HOW IS SEEING 100% OF THE PATIENT POPLUATION HELPING AND O/E RATION? Wouldn't it be by reviewing 100% of the DEATHS that we affect that. How would reviewing 100% of the population of medicare-MOST of whom leave ALIVE affect the o/e ratio? AS long as we review 100% of deaths, it seems to me we would be affecting the o/e ratio!
So, is it based on national mortality or based on the SOI, ROM levels? One of our CDI just returned from the ACDIS boot camp and was told to us the highest SOI and ROM and that is what impacts it, but with so much conflicting info, we want to ensure we put the process in place that is going to help us reach our goals. HELP!!!!! And thanks in advance! SOOOOO frusterated......
Juli Bovard RN CCDS
Certified Clinical Documentation Specialist
Clinical Effectiveness/Clinical Quality
Rapid City Regional Hospital
719-4390 (work)
786-2677 (cell)
"No Limit to Better......"
[CCDS_pin_1inch]
"The difference between the right word and the almost right word is the difference between lightning and the lightning bug."- Samuel "Mark Twain" Clemens
Comments
I review 100% of our discharges post discharge but before the bill drops with the goal of getting to a soi/rom of 4/4 (obviously when appropriate)-also making sure that you have an appropriate PDX. By doing so, our publicly reported data did greatly improve. The other factor is making sure that the palliative care code is coded on all comfort care cases (v66.7). Please feel free to email me directly or call me if you have more questions.
Kerry Seekircher, RN, CCDS
Documentation Specialist Supervisor
Northern Westchester Hospital
400 East Main Street
Mount Kisco, NY 10549
Email: kseekircher@nwhc.net
Phone: 914-666-1243
Fax: 914-666-1013
1. ALL of your patients do get a risk of mortality calculation performed on them, even those who don't die. This is why you want to review and impact as many charts as possible.
2. SOI and ROM is proprietary software by 3M and these numbers may or may not be used with the mortality models you use to risk adjust. Use SOI and ROM with caution, as these are generally based upon the presence of all diagnoses coded and how they "interact" (occur together in a statistical population).
3. Various risk adjustment models only factor in diagnoses that are POA-Y. This seems logical because only diagnoses and conditions that the patient has at the time of admission should be used. Those that develop during the stay may be hospital acquired (and could be considered a potential quality concern). For example, most patients that die can easily get an ROM of 4 at discharge. Is that really accurate? If you come in for an appendectomy, your discharge ROM should be 1, maybe 2. However, after you develop post-op sepsis, VAP and encephalopathy, you are likely at a ROM of 4. Should you be? Probably not since you didn't have those conditions POA-Y. You got them on "our" watch.
Try calculating your ROM on admit after any CDI intervention that impacts admit POA and diagnoses. If you are impacting admit ROM, I'd say you are accomplishing something. Also, look at your admit ROM and discharge ROM. If you see big differences here you may need to look review for possible quality of care and/or documentation.
We really like UHC's models because we have access to all the statistical models used in the calculations of our patients. Nothing is hidden or proprietary.
Hope this helps.
Pam Florence, RN
Clinical Documentation Specialist
UK HealthCare
Phone: (859) 323-1236
Pager: (859) 330-8608
E-mail: paflor2@uky.edu
I am sorry you are frustrated, I know the feeling. Here is what I know:
1. ALL patients, not just patients who die impact your O:E ratio. You cannot impact you 'observed' so you have to focus on the 'expected' part of the equation. This is derived from the severity of ALL patients.
2. My understanding is that SOI/ROM is a factor, but I will be interested in hearing opposing views.
3. If you are an academic medical center using UHC, there may be other factors at play. Don Butler can provide great info on this if needed.
When I started, we had a very high O:E ratio. We implemented our concurrent CDI program largely to combat this. I also review every death chart for documentation and coding prior to it being dropped for billing. We have seen dramatic improvement. If you want more detailed info on our process let me know.
Good luck!
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
So you want all patients to be at highest level of SOI/ROM. Your discharge alive which is a greater population than your deaths factors into your ratio.
Also you need to know what metrics are used for comparison. For example UHC has their own O/E formula and some other things go in to that other than just coded data.
Robert and Mark are pretty savvy on this issue - hope they add their 2 cents worth.
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
sabullock@umc.edu
umhc.com
Thanks!
Renee
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
Renee
Methodology
– AHRQ PSIâ€90 Composite
• Riskâ€adjusted and reliabilityâ€adjusted rates
– CDC measures
• SIR (Standard Infection Ratio), which compares actual
number of HAIs at a facility to a national baseline
(observedâ€toâ€expected ratio)
So, it seems like O/E is going to be a HAC measure come FY 2015 (if I'm reading/understanding this appropriately)
Melissa Varnavas | Associate Director
ACDIS | 75 Sylvan Street, Suite A-101, Danvers, MA 01923
P 781-639-1872, ext. 3711 | www.acdis.org
Pam Florence, RN
Clinical Documentation Specialist
UK HealthCare
Phone: (859) 323-1236
Pager: (859) 330-8608
E-mail: paflor2@uky.edu
Here is a link to audio : http://www.hcmarketplace.com/prod-11507/2014-IPPS-Final-Rule-Explained.html
Here is a link to the Final Rule *warning-the document is more than 2,000 pages* http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/FY2014-IPPS-Final-Rule-Home-Page.html
Anyone else out there have additional information to weigh in?
Melissa Varnavas | Associate Director
ACDIS | 75 Sylvan Street, Suite A-101, Danvers, MA 01923
P 781-639-1872, ext. 3711 | www.acdis.org