Staffing
I'd be very interested in some feedback on questions our leadership is presenting:
1. We are currently (as of Oct. 2014) reviewing all payers, but due to other duties and seldom having a full staff, we are reviewing approx. 60% of all inpatients. At that rate, would you say there is still value in reviewing all payers or would you go back to reviewing DRG payers only?
2.Have any of you found value in CDI Specialists working holidays or weekends?
3.Are any of you able to see 100% of all inpatients?
We have a mature program (over 6 years)that performs very well but there seems to be intense scrutiny on our program as well as higher demands! Any of you also feeling that pressure?
Thanks for your feedback.
Linda Haynes, RHIT, CCDS
CDI Manager
lhaynes@lhs.org
503-692-8862
1. We are currently (as of Oct. 2014) reviewing all payers, but due to other duties and seldom having a full staff, we are reviewing approx. 60% of all inpatients. At that rate, would you say there is still value in reviewing all payers or would you go back to reviewing DRG payers only?
2.Have any of you found value in CDI Specialists working holidays or weekends?
3.Are any of you able to see 100% of all inpatients?
We have a mature program (over 6 years)that performs very well but there seems to be intense scrutiny on our program as well as higher demands! Any of you also feeling that pressure?
Thanks for your feedback.
Linda Haynes, RHIT, CCDS
CDI Manager
lhaynes@lhs.org
503-692-8862
Comments
I have the same questions.
We are also a program that has been around for more than 5 years, reviewing all payers and only getting to 65% of all inpatients.
1. We have never just looked at DRG payers only and I am hesitant to set that precedent as our overriding mission is completeness of record for all patients.
2. My staff does not work weekends on a regular basis, just sporadically to make up time.
3. no- we also perform very well but the issue of only getting to 65% of inpatients perplexes and bothers me.
I am looking forward to other CDI programs answers
Kathy
Kathleen Benson RN, BSN, CCDS
Supervisor, Clinical Documentation Integrity
University of Wisconsin Hospital
608-890-5935
kbenson@uwhealth.org
From the point of view of quality I can see the request to review non DRG payors as well.
Donna
Suggest concentration of coverage for cases that may represent high-volume, problematic scenarios subject to query.
Consider audits of:
High Dollar Cases
ICU
CCU
Cardiovascular Surgery
General Surgery
Other
I do personally believe a program should not concentrate solely on Medicare cases, but should review a representative sampling of all payers.
Regarding mortality, ALL admission factor into the Expected portion of the ROM equation - hence, my belief is that we are best served by reviewing those locations within our facilities whereby the patients with the highest complexity of acuity of care are treated.
PE
Paul Evans, RHIA, CCS, CCS-P, CCDS
Manager, Regional Clinical Documentation & Coding Integrity
Sutter West Bay
633 Folsom St., 7th Floor, Office 7-044
San Francisco, CA 94107
Cell: 415.412.9421
Hope this helps.
Vickie Smith RN, BSN, CCM, CCDS | Clinical Documentation Specialist-Manager | 740-779-7548 | vsmith@adena.org
Adena Health System | Clinical Documentation Integrity Program
272 Hospital Rd. | Chillicothe, OH 45601
Phone: 740-779-7548
You have quite the dilemma on your hands.
1. Though I completely understand wanting to stick with an all-payer structure for altruistic reasons, I also think we have to look at what is best for the hospital as a whole. If you are 'sampling' patients, why not focus on those who also have the potential to improve revenue while you improve quality? Even if you choose to still review patients that are not DRG payers, it may be helpful to trim it down some by reviewing those patients where review may impact certain quality metrics or other at risk areas . This only increases CDI's value to the hospital. This could be done by excluding certain payers but also by hitting high risk service lines or at-risk Pdx.
2. We do not cover major holidays. We have had some CDI's who prefer to work a weekend day over a weekday and we allow this but we do not traditionally have weekend 'coverage'. They only review their traditional workload on the weekend day they work.
3. We do review 100% of inpatients (excluding WIC and BH) but we have robust program with more than enough staff to do so. We do this without weekend/holiday coverage because we do a post-discharge review prior to coding even if the patient was admitted/diacharged over the weekend/holiday.
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
We are a mature program (over 12 years old) with a relatively new staff with the exception of myself (I have been here since the inception of the program).
In the past we reviewed only Medicare and Medicare HMO.
We developed a new report which allows us to capture our priority patients for review based on clinical indicators in our EHR such as pressure ulcers documented by nursing, certain lab values, etc.
We have a hybrid medical record (physicians still document their progress notes and consult on paper - everything else is in the EHR).
We review all of the charts that appear on our report. The report included Medicare and Commercial payors.
If our nurses have time, they will review additional charts based on their admission diagnosis and/or LOS.
We are finding this process much more effective.
We do not work weekends or holidays. We pick up our weekend/holiday admissions the following business day. If the patient is dc'd we will do a retro chart review if appropriate (based on admission diagnosis).
It is impossible to capture 100% of your admissions unless you are staffed 24/7.
When we changed our process, we looked at our most frequent queries and developed our report based on that information. We are not reviewing 100% of our charts but we are reviewing the most important charts where we will have the biggest impact. Our query rate has increased and responses with DRG impact has increased.
It seems to be working for us right now.
Debby
Deborah A Dallen,RN, CCDS
Supervisor
Clinical Documentation Improvement
Einstein Medical Center
Health Information Management
Phila PA 19141
215-456-8902
dallend@einstein.edu