Metrics
The other day someone on this blog requested whether CDIS as a profession could come up with a distinct set of metrics to be used in tracking the effectiveness and value of our efforts at clinical documentation improvement. While we can all agree that calculation and monitoring of case mix as well as CC/MCC capture rate is pervasive and ingrained in the minds of CFOs and other hospital administrators, it is incumbent upon us to develop, implement and "sell" others that reimbursement and financial gain are in reality only part of the equation.
The value of clinical documentation beyond reimbursement alone comes to light when you consider the role of specific, accurate, and detailed documentation to measures of efficiency, quality, costs and risk adjusted outcomes, all the fundamental basis for healthcare reimbursement processes such as accountable care organizations, bundled payments, shared savings and gain sharing initiatives, and physician and hospital value based purchasing initiatives slated to begin in 2012. Consider the need for more robust clinical documentation under the Medicare Acute Episode Demonstration Project where cardiologist and orthopedist have a financial incentive to practice efficient, quality oriented medical care, predicated upon the practice of good clinical medicine that reflects adherence to recognized standards of care, and most importantly the accurate reporting of this said practice of medicine.
While the indisputable value of clinical documentation goes without saying, what we presently can do today to incorporate the value of our efforts at affecting positive change in physician behavior patterns of documentation is to engage the physician's interest in improving their own clinical documentation for their own business of the practice of medicine. How so? Well, the quality of clinical documentation encompasses the realm of completeness, accuracy and detailedness of the physician's amount of work performed and medical necessity for performance of this work. This completeness of documentation is tangible to the extent the documentation is reflective and supportive of the physician's thought processes, clinical judgment, and medical decision making inherent to patient care. Ever look at a History and Physical and say wow, now that is great documentation, know what the physician is really clinically thinking, can see why each test was ordered, and can almost read the physician's mind like a roadmap. This degree of clinical documentation constitutes a minute portion of what we see in our daily practice of clinical documentation improvement.
There are specific elements of clinical documentation in the ER dictation, H & P, and progress notes that we can focus upon in expanding the profession of clinical documentation improvement. Stay tuned for the next episode of the CDI Talk edition where I outline key provisions to consider when reviewing the record and identifying clinical documentation improvement opportunities. CC/MCC queries and capture rate are eventually going to be assuming less importance as payment reimbursment and healthcare delivery system transformations take hold.
Now a word from our sponsor, ACDIS- Be sure to listen in to the Quarterly Conference Call next Thursday the 18th between 1 and 2 PM EST. Take an hour from your regular routine!
The value of clinical documentation beyond reimbursement alone comes to light when you consider the role of specific, accurate, and detailed documentation to measures of efficiency, quality, costs and risk adjusted outcomes, all the fundamental basis for healthcare reimbursement processes such as accountable care organizations, bundled payments, shared savings and gain sharing initiatives, and physician and hospital value based purchasing initiatives slated to begin in 2012. Consider the need for more robust clinical documentation under the Medicare Acute Episode Demonstration Project where cardiologist and orthopedist have a financial incentive to practice efficient, quality oriented medical care, predicated upon the practice of good clinical medicine that reflects adherence to recognized standards of care, and most importantly the accurate reporting of this said practice of medicine.
While the indisputable value of clinical documentation goes without saying, what we presently can do today to incorporate the value of our efforts at affecting positive change in physician behavior patterns of documentation is to engage the physician's interest in improving their own clinical documentation for their own business of the practice of medicine. How so? Well, the quality of clinical documentation encompasses the realm of completeness, accuracy and detailedness of the physician's amount of work performed and medical necessity for performance of this work. This completeness of documentation is tangible to the extent the documentation is reflective and supportive of the physician's thought processes, clinical judgment, and medical decision making inherent to patient care. Ever look at a History and Physical and say wow, now that is great documentation, know what the physician is really clinically thinking, can see why each test was ordered, and can almost read the physician's mind like a roadmap. This degree of clinical documentation constitutes a minute portion of what we see in our daily practice of clinical documentation improvement.
There are specific elements of clinical documentation in the ER dictation, H & P, and progress notes that we can focus upon in expanding the profession of clinical documentation improvement. Stay tuned for the next episode of the CDI Talk edition where I outline key provisions to consider when reviewing the record and identifying clinical documentation improvement opportunities. CC/MCC queries and capture rate are eventually going to be assuming less importance as payment reimbursment and healthcare delivery system transformations take hold.
Now a word from our sponsor, ACDIS- Be sure to listen in to the Quarterly Conference Call next Thursday the 18th between 1 and 2 PM EST. Take an hour from your regular routine!
Comments
Robert
Robert S. Hodges, BSN, MSN, RN
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
"The difference between the right word and the almost right word is the difference between lightning and the lightning bug." Samuel "Mark Twain" Clemens
- Norma
Robert
Robert S. Hodges, BSN, MSN, RN
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
"The difference between the right word and the almost right word is the difference between lightning and the lightning bug." Samuel "Mark Twain" Clemens
Thanks,
Heidi Koenig, RN
Clinical Document Specialist
Ocala Regional Medical Center
Heidi.koenig@hcahealthcare.com
352-401-1686
annual discharges .................
Thank You,
Susan Tiffany RN, CCDS
Supervisor Clinical Documentation Program
Guthrie Healthcare System
phone: 570-882-6094, pager #465
fax: 570-882-6768
email: tiffany_susan@guthrie.org
"Twenty years from now you will be more disappointed by the things you
didn't do than by the ones you did do. So throw off the bowlines. Sail
away from safe harbor.Catch the trade winds in your sails. Explore. Dream.
Discover." Mark Twain
Thanks,
Heidi Koenig, RN
Clinical Document Specialist
Ocala Regional Medical Center
Heidi.koenig@hcahealthcare.com
352-401-1686
I feel your pain. Our consultants have presented "opportunities" to administration which the facility has for capturing certain diagnoses (and $), however many of these "opportunities" consist of things I would not query for.
i.e. it was suggested that a query opportunity existed for:
acute renal failure for a patient whose creat on admission was 2.4 and his baseline is 2.1 with an unchanged GFR (they took the chart at face value, I have access to previous lab results)
malnutrition on a patient whom weight loss in the past was mentioned in the H&P, the dietician had seen, the albumin was 2.2 and there was no prealbumin.
When our program was fairly new I was very concerned about all these opportunities.
I understand now that the consultants search every nook and cranny for any little thing which could possible change the SOI, ROM or financial impact. We must look at the context and decide if an opportunity really existed for that record.
I now use these yearly reviews as an educational opportunity for little tidbits.
Charlene Thiry RN, BSN, CPC, CCDS
Clinical Documentation Specialist
Quality Resources
Menorah Medical Center
5721 W. 119th Street | Overland Park, Kansas 66209
Charlene.Thiry@hcamidwest.com
Mobile: 913-498-6388
www.menorahmedicalcenter.com
I agree that the consultants have 20/20 hindsight vision and nitpick to remain relevant. I also do not query for problems that have not changed from previous admissions. I believe that is why my physician agree rate is high. Looking at what the coders retroactively query for, I don't always agree with their decisions. But that's what keeps things interesting. I still consider myself new at this and look for opportunities to improve, but I also query for documentation improvement not benchmarks.
Thanks,
Heidi Koenig, RN
Clinical Document Specialist
Ocala Regional Medical Center
Heidi.koenig@hcahealthcare.com
352-401-1686
ACDIS had started with their marvelous web site and CDI talk. I read everything that was posted and we chose to go for documentation specificity instead of MCC/CC capture.
The first year we did not reach the set financial goal but the CMI and SOI/ROM really improved and have continued to improve. Our coders all have a better understanding of the role of the Clinical Documentation Specialist and we work well together which helps a great deal.
Charlene Thiry RN, BSN, CPC, CCDS
Clinical Documentation Specialist
Quality Resources
Menorah Medical Center
5721 W. 119th Street | Overland Park, Kansas 66209
Charlene.Thiry@hcamidwest.com
Mobile: 913-498-6388
www.menorahmedicalcenter.com
and completeness of the record. That is where the real value is, in my
opinion of course.
Robert
Robert S. Hodges, BSN, MSN, RN
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
"The difference between the right word and the almost right word is the
difference between lightning and the lightning bug." Samuel "Mark Twain"
Clemens
reason I ask is they sound VERY much like our consultant.
Thank You,
Susan Tiffany RN, CCDS
Supervisor Clinical Documentation Program
Guthrie Healthcare System
phone: 570-882-6094, pager #465
fax: 570-882-6768
email: tiffany_susan@guthrie.org
"Twenty years from now you will be more disappointed by the things you
didn't do than by the ones you did do. So throw off the bowlines. Sail
away from safe harbor.Catch the trade winds in your sails. Explore. Dream.
Discover." Mark Twain
1900 discharges and is as aggressive as described. Do believe they are
headquartered out of that big red clay state in the SE.
Feel they did a very good job in getting us off the ground, teaching
and getting rolling.
Have found other consultants and sources of information to be very
important for our growth and goals as time has progressed.
**********
It is quite impressive to me the level of response to this
topic....seems to really have some interest and resonance!!
Appreciate the OP for starting!!
Agree completely about the ways healthcare are moving and how that is a
call for our profession to rise to the challenge and really focus on
what is most important -- accurate and complete documentation that
allows clean & accurate data to be captured and utilized.
The value is more difficult to capture and measure, but that is one of
the aspects of our professional challenge. For those that have access
to mortality profiling, that is clearly one resource but not everyone
does (the recent poll about the APR DRG grouper suggests as many as
half).
Also a real part of our professional challenge is education and
development of professional standards and expectations. Seems to me
that there have been important strides in this direction.
PARTLY Rhetorical question -- what can each of us do to grapple with
these challenges?
Don
Cindy Goewey RN, BSN
Clinical Documentation Specialist
Coding Operations
Dartmouth-Hitchcock Medical Center
Robert
Robert S. Hodges, BSN, MSN, RN
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
"The difference between the right word and the almost right word is the difference between lightning and the lightning bug." Samuel "Mark Twain" Clemens
Patsy Fowler RN, MSN, CCDS
Certified Clinical Documentation Specialist
Marion Regional Hospital
PO Box 1150
Marion, SC 29571
Office 843-431-2044
Cell 843-431-2863
Fax 843-431-2432
Robert
Robert S. Hodges, BSN, MSN, RN
Clinical Documentation Improvement Specialist
Aleda E. Lutz VAMC
Mail Code 136
1500 Weiss Street
Saginaw MI 48602
DAWN M. VITALONE, RN
Clinical Documentation Improvement Specialist
Community Hospital
Munster, IN 46321
(219) 513-2611
Patsy Fowler RN, MSN, CCDS
Certified Clinical Documentation Specialist
Marion Regional Hospital
PO Box 1150
Marion, SC 29571
Office 843-431-2044
Cell 843-431-2863
Fax 843-431-2432
Sincerely,
Karen A. Johnson
DRG Assurance ext. 43559
We have a combination of 30 reviews each day. However on Mondays, when we seem to have significantly mostly new reviews, the number is 23-28.
Hope that helps.
Lisa Romanello, RN,BSN,CCDS
CJW Medical Center
804-228-6527
CDI, RNs are to see 7 new and 7-8 follow ups per day also-this is including all the other duties such as physician education, making unit rounds, ICD-10 training, entertaining DRG mismatches and asst physician with query responses
CDI, Coders are to see 5 new and 7-8 follow ups per day with the about duties plus query audits, query deficiency reports
All new cases should be reviewed within 2 days of admission, all re reviews should been seen every 2 days except if there is a query then that case should be reviewed q day until query answered.
We had EHR and CDIS as our CDI program.
me asking?
Is that 30 reviews per CDS?
Mary A Hosler MSN, RN
Clinical Documentation Specialist
Alumnus CCRN
McLaren Bay Region
1900 Columbus Ave.
Bay City, Michigan 48708
(989) 891-8072
mary.hosler@mclaren.org
We were using CDIS which we loved, recently the hospital converted us to MIDAS +.
We use McKesson for our electronic queries.
CDS productivity should be determined by the focus of your program (reviewing for DRG assignment and CC capture vs. reviewing for complete and accurate documentation to impact quality outcomes, maturity of program/CDS and overall CDS responsibilities. For instance:
Facility with 1-2 CDS responsible for all aspects of the program (education, monitoring, reporting, etc.)
*DRG assignment/CC capture focus: 25-30 charts per day
*Complete and accurate documentation: 20 charts per day
Large facility with full program management support and reviewers are responsible for reviews and query reconciliation only:
*DRG assignment/CC capture focus: 30-40 charts per day
*Complete and accurate documentation: 20-25 charts per day
Hope this helps!
Wendy
Wendy Clesi, RN, CCDS
Huff DRG Review
wendy.clesi@drgreview.com
We are to query for everything.
We look at all payers.
I have many conversations with MD for response ,which takes up time.