SOI/ROM impact - Where do these clarifications fit in your CDI program?

I am reaching out to see what other facilities are doing with clarifications that are not a CC/MCC impact.  I use the 3M Encompass software and the SOI/ROM is calculated during the CDI review.  All codes have a value attached as SOI/ROM however, the final numbers reported have a specific formula (which I do not know) and not all codes impact the final number. 

With ICD-10 specificity - many clarification may impact only the final SOI/ROM - reporting a higher acuity of patients conditions.   

Do you include this type of clarification in metrics?   How do you measure the impact? Does your program get credit for the clarifications?  

any advice is appreciated

stschelsea@yahoo.com

Comments

  • Hi.  We compute the SOI/ROM as we code and audit - issuing a query if either may be impacted.  Ultimately,  accurate SOI/ROM impacts many quality measures, our most followed being the Observed/Expected Ratio, driven by ROM for all/every acute inpatient admission. Yes - we get 'credit' (and blame) for O/E metric.


    Paul Evans, RHIA, CCDS

  • Same here, we compute SOI/ROM as we review/code. We also query for anything impacting either metric and that is one portion of my audit process as well (to make sure the CDS did not miss a query opportunity for a dx that would have impacted SOI/ROM). The SOI/ROM is an important quality measure that shows the acuity of your patients and can affect the facility’s mortality index and profiling . Like you said, we do not know the formula used for calculation and it is sometimes surprising what will influence these metrics. Our reporting to executives does show these metrics. I'm sure they do not grab their attention like the dollars for CC/MCC capture rates, but they do look at this.
  • :) Thanks - for the information... keep it coming.
  • There are reports in 360 that you can run to show SOI and ROM impacts....you may want to consider adding them to whatever you are reporting to leadership. We are still new to 360, so I don't have a lot of experience with the reports, but I believe the Director of HIM (our boss) is running these to look @ impact.

    Jeff

  • Thanks, I'll look into that also.
  • jwmorris1 said:

    There are reports in 360 that you can run to show SOI and ROM impacts....you may want to consider adding them to whatever you are reporting to leadership. We are still new to 360, so I don't have a lot of experience with the reports, but I believe the Director of HIM (our boss) is running these to look @ impact.

    Jeff

    Do you know which number this report is in 360? I'd like to find that report. Thanks!
  • 25b and c and 29 a and b seem to be those that will show SOI and ROM impact. I personally haven't ran them but plan to in the future, I believe my HIM Director runs them.

    Jeff

  • Something to keep in mind, if you're looking at SOI/ROM in the broader sense of risk adjustment and of O:E rations.  One can look very good with APR SOI/ROM and still be missing a lot of the risk adjustment factors that play into other methodologies, such as CMS readmission, cost efficiency or mortality as well as PSI (all of which are risk adjusted).

    If there is attention (and there ought to be) on these other models, it will take additional study to understand what 'makes a difference' in those models.  That being said, when looking at those other models, there is at least 80%, if not 90% overlap on the dx's that impact expected.

    Don
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