Converting CDI Focus

dbutler

Was wondering if anyone could share details as far as planning, execution, education, work flow changes, staffing impacts, etc...... observed when changing program focus. Specifically, moving fully into ROM/SOI and completeness of documentation (accuracy, specificity, etc.) when the focus was more on the financial impact (either along with severity or purely financial).

Would suggest to anyone that has experienced this shift from a leadership or staff point of view, would make an excellent ACDIS Journal article!!

Thanks,
Don

leah.taylor

Don did you go to the presentation done by MUSC in Chicago at National ACDIS? They completely changed there focus to SOI/ROM I believe her presentation is on the website (just checked it is done by Cheryl Erickson, Manager, MS, RN, manager of CDI). I was really impressed by her.

Thanks!

Leah Taylor,RN, CCDS
NC ACDIS President
557 Brookdale Drive
Statesville, NC 28625
E- leah.taylor@iredellmemorial.org
p- 704-878-7436

dbutler

Thanks, I did not attend that particular session, had reviewed the presentation a while back, will re-look at it! (Like all of the ppt's, have copies saved)
I too am quite impressed with Cheryl, have talked with her once or twice.

Don

NormaB

Thanks Leah like Don I did not attend that session. Also her title referred to Death review so my thoughts went otherwise. I will read this article. I'm very interested in how to incorporate this into our program.

Thanks!

Norma

lspryszak

Hi, Don:

From a staffing level we moved from 2000 discharges/reviewer to a staffing ratio of about 1600 discharges/reviewer. That being said, my program only reviewed for CDI. We did not have any CM responsibilities (medical necessity, quality, etc.).

Do you have an opportunity to do a "trial" for 3 months? Maybe you could look at your current productivity compared to the productivity of adding additional reviews for a few months and see how changing the focus would affect % of reviewed charts, % queries, etc.

From a CMI standpoint, once we changed our focus to overall specificity we absolutely saw improvements in the CMI. And from a RAC focus, the better (and more consistent) the documentation, the better off you'll be.

jrstee2

Hi Don,

That's exactly what we have done at the University of Kentucky. We went from primarily a revenue enhancement program to a risk
adjustment program. We review charts with three goals in mind: assign the correct MSDRG, move cases from lower SOI/ROM to major and extreme, and use the UHC(University Healthcare Consortium)risk models as a guide for clarifications.

Our process is mostly automated, very little analog. We use the 3m encoder and Softmed, which allow us to communicate data in real time with our colleges in Quality and Core Measures.

I believe we are doing some cool things at UK, and if you are interested shoot me an email.

Thanks
Julian Steele, RN
UK HealthCare
jrstee2@uky.edu

dbutler

Thanks for that concrete experience on productivity expectations. Our current volume is about the same as yours was (2000). We are also dedicated to CDI.

I believe we could attempt a trial for a quarter. Would probably want to spend some prep time -- making sure we are familiar and tuned in for the more common items that we will be encountering and needing from a severity and coding point of view, so that we will be better able to hit the ground running.

With the trial period, we would hopefully be able to get a feel for changes in discharge volumes reviewed, query rates, financial results, post discharge query influences, etc. With that information, can make a better informed long term decision and then identify resources or other program changes to allow permanent adjustments.

Don

Donald A. Butler, RN, BSN
Manager, Clinical Documentation
PCMH, Greenville NC
dbutler@pcmh.com


Never give in. Never, never, never, never--in nothing, great or small, large or petty--never give in, except to convictions of honor and good sense. Never yield to force. Never yield to the apparently overwhelming might of the enemy
Sir Winston Churchhill

dbutler

Sounds exciting. Will be contacting you in the near future (among other things, have family in hospital and working now more from a urgency than strategic view, as well as the normal holiday routines and cross coverage),

Thanks!

Donald A. Butler, RN, BSN
Manager, Clinical Documentation
PCMH, Greenville NC
dbutler@pcmh.com


Never give in. Never, never, never, never--in nothing, great or small, large or petty--never give in, except to convictions of honor and good sense. Never yield to force. Never yield to the apparently overwhelming might of the enemy
Sir Winston Churchhill