Most impactful direction to go next with program..

mikki.medinemikki.medine
in CDI Expansion

We currently have a 180 acute care facility and our CDI staff review all DRG payers (inpatient only). Our program has gotten to a point where we are achieving our goals, have increased CMI, and are looking for ways to expand/make the biggest impact. Two things I've been reading about are:

1. Expanding to review for PSI's/HACs. I currently run these stats for administration and we don't seem to have issues in this area. We have very few PSI's or HACs. Our CDI do notice when they come across these cases and try to make sure to get clarification if needed. Is there anything more they could be doing with this?? I feel like I'm missing something here!


2. Expanding to outpatient areas. Where is the best place to start? Outpatient surgeries, ER visits? What is the impact here? Is this more of a quality impact or a financial impact in the outpatient areas?


Thanks,

Mikki

Comments

  • morris-jeff@CooperHealth.edumorris-jeff@CooperHealth.edu

    What about expanding your program to review all payers? I find that the non-DRG patients are sometimes the ones the Coder's have to query more on and have a higher mortality. If you guys are good on PSI's and HAC's then maybe expanding your reviews would help with the overall CMI, Quality Measures, and Mortality O:E

    Jeff

  • lprescott1lprescott1
    when people tell me they are expanding to outpatient , i ask them what is your intended goal? Outpatient reviews can focus on a number of areas to include risk adjustment, medical necessity (NCDs, and LCDS), professional billing, organizational billing to name a few. You might want to investigate as to what issues your organization is having related to outpatient and then focus on that one issue. This would allow you to measure and identify your impact in that in area if you choose to go that route. 
  • christinear17@msn.comchristinear17@msn.com

    Here are some ideas: involvement in denials reviews; reviews for SOI/ROM impact; mortality reviews; review PEPPER report and work on outlier improvement;  unspecified diagnoses reduction. Review for comorbid conditions that have a high impact on risk adjustment for readmissions, mortality rates, and PSI 90 for PFP, HCCs, PPCs.

  • mikki.medinemikki.medine
    awesome ideas. Thanks!!
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