Financial Impact

JMontg01JMontg01
in CDI Management

I am interested to hear how everyone is tracking their financial impact both current and projected.  Is there a standard model or template to use?  We have transitioned from the Quality Division to Finance.  I do not want to lose the quality focus of our program, but I need to accurately reflect our financial impact.  In addition, I need to be able to display our future financial impact.

Any advise would be beneficial.

Comments

  • janinepodany@yahoo.comjaninepodany@yahoo.com

    Hello,

    We take our blended/base rate times the pre-query DRG and then the after query DRG and the difference is our financial impact if that query was the only thing that made the difference.  We do not report negative financial impact in our monthly reporting.  We do not project our financial impact.  With that said, we also do not regularly track our CMI due to reporting issues with our system and the fact that it is very cumbersome to calculate.

    Feel free to reach out if you have any questions.


    Thank you,

    Janine Podany, MSN, RN, CCDS

    jpodany@kearneyregional.com

  • izusmanizusman
    Our process is very similar - we calculate the difference in DRG weights pre- and post- query and multiply by the blended rates. I live in New York, and we have a high percentage of payers who use APR DRGs for payment, so the difference in weights is calculated in accordance with the grouper that the payer uses.  We also use different blended rates for different type of payers (Medicare vs. managed care government payers, vs. commercial payers). It might sound complex, but actually you have to create a good report template only once. The most time-consuming component is double-checking whether the result of the query really moved the DRG, but we want to be thorough. 
    We also report average changes in SOI and ROM, and number of prebill reviews of HACs, PSI and severe sepsis cases, so from my experience I would say that it is possible to keep focus on both quality and financial metrics.
    We are sometimes asked to provide our input if there are CMI changes for certain services, but we do not report it as our KPI since CMI changes are usually multifactorial and do not reflect solely CDI efforts (i. e. if your Cardiac Surgery department loses a surgeon with good reputation, your CMI is bound to drop).
    Any kind of projections is rather difficult. We have never been asked to project the total impact, but sometimes had to make certain assumptions when we were expanding, merging with another facility and so on. It always depends on the situation - for example, if you are planning to expand to a different unit, you can usually do a short pilot, and then make projections based on your findings. You can also base your estimates on the current CC/MCC capture rate vs.average for your types of facilities, and on how much you think you can realistically change the rate within a certain period of time.

    Good luck.

    Irina.




  • abanchy@me.comabanchy@me.com
    Hi.  I was wondering how do you handle impact on those patients who discharge to STR/LTAC and the reimbursement is bundled? Our facility recently started defining impact as the difference between Final DRG (coder's DRG $) minus CDI baseline working DRG.  It's still comparing pre-queryDRG (baseline) but instead of comparing to Working DRG it's compared with the DRG Amt in $$ actually billed.  What do you think?
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