"Failed" Programs
I have seen a couple of times (mostly in the context of private communications) of programs that have "failed".
Not being able to speak to any specific experiences on this topic (though we, like many, have had a moment or two of grave concern), was wondering if there was someone (or several) out there who might be able to speak to experiences that contribute to a program failure? If the experiences from several institutions could be combined, would help to maintain the privacy of the organizations studied.
It seems to me that such an article (I am suggesting something for the ACDIS Journal) would potentially provide a great deal of insight and help a large number of organizations that are in the early rapid growth stages as well as those more in the medium or even longer time frames. Having improved insight into the potential challenges would be a real benefit. It would also be great if some of the experiences and thoughts included successful re-start or turn-around -- what worked? didn't work?
Genuinely don't have anyone to specifically suggest to write such an article, just hoping that maybe there is someone who would like to give this a try.
Thanks,
Don
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Not being able to speak to any specific experiences on this topic (though we, like many, have had a moment or two of grave concern), was wondering if there was someone (or several) out there who might be able to speak to experiences that contribute to a program failure? If the experiences from several institutions could be combined, would help to maintain the privacy of the organizations studied.
It seems to me that such an article (I am suggesting something for the ACDIS Journal) would potentially provide a great deal of insight and help a large number of organizations that are in the early rapid growth stages as well as those more in the medium or even longer time frames. Having improved insight into the potential challenges would be a real benefit. It would also be great if some of the experiences and thoughts included successful re-start or turn-around -- what worked? didn't work?
Genuinely don't have anyone to specifically suggest to write such an article, just hoping that maybe there is someone who would like to give this a try.
Thanks,
Don
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Comments
The so-called 'consultants' are responsible for a significant portion of the problem, I think. They have sold their services with the promise of revenue enhancement for the hospitals, and the hospitals make their deals with the devil. They pay lip service to compliance while focusing on revenue, while the CDS is forced to skew the program to meet the consultants' demands. An established program shouldn't need consultants; there should be enough home-grown talent to evaluate and drive a strong CDS program.
Just my opinion.
I believe they hook us with their software ......... and in turn create
the contracts that wont allow us to be free from the consultants. I have
one company, 2 contracts.... one allegedly for the software, and the
second for the consultants .... except they tied the data reports from the
software into the consultant contract. So, I can eliminate the consultants
if I want to eliminate the reports!!! Not very user friendly. Now, I cant
afford to switch to anyone else!
You can access the article here - you'll need to provide your contact information, but the article is free if you care to read it:
"What Every CDI Program Needs to Succeed: Structure, Staff, Process"
http://blogs.hcpro.com/revenuecycleinstitute/white-papers/
"reimbursement/CMI" Syndrome that many programs are suffering from? I think
most of us agree that the overall focus cannot be on reimbursement but on
quality documentation that can stand against RAC (MAC, etc.), litigations
and so forth.
The failure still seems to fall with the lack of consistent tools to measure
the success of CDI programs - other than how much $ we recoup in
documentation, how healthy the CMI or with Severity of Illness/Risk of
Mortality. (not all hospitals use APR DRG)
Most CDI programs are now 3 years out in experience. Some have been
established longer. But all of us should be at a point where documentation
is better amongst our medical staff - but still have the occasional
stragglers and forgetful.
"We" need to establish those overall measures as a Standard. Once there is
a single agreement in our focus and a "TOOL" to measure our success,
Consultants and administrations can have no other choice but to follow suit.
~Norma
If we could originate in quality and measure in quality. Utilize the
multiple sources of quality data that is available. We need to understand
coding to explain why we ask what we do, but not structure our programs
around it. We need to ask the questions that reflect care given, resources
used and enhance care provided to our patients!!!
"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
Received this separately, and forwarding from an anonymous source (perhaps direct personal experience?). I added a bit of my own also.
PLEASE -- intended as humor!!
Don
Recipe for CDI failure:
1-Hire fewer CDIs than needed for the comprehensive job.
(and then wonder why staff leaves)
2-Train minimally (if at all)
(do not provide the orientation period demonstrated at most programs of at least several months -- see ACDIS poll).
3-High expectations of unrealistic returns immediately
(and completely accept the forecast of the consultants, even to the point of including in the organization budget process)
4-Pay no attention to SOI/ROM-focus on the money
(forget about RAC, medical necessity, profiling, VBP, etc.)
5-Do not educate physicians about the program nor allow CDIs to provide education...do not actively reach out and collaborate with the medical staff, do not promote the ways in which the program can be of benefit to the medical staff.
6-Create reports that skew the results (so the CDIs do not get overconfident)
7-Do not fund or provide any continuing education.
8-Discourage collaboration with coding.
In fact, foster an adversarial coding/CDI relationship -- wouldn't want that, now would we?.
9-Do not provide tools such as the encoder and under no circumstances give CDIs access to the APR-DRG Grouper.
>>> "CDI Talk" 3/14/2011 10:28 AM >>>
I have seen a couple of times (mostly in the context of private communications) of programs that have "failed".
Not being able to speak to any specific experiences on this topic (though we, like many, have had a moment or two of grave concern), was wondering if there was someone (or several) out there who might be able to speak to experiences that contribute to a program failure? If the experiences from several institutions could be combined, would help to maintain the privacy of the organizations studied.
It seems to me that such an article (I am suggesting something for the ACDIS Journal) would potentially provide a great deal of insight and help a large number of organizations that are in the early rapid growth stages as well as those more in the medium or even longer time frames. Having improved insight into the potential challenges would be a real benefit. It would also be great if some of the experiences and thoughts included successful re-start or turn-around -- what worked? didn't work?
Genuinely don't have anyone to specifically suggest to write such an article, just hoping that maybe there is someone who would like to give this a try.
Thanks,
Don
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Thanks,
Heidi Koenig, RN
Clinical Document Specialist
PLEASE -- intended as humor!!
Don
Recipe for CDI failure:
1-Hire fewer CDIs than needed for the comprehensive job.
(and then wonder why staff leaves)
2-Train minimally (if at all)
(do not provide the orientation period demonstrated at most programs of at least several months -- see ACDIS poll).
3-High expectations of unrealistic returns immediately
(and completely accept the forecast of the consultants, even to the point of including in the organization budget process)
4-Pay no attention to SOI/ROM-focus on the money
(forget about RAC, medical necessity, profiling, VBP, etc.)
5-Do not educate physicians about the program nor allow CDIs to provide education...do not actively reach out and collaborate with the medical staff, do not promote the ways in which the program can be of benefit to the medical staff.
6-Create reports that skew the results (so the CDIs do not get overconfident)
7-Do not fund or provide any continuing education.
8-Discourage collaboration with coding.
In fact, foster an adversarial coding/CDI relationship -- wouldn't want that, now would we?.
9-Do not provide tools such as the encoder and under no circumstances give CDIs access to the APR-DRG Grouper.
"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
Couple of thoughts (well, started with 2 then got on a roll):
First, do take a careful look at / research the market for CDS -- I suspect that finding another job (and specifically at a more supportive / collaborative organization) might be much easier than one might think. This skill set is hard to develop and in my opinion in demand. Of course, personal factors play a big role. Don't rush into it, but actively look around to understand what options are available.
Second, consider what level of risk your organization has self evaluated regarding RAC et al. The ability to eliminate that risk by adding the second/third cc or mcc, to solidify the documentation supporting the pdx, to ensure that debridement is 100% captured correctly, etc. has a real financial return I would argue (can you look back at your actual RAC cases, can you identify any that had potential additional diagnosis that if queried would have prevent a financial loss?).
Third, take a good look at where VBP is moving, and how the additional work you would like to do ties into that (and there is money involved, though a couple of years away).
Fourth, can you start to estimate if you might be subject to any financial risks with ICD10?
Finally, be aware of the coming trends. There is no question that organizations are going to be affected and many I suspect will suffer if not addressing these types of issues now.
Don
Carla
Why is their little buy-in from the physicians? The consulting companies put little emphasis and focus upon this important, crucial aspect of CDI. The focus is on promoting the capture of CCs/MCCs, to the ultimate detriment to the overall effectiveness of the program short and long term.
Just some food for thought
In fairness, there are several consulting companies that do work much more closely and proactively with the medical staff. Granted, these may (or may not) be the exception, but there are those options available and can be discovered with a little research & networking.
I agree however, it often seems the actual on the ground focus of many consulting companies is weighted too much toward the financial aspects.
I suspect part of the problem is the challenges in effectively measuring impact/results on ROM/SOI, etc. to satisfy the desire for measurable progress. The only universal measure is CMI, and that has too much of a financial sense as well as being a bit too simplistic for reflecting severity (though improved with MS-DRG).
Don
We have put together a Mortality Committee whereby we review the death cases so we can begin the process of how can we document better. We also with physician leadership, query and try to clarify areas that would by fuzzy to the coders. We use this as an educational process for both Coding, CDS, and physicians. We have also decided to put together a standardized Death summary which should help some of the physicians who need structure. We are totally EMR so it has been a little rough around the edges.
Carla
I would be interested in learning more about your standardized death summary. Perhaps, we could communicate off line? You can reach me at my email below.
Thanks in advance.
Best,
Holly
Holly Flynn, RN CCRN
Medical Quality Improvement Consultant
Medical Directors Office
University of Washington Medical Center
Seattle, Washington
hollyf1@u.washington.edu
206-598-5942
are all over with the documentation ...no consistency. I always feel
they do better with the template created for them with what is required.
Please share.
Thank you, JoAnne Price
jprice@azkrmc.com
Carla