CDI Expansion

tammy.werth

Hello everyone,

I manage a CDI program at a 563 bed hospital in Southwest Missouri and am in the process of looking at an expansion of the program and was wondering if anyone could give me any feedback to assist in this process. We currently review all pts with a DRG based payer but I would like to expand out to all inpatient admissions. I am also looking into adding core measures into the documentation we review. Have any of you made an expansion such as this? If so would you share the advantages and disadvantages you have encountered? I also wonder if having a working DRG assigned to each inpatient admission would benefit the organization in evaluating patient throughput if any of you have worked on this I would like to hear the feedback.

Thanks

Tammy



Tammy Werth
CDMP Manager, HIM Documentation Improvement
CoxHealth
Tammy.Werth@coxhealth.com
Phone: (417) 269-7040
Mobile: (417) 631-0040



__________



CoxHealth - a Top 100 Integrated Health Care Network

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digardsk

Hi Tammy!

We follow core measure elements that can be impacted concurrently. Not the elements that are timing to admission specific, or the discharge elements. We do not have "responsibility" for core measures, but can be helpful while keeping our focus on our primary CDS responsibility.

We also push our drg assignments to case management for a working LOS tool.

kmckaig

Hi, Tammy,

I am in Mountain Home, Arkansas and we assign a working DRG to our pts.
Last year we looked at all inpt admissions except self-pays, Workers
Comp and OB. Our consultant recommended we scale that back in order to
do more of a quality review rather than a focus on quantity because
based on our discharges per month and our CDI staff, we didn't have time
to do many re-reviews etc. This year, we are only looking at Medicare
and our biggest DRG payers.
We review our working DRG's and LOS in morning huddle every day with
the case mgrs and social workers so everyone is on the same page. We
find that a good time to have a team discussion and hopefully gleen any
additional info that might help capture additional indicators of
severity of illness or intensity of service, barriers to dc etc.


Karen McKaig, BSN, RN, CCM, CPUR, CCDS
Case Manager
Clinical Documentation Specialist
Baxter Regional Medical Center
Mountain Home, AR 72653
870-508-1499
kmckaig@baxterregional.org

Unknown

I think it is a positive development that your facility thinks your CDI
program is how best to address the deficiencies. But I also think they
must be made aware of the dip it will inevitably make in your
productivity.

We are also in the Quality Department and as such are asked to
participate in a number of other things other than pure chart review for
"DRG Assurance". It is my firm belief and I really try very hard to
reinforce the fact that accuracy demonstrating high quality of patient
care is the ultimate goal. Not cc/mcc capture rate. Granted, I'm
finding it to be an uphill battle but one that in the long run serves
patients, facilities, doctors and CDI programs.

Good luck.

Donna Kent, RN, BSN, CCDS
Manager, Clinical Documentation Integrity Program
Clinical Quality and Accreditation
Torrance Memorial Medical Center
ph.:310 784-6884 fax:310 784-6899
donna.kent@tmmc.com

dbutler

Tammy,

We have had a couple of cycles of expansion for a variety of reasons. I would caution that one does not want to expand to soon or too fast. If most of the CDS's are not fairly solid, I suspect that can lead to problems. Secondly, expanding too fast is also problematic -- I've found there is a real limit to how many new CDS's we can properly train. This limit is pretty small -- 2 new CDS's were a big challenge (normally have 9, last time I hired had 2 positions that came open).

As far as expanding program targets & goals, sounds like you have some very admirable goals. I am thinking it might be better to expand your staffing first before fully expanding into many of the areas you're considering. Might also be a good idea to slight stagger some of that to allow training and practice cycle to occur on each new area of emphasis.

An (accurate!) working DRG can be very helpful -- helps to focus consideration on the individual pt for benchmarking or comparison on expected length of stay. It can give a real impetus for keeping on the ball for the proactive management of individual patients.

One of the biggest things to keep in mind as you expand either the program size and target population OR expand the role into core measures/other -- make sure to keep an eye on metrics and expectations and adjust accordingly. Reviewing & querying for core measures (for example) would likely have some negative impact on # cases reviewed. Buy in has to be there from administration and support given to staff.

Core measures is an area that I personally get leary about -- concerned that it can be a large sink hole to fall into.

Don

>>> "CDI Talk" 1/28/2012 6:45 AM >>>
Hello everyone,

I manage a CDI program at a 563 bed hospital in Southwest Missouri and am in the process of looking at an expansion of the program and was wondering if anyone could give me any feedback to assist in this process. We currently review all pts with a DRG based payer but I would like to expand out to all inpatient admissions. I am also looking into adding core measures into the documentation we review. Have any of you made an expansion such as this? If so would you share the advantages and disadvantages you have encountered? I also wonder if having a working DRG assigned to each inpatient admission would benefit the organization in evaluating patient throughput if any of you have worked on this I would like to hear the feedback.

Thanks

Tammy



Tammy Werth
CDMP Manager, HIM Documentation Improvement
CoxHealth
Tammy.Werth@coxhealth.com
Phone: (417) 269-7040
Mobile: (417) 631-0040



__________



CoxHealth - a Top 100 Integrated Health Care Network

COXHEALTH CONFIDENTIALITY NOTICE: This e-mail message, including any attachments, is for the sole use of the intended recipient(s) and may contain confidential and privileged information protected by law. Any unauthorized review, use, disclosure or distribution is prohibited. If you are not the intended recipient, please contact the sender by reply e-mail and destroy all copies of the original message.





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