Meeting the Challenge of Provider Documentation in the Ambulatory Setting. At completion of this educational activity, the learner will be able to:

Transcription

1 Meeting the Challenge of Provider Documentation in the Ambulatory Setting Amy Fulp, BSN, MHA, CPC, CRC, CDEO Clinical Documentation Specialist Novant Health This is the Full Title of a Session Winston Salem, NC 1 Learning Objectives At completion of this educational activity, the learner will be able to: Discuss methods to educate providers regarding diagnosis and documentation specificity Identify tools used by ambulatory CDI specialists Identify the data that demonstrates the effectiveness of providing outpatient CDI education Understand that relationships can impact provider education 2

2 Novant Health: A System of Remarkable Care 15* medical centers 528 outpatient locations 1,532 medical group physicians 863 medical group APCs 28,092 employees *Novant Health Mint Hill Medical Center opening Fall

3 5 Novant Health Ambulatory Clinical Documentation Improvement Program 9 CDI specialists Risk adjustment education E queries 2 data analysts Quality improvement focus Targeted push for AWV completion Retrospective and prospective reviews Implemented Epic tools for HCC recapture Quality reporting (formerly known as PQRS) Creation of CBLs Authorized updating of problem lists Focused education initiatives 6

4 Challenges 7 What Are the Challenges? At Novant Health, providers code their charts This is not often taught in medical school Not every chart falls into a coding work queue Multiple specialties covered by CDI within Novant Health Diagnosis idiosyncrasies of varying specialties Coding guidelines that are specific to systems 8

5 What Are the Challenges? Resources At Novant Health, there are nine CDI specialists to educate more than 1,000 providers Two analysts to help break down data for practical use Technology Integrating technology (E query transition from paper query) Optimizing functions in Epic for providers and CDI specialists 9 Goals and Focus 10

6 5 Key Goals for Documentation 1. Specificity: choosing the most specific diagnosis and supporting it with appropriate documentation 2. HCCs: ensuring year over year recapture of diagnoses 3. MDM: include each diagnosis needed for medical decision making 4. Substantiate the quality of patient care delivered Ultimate goal Reflect the most accurate, true patient disease burden 11 Focus on Education Onboarding: scheduled one on one meetings with new providers Initial interactions between CDI specialist and provider is important for establishing rapport, trust, and mutual respect. Clinic administrators (CA) also meet with CDS during onboarding. This facilitates their relationship, as often the CA is the first line of communication between provider and CDI specialist. Provider group meetings Most practices have monthly meetings in which CDI specialists could request to be placed on agenda to share new education Collaborate with coders 12

7 Relationships With Providers 13 Positive Relationships Are the Key Purposeful interactions Market CDI as a provider resource Be present, patient, and willing to improvise 14

8 Tools 15 What s in Our Toolbox? An * marking each diagnosis with HCC value HCC refresh tool (new and improved) CBLs created for specific topics Favorites list for diagnoses (provider specific) Tip sheets for major disease processes with subsequent coding conundrums 16

9 Clinical Documentation Improvement Sample Behavioral Health Quick Reference Guide Update problem list Document chronic conditions and diagnoses at least yearly Document association with all manifestations, i.e., due to, related to, assoc with, etc. Depression Major Depressive Disorder (MDD) (Consider if patient on SSRI and PHQ 9 score) Previous 311 depression, unspecified now maps to F32.9 MDD single episode, unspecified (MDD in full remission include patients on SSRI but now have PHQ 9 score = 5 or less; or patient not on meds/tx but has hx of MDD) Single episode F32.XX: specify and document if mild/mod/severe/severe with psychotic features/in partial or full remission Recurrent episode F33.XX: specify and document if mild/mod/severe/severe with psychotic features/in partial or full remission Anxiety disorders F41.X: specify and document if panic disorder without agoraphobia (panic attack)/generalized anxiety disorder/mixed/other (anxiety, depression, mixed anxiety and depressive disorder)/unspecified Bipolar disorder F31.XX: specify and document if; Hypomanic/manic mild, mod or severe, with/without psychotic features/depressed mild, mod or severe, with/without psychotic features 17 Clinical Documentation Improvement Sample Cardiology Quick Reference Guide Update problem list Document chronic conditions and diagnoses at least yearly Document association with all manifestations, i.e., due to, related to, assoc with, etc. Cardiac Arrhythmias I44.2 Complete AV block (third degree) I44.X Conduction disorders (includes 1st or 2nd, left and right BBB, and other unspecified and specified blocks) I47.1 Supraventricular tach: includes PAT, AVNRT, AVRT, junc (parox) tach, nodal (parox) tach I48.X A fib: must specify and document chronic, paroxysmal, persistent I48.X A flutter: must specify and document typical (Type I) or atypical (Type II) (Also assign Z79.01 long term (current) use of anticoag, if appropriate) I49.5 Sick sinus syndrome tachy brady syndrome, persistent bradycardia R00.1 Sinus bradycardia I49.9 Cardiac dysrhythmia unspecified 18

10 Education and Data Confirmation 19 Why Focus on the Education? Data supports our educational efforts Creates a culture of open dialogue When executed effectively, may reduce the volume of queries sent 20

11 Technology Integration The Big Query Transition Paper query Required travel to clinics Difficult to get responses Often lost in the shuffle Facilitated face time with providers E query In basket message in Epic Query attached to patient chart Increased response and review rate Communication evolution 21 Deciphering Our Documentation Through Data Validation HCC refresh tool Chart audits CBL completion Query responses 22

12 Improvements Made Through Data Validation Morbid obesity Visit diagnoses increased by 37% Major depression Specified MDD visit diagnoses increased by 43% Use of unspecified MDD decreased by 18% Completion of PHQ screening 2015 to 2017: increased PHQ 2 completion from 48% to 74% 23 Meeting, Not Overcoming Challenges can keep us focused Healthcare is evolving ICD 10 Epic upgrades CMS Providers 24

13 Thank You. Questions? Amy Fulp In order to receive your continuing education certificate(s) for this program, you must complete the online evaluation. The link can be found in the continuing education section at the front of the program guide. 25