Clinical Documentation Improvement Program Family Medicine Service April 4, 2011 Session 1

Transcription

1 Clinical Documentation Improvement Program 2011 Family Medicine Service April 4, 2011 Session 1

2 2010 Goal Update Physician Query Response Rate 97.8% Goal for 2010 $4.3 million Goal 96% Financial Impact of CDIP for 2010 = > $10 million

3 2011 Goals for CDIP 2 Education Sessions for assigned Provider groups April 4, 2011 June 6, CME Hour for Provider groups with Dr. Meyers December 5, 2011 Response rate: Goal 100%; Threshold 96%

4 Family Medicine Query Response Rate for January & February 2011 January Queries = 8 Response Rate = 100 % February Queries = 19 Response Rate = 100%

5 Family Medicine Queries January & February 2011 Family Medicine POTTS, JEROME COUNCILMAN, DAVID NEWMAN, NANCY NGODUP, TSEWANG SCHABERT, MICHELLE NESHEIM,MIRTHA BROTHERSON, ALLYSO PETERSEN, KIMBERLY HEMMATI, MASHA A KERANDI, HENRY KARSTEN, MICHELLE HAYES, NATALIE A CULLINAN, BRENDON PIRA, LOURDES HASTI, SUSAN Family Medicine February Total % Family Medicine Annual Total %

6 Recall Inpatient episodes of care are reimbursed according to DRG assignment. Only one DRG is chosen per episode of care. The DRG is based on physician documentation that indicates to the coder the primary reason for which the patient was hospitalized.

7 Recall Each inpatient is assigned a Severity of Illness (SOI) on a scale of 1-4 and Risk of Mortality (ROM) on a scale of 1-4. Physician documentation is the sole determinant of this assignment. A DRG assignment can include one additional descriptor if applicable, a CC (complication and co-morbidity), or an MCC (major complication and comorbidity).

8 Examples of Potential CC/MCC CC Hypo/ hypernatremia Drug induced delirium UTI Respiratory Distress TIA Atelectasis BMI >40 or BMI<18 Malnutrition Opioid dependence, continuous MCC Coma Respiratory Failure CVA Acute Renal Failure Sepsis Pneumonia Encephalopathy Severe malnutrition/proteincalorie malnutrition 8

9 HINTS The terms which are appropriate and, acceptable for documentation purposes. Possible Probable Suspected Likely

10 Example of Specificity Hypertension Medical Documentation Hypertensive urgency Hypertensive crisis Hypertensive emergency Uncontrolled hypertension Coding Documentation Accelerated hypertension - CC Hypertensive encephalopathy - CC

11 Coding Terminology DRG: Diagnostic Related Group: an umbrella term for a group of diagnoses each with their own ICD-9 code ALOS: Average Length of Stay: the mean number of hospital days for a DRG GMLOS: Geometric Mean Length of Stay: the geometric mean number of hospital days for a DRG, less sensitive to outliers than the ALOS RW: number used to calculate reimbursement based on the DRG

12 ALOS vs. GMLOS Three patients are hospitalized for the same condition, one stays 2 days, one 4 days and one 24 days (the outlier ) The ALOS is = 30; 30/3 = 10 days. The GMLOS is 2 x 4 x 24 = 192; cube root of 192 = 5.7 days. GMLOS = (x 1 *x 2 * x n ) ⅟ n

13 CDIP: In Development More efficient working relationship with care team and care coordinator. Note will be generated and updated in EPIC as CDS reviews chart. Plan for CDS to place a note in reviewed chart with information pertinent to coding including DRG, Length of Stay, Severity of Illness (SOI), and Risk of Mortality (ROM).

14 Wrap-Up Please be as specific as possible with documentation. Use Acute, Chronic, or Acute-on-Chronic when applicable. Possible, Probable, Likely, or Suspected are all codable terms (even on D/C Summaries). If the diagnosis is ruled out, we change the DRG to what appropriately reflects the pt s diagnosis.

15 Clinical Documentation Improvement Program Contact Information Monica McCollom, RHIA, BS Clinical Documentation Specialist (612) Pager: (612) Dr. Roberta Meyers, MD, MPH Assistant Medical Director of Documentation Quality Willie Larson, RN Clinical Documentation Manager (612) Pager: (612) Office located in the HIM Department (Red Lower Level)