Clinical documentation improvement programs at hospitals
usually conjure up notions of coding and health information management, but CDI
goes much further. A main tenet of a successful CDI program is that it should
lead to an increase in the hospital's revenue because most hospitals fail to
capture the actual severity of illness of patients due to inadequate physician
documentation.
CDI programs help hospitals better interpret coded data for
comparisons, benchmarking and quality reporting, and the resulting
documentation improvement benefits the bottom line in a plethora of ways, says
Paul Weygandt, MD, JD, vice president of physician services for J.A. Thomas
& Associates, a healthcare compliance and documentation firm.
Dr. Weygandt, an orthopedic surgeon, used to be vice
president of medical affairs at Conemaugh Health System in Johnstown, Pa. He
has been with JATA for the past eight years, helping hospitals that may be
losing money from inadequate documentation. He says documentation problems do
not just affect physicians and coders — the impact runs all the way up to the
C-suite.
"Many CFOs historically have thought of CDI as a branch
of the HIM department for the sole purpose of improving their coding," Dr.
Weygandt says. "It really is a collaborative process. That's the
key."
Here, he explains four areas that impact a hospital's
revenue that could also be improved through a successful CDI initiative.
1. Case mix index. CMI is an essential measurement for any
hospital CFO and financial department. CMI measures the relative cost needed to
treat a hospital's Medicare population, and it explains the types of patients
the hospital treats (by co-morbidities, complications, gender, etc.). Basically,
it reflects the average severity of illness of all Medicare patients treated at
the hospital. The higher the CMI, the more high-revenue services the hospital
performs.
Documentation directly impacts CMI. For instance, if
physicians are too vague in their descriptions, the result could could be
undercoding, which lowers the CMI and leaves revenue on the table. "The
starting point [of CDI] is CMI," Dr. Weygandt says. "Every CFO
relates CMI to revenue and to any case-based payment methodology."
2. Management of recovery audit contractors. It's no secret
that Medicare RACs are aggressively pursuing hospitals and health systems for
potential overpayments. In the third quarter of the 2012 federal fiscal year,
Medicare RACs collected $657.2 million in overpayments — the highest total of
any quarter in the program's history.
A CDI program can refine and clean up a hospital's claims,
which could both provide payment justification to RACs and allow a hospital to
spend less administrative resources on managing the RAC process. "Hospital
CFOs are acutely aware of short-stay admissions and observation stays monitored
[by RACs]," Dr. Weygandt says. "Correct coding of medical necessity
for admission is a huge revenue cycle focus. And that's all driven by physician
documentation and medical necessity for admission."
3. Quality standards and readmissions. Under the Patient
Protection and Affordable Care Act, Medicare readmissions penalties are now
under way across all hospitals. Hospitals stand to lose portions of their Medicare
funds if their readmission rates are too high, and Dr. Weygandt says
readmissions and other quality standards — such as hospital-acquired infections
— are often defined by documentation.
This is where the finance, HIM and clinical departments must
collaborate. This is especially true for the hospital CFO and CMO. Dr. Weygandt
says in order for a hospital to maintain high clinical quality scores, thus
maintaining appropriate revenue, CFOs and CMOs must incorporate each other's
mindsets into their strategic planning. CFOs must be mindful of clinical
standards, while CMOs must be aware of the hospital's cash flow — and better
documentation connects the two ideas together.
"There is a blurring between the silos of CMOs and
CFOs," Dr. Weygandt says. "CFOs have to be more conscious of quality,
and CMOs have to be more conscious of maintaining appropriate revenue, limiting
readmissions and preparing for accountable care."
4. ICD-10. CDI initiatives are most closely linked to coding
projects, and no coding project is bigger right now than ICD-10. CDI programs
could directly help a hospital's ICD-10 implementation, which will affect a
hospital's bottom line and budget planning in numerous ways — ranging from IT
changes to staff training.
"ICD-10 will be a big transition for the revenue
cycle," Dr. Weygandt says. "It's a perfect time for CFOs and CMOs to
build the appropriate infrastructure for success, if they don't already have it."
Executive and physician leadership
Dr. Weygandt has more than two decades of experience as a
physician leader and CDI specialist, and he reiterates that in order for CDI
programs to be successful and assure appropriate hospital revenue, there must
be physician buy-in. Hospital executives will need to put their physician
relationship skills to the test, and selling the idea rather than ordering a
mandate will lead to the desired result.
"A documentation program only succeeds with the
cooperation of medical staff," Dr. Weygandt says. "I would push to
have the program structured under the medical staff's direction to some extent.
For example, it's easier to get physician cooperation if documentation
initiatives are driven by physician leadership. If this is thrown at a medical
staff, it may be accepted, rejected or somewhere in between."
Source: beckershospitalreview
No comments:
Post a Comment