Integrating Analytics Into CDI Operations to Build a Stronger … · Susie Gleason, RHIT, CCDS System Director CDI & Education, Revenue Cycle Administration Henry Ford Health System
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Integrating Analytics Into CDI Operations to Build a Stronger Program
Susie Gleason, RHIT, CCDSSystem DirectorCDI & Education, Revenue Cycle AdministrationHenry Ford Health SystemDetroit, Michigan
Sandeep Soman, MD, FNKFAssociate Division HeadDivision of Nephrology and HypertensionPhysician AdvisorHenry Ford HospitalDetroit, Michigan
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Learning Objectives
• At the completion of this educational activity, the learner will be able to:– Identify the factors essential to standardizing CDI performance measures across multiple facilities
– Understand the relationship between CDI outcomes and the integration of analytics
– Identify outcomes related to the roles and responsibilities of an internal quality and educational team members within the CDI department
– Improve physician engagement through the application of new performance metrics and an analytics dashboard
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6 hospitals – 2,200 beds
1,200 employed physicians
2,200 privatephysicians
23,000 employees
Health alliance plan
102,000admissions
418,000 ED visits
3.2 million office visits
Henry Ford Health System (HFHS)
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Agenda
CDI Journey Organizational Structure CDI Quality Improvement & Education Importance of Improved Documentation Role of Physician Champion Reports Used for Operational Performance Report Samples
Technology Used for Optimization HFHS DRG Analysis 3M Data Monitoring Reports
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PEOPLE Consolidation of all CDI programs under corporate structure
PROCESS Developed standardized work flows
TECHNOLOGY Conversion to 3M 360 Encompass Suite including: CDI software system (CDIS), computer‐assisted coding (CAC), encoder/grouper
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018
HFH Nurse‐Based Program
Integrated Program on 3M 360 Platform
Transitioned to All Payer
ImplementQI & Edu.
Development Teams
Implementing Outpatient
CDI
HFMH Nurse‐Based Program Nurse‐Based w/ Vendor
HFWB Physician‐Based w/ Vendor
HFWH Coder‐Based Program
Physician‐Based w/ Vendor
Nurse‐Based w/ Vendor
HFAH Physician‐Based w/ Vendor (2003–2010) Nurse‐Based w/ Vendor Integrated Program
on 3M 360 Platform
HFH: Henry Ford Hospital – DetroitHFMH: Henry Ford Hospital – MacombHFWB: Henry Ford Hospital – West BloomfieldHFWH: Henry Ford Hospital – Wyandotte HFAH: Henry Ford Hospital – Allegiance
Henry Ford Health System – CDI Journey
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Organizational Structure
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Mgr. Edu. Delivery1 FTE
Direct Reports: 4SOC: 24
Supv. Delivery1 FTE
SOC: 10
Educ. Dev. Spec.4 FTE
Educators10 FTE
ED Educators2 FTE
Mgr. Edu. Development
1 FTEDirect Reports: 4
Data Reviewers
16 FTE
Coordinators4 FTE
Educators10 FTE
Supv. Delivery1 FTE
SOC: 10
Total Education FTEs: 54
CDI SpecialistDetroit10.8 FTE
10 Full Time1 Part Time1 Contingent
Mgr. Edu. Support1 FTE
Direct Reports: 5SOC: 21
Supv. Dev1 FTE
SOC: 16
Coor/Phys. Liaison Wyandotte
1 FTE
Mgr. Det/Wyn1 FTE
SOC: 15.7
CDI Specialist Wyandotte4.9 FTE
Mgr. WB/Mac1 FTESOC: 9
CDI Specialist Macomb6 FTE
CDI Specialist
West Bloom3 FTE
System DirectorCDI & Education
Susie GleasonDirect Reports: SOC: 141.2
Total IPC FTEs: 53
VP Mid‐Revenue CycleKathy Hartman
Total CDI FTEs: 34.2
Quality Coor.4.5 FTE
Mgr. CDI Quality1 FTE
SOC: 4.5
Mgr. IPCDirect Reports: 6
SOC: 53
Outpt. CDI Spec.7 FTE
Mgr. Outpt. CDI Spec.
OPEN1 FTE
CDI Educ. Coord.2 FTE
Organizational Structure: CDI & EducationSenior VP
Revenue CycleSteve Hathaway
*Physician Champion(s) Assigned Per SiteTotal of 6
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CDI Quality Improvement & Education
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Expansion of Quality & Education Program
• With expansion of HFHS CDI department, a need was identified to incorporate a dedicated quality improvement & education team within the CDI department.– Previous structure not aligned with quality‐driven program that measured
effectiveness, unity in program direction, & efficiency focused on quality– Improve quality & education– Develop standardized work & metrics to audit/measure CDIS queries– Create meaningful education– Create quality improvement team– Employee satisfaction & competitive job market
• Increase remote days– Expand standards to include internal quality metrics on DRG assignment & queries– Foster autonomy– Streamline & promote focus to operational managers & staff
• Regional managers• Clear expectations
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CDI Quality Improvement TeamDeveloped in 2017
• HFHS worked with a consultant group to create our own internal quality improvement team. We developed structure, tools, & staffing.
• Quality improvement coordinator role includes: – Scope: Audit 10 cases each month on each CDIS using standardized approach & quality tool (see appendix)
– Monthly meetings with CDIS to review findings & educate– Inter‐reliability completed monthly by manager– Yearly external audit– DRG analysis reviews– Mortality reviews: CDI manager review if SOI/ROM not 4/4– Onboarding preceptorship
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CDI Quality Improvement TeamDeveloped in 2016
• The CDI education development team was created as an effort to allow the CDIS to focus fully on reviews to include all payers. The original focus was on physician education.
• The focus has since expanded to include: – Remain current on CDI department coding guidelines– Design & update standardized education resources: PowerPoint
presentations, tip sheets, pocket cards, etc.– Provide CDI education for medical staff, residents, CDI nurses– Develop, maintain, & facilitate CDI onboarding education content
to include current guidelines for CDI new hires– Didactic education for CDI new hires– Assess for departmental education needs
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UpdateSince implementation of quality improvement and education development teams, we have seen improvement in:
Physician satisfaction
Physician engagement
Overall query impact
As evidenced by improved query response & agreement
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Importance of Improved Documentation
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Enhanced CDI
model
Resource utilization equals DRG
HFHS strategic initiatives
Publicly reported phys./data profiling
Regulatory requirements
Quality/safety reporting
PSIsHACs
Risk adjustment models, ACOs
Value‐based purchasingPay‐for‐
performance
Many drivers lead to the need for improving documentation
Importance of Improved Documentation
Research
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Role of CDI Physician Champion
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Physician Champion
• Well respected by medical staff • Personality and skills to lead and model best‐practice behaviors
• Knowledgeable regarding relevant policies, procedures, & regulations relevant to CDI
• Close involvement regarding daily CDI operations specific to business unit
• Ability to collaborate with other physician champions
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Role of Physician Champion
Gain confidence & cooperation of: —Physicians —Executives —Senior management
Work with physicians for better documentation — CMI/SOI/ROM— Justify LOS/IP days
Identify opportunities to improve quality & safety indicators—POA—HACs—PSIs
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Role of Physician Champion
• Research and provide benchmarks• Ensure quality of care• Ongoing, frequent, and timely reporting of process improvement
• Query and communication processes• Serves as liaison between CDI & providers• Advise and assist with educational strategies• Understand metrics and incorporate into provider documentation education
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Components of Improved Documentation
• Clarity: Each diagnosis should be supported by a statement of cause, suspected cause, or time of occurrence.
• Consistency: Clarification of documentation that differs between providers with respect to diagnosis and/or treatment. The need to document acute conditions throughout record, including discharge summary.
• Reliability: Documentation supported by evaluation, treatment, & management of care.
• Accuracy: Support highest level of specificity. Document stage, severity, & acuity.
Good Documentation Drives Metrics
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Accurate performance metricsOptimize revenue cycleResearch opportunities
Results of Improved Documentation
Improved quality core measures
Better accuracy & specificity
Improved patient safety
400K lives lost per year
Better quality of care
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Reports Used for Operational Performance
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Reports Used for Operational Performance
• In an effort to build consistency & efficiency within our CDI program, we have incorporated several reports into our operations used to measure program effectiveness on a day‐to‐day or month‐to‐month basis
• These reports drive changes that may impact the following: – Coverage– Leverage resources & technology– Education (CDI and/or physician)
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Reports Used for Operational Performance
• Review activity summary– What: Individual stats (reviewed visits, initial visits, queried visits, &
query details)– When: Weekly on Monday– Why: Evaluate productivity from previous week
• Financial impact listing– What: Shows query & financial information/financial information
(queried prior, baseline to final impact, query author, etc.)– When: Monthly– Why: End‐of‐month reconciliation (ran prior to quick look report)
• Executive summary dashboard– What: Productivity, query totals, physician response & agree rates,
impact– When: Ran approximately second week of month for previous month– Why: Monthly numbers & quick look dashboard
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Reports Used for Operational Performance (cont.)• Working DRG LOS variance listing
– What: Actual LOS vs. expected LOS– When: Weekly (or as needed)– Why: Cases over LOS to evaluate if DRG/SOI/ROM at maximum potential
(variance days of actual vs. expectation) • Provider query summary
– What: Individual stats (reviewer, reviewed visits, query details, including response & agree rate)
– When: Ran approximately second week of month for prior month– Why: To obtain monthly individual numbers for CDI team, or as group
• Provider query summary by query– What: Query summary (provider name, query template, net queries
received, response & agree rate, etc.)– When: Quarterly– Why: Obtain quarterly physician stats (can run as individual or with group)
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Reports Used for Operational Performance (cont.)
• Quick look dashboard– What: Snapshot of each business unit’s performance– When: Monthly (by 12th of month)– Why: Productivity percentage, financial impact percentage, query
rate, & physician agree rate • Productivity report
– What: Initial & subsequent reviews, query agree rate, clarification rate
– When: Monthly using data provided by business unit managers– Why: CDIS productivity
• Trended coverage rate report– What: Coverage by payer for each business unit– When: Monthly– Why: CDIS actual number of reviewed cases by payer
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Report SamplesQuick look dashboardProductivity reportTrended coverage rate report
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Quick Look Dashboard Developed by HFHS
3M QUICK LOOK BY BUSINESS UNIT – HENRY FORD Business Unit 2 (2017)
All PayersJan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
Productivity 89% 92% 91% 82% 89% 80% 72% 84% 83% 87% 87% 80%Impact Rate 11% 12% 13% 13% 12% 11% 12% 11% 14% 11% 11% 12%Query Rate 36% 34% 41% 42% 37% 42% 46% 40% 43% 37% 33% 34%Response Rate 98% 99% 99% 99% 98% 99% 95% 98% 97% 96% 98% 95%Response Rate actual ‐‐‐ ‐‐‐ ‐‐‐ 380 391 454 409 372 393 410 261 381Agree Rate 88% 86% 85% 88% 82% 78% 82% 81% 86% 88% 89% 86%Agree Rate actual ‐‐‐ ‐‐‐ ‐‐‐ 374 341 355 335 284 338 362 274 287*Using 3M report 02d, filtered, inpatient visits, all, visits with final DRG excluding psych/rehab/ungroupable, all inpatients, all payers, coder work excluded, for this hospital only.**This % is without removing Pediatric and OB pts that were admitted to Unit 28.
Medicare/Medicare Advantage Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
Productivity 96% 95% 97% 88% 91% 90% 83% 90% 89% 91% 93% 88%Impact Rate 12% 14% 15% 16% 13% 12% 14% 12% 13% 13% 12% 14%Query Rate 39% 41% 47% 48% 42% 47% 52% 44% 46% 44% 38% 38%Response Rate 99% 98% 99% 99% 98% 99% 97% 98% 97% 96% 99% 95%Response Rate actual ‐‐‐ ‐‐‐ ‐‐‐ 305 322 363 323 288 297 339 282 314Agree Rate 88% 84% 86% 88% 83% 80% 82% 81% 86% 89% 89% 85%Agree Rate actual ‐‐‐ ‐‐‐ ‐‐‐ 300 275 292 266 217 256 301 236 234*Using 3M report 02d, filtered, inpatient visits, concurrent, visits with final DRG excluding psych/rehab/ungroupable, all inpatients, Medicare, Medicare Advantage, coder work excluded, for this hospital only. **This % is without removing Pediatric and OB pts that were admitted to Unit 28.
Case Mix Index Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
All‐Medical 1.2979 1.2625 1.2878 1.2933 1.2746 1.331 1.3198 1.2676 1.3356 1.3647 1.297 1.332All‐Surgical 3.1445 2.9074 2.8035 2.8005 2.7961 3.0108 3.0622 2.878 2.8567 2.9852 2.806 2.7777Combined CMI 1.8876 1.8012 1.7472 1.7459 1.7532 1.8446 1.8561 1.7716 1.8155 1.9321 1.845 1.7213
M/MA‐Medical 1.3309 1.3065 1.31 1.3273 1.3111 1.374 1.3604 1.3106 1.3698 1.4041 1.332 1.3753M/MA‐Surgical 3.2207 3.0255 3.0059 2.8716 2.9419 3.0086 3.0772 3.0293 2.9223 3.1445 2.794 2.9241Combined CMI 1.858 1.7992 1.7354 1.7129 1.7615 1.8239 1.8544 1.7872 1.8147 1.9555 1.778 1.7349*Using 3M report 20 for CMI all payer and Medicare/Medicare Advantage.
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Productivity‐ Initial Review
CDI Expectations Adjusted Weekly Productivity KeyHigh Low Meeting Minimum Expectations
Seasoned 60 50 Within 5 of Meeting ExpectationsNew 50 40 Not Meeting Minimum Expectations
Part‐Time seasoned 25 20
Location CDI 2016 Average Productivity New? Jan‐17 Feb‐17 Mar‐17 Apr‐17 May‐17 Jun‐17 Jul‐17 Aug‐17 Sep‐17 Oct‐17 Nov‐17 Dec‐17
BusinessUnit 1
Boyer 39 No 47 51 49 48 55 49 53 48 42 56 53 50Dedecker 50 No 61 64 59 62 57 55 52 46 50 63 52 49Equia Yes 14 35 35Finn 51 No 64 65 64 61 58 57 51 60 51 62 57 46Gleason Yes 6.6 12.8 24 30 38 28
Jacques, T. 61 No 60 60 57 56 54 53 44 47 43 56 60 55Mahar Yes 9 19 31 30 37 46McDowell 68 No 83 75 81 64 66 62 65 54 39 17 34 27Monti ‐ Yes 6 19 39 46 58 59 63 57 55 58 54 11Rasmussen 9 Contingent 8 16 3 12 9 5 6 9 5 10 12 10Smith 62 No 65 64 62 50 51 50 33 54 55 60 40 29Stumpf 54 No 45 67 49 61 61 58 31 42 36
BusinessUnit 2
Bautel 58 No 51 51 49 50 54 54 55 48 48 42 34 49Day 65 No 53 50 52 48 54 57 54 48 47 37 61 59Fisher 47 No 51 49 52 48 56 59 54 48 48 55 66 61Hanna 63 No 53 50 52 48 31 0 0 LOA 48 56 61 63Harding 58 No 54 50 50 44 55 59 50 48 48 57 63 60Jacques 56 No 51 49 51 46 55 56 54 48 46 67 60 58
BusinessUnit 3
Austin 56 No 59 55 58 60 66 58 57 51 50 62 66 56Brinkmeier 59 No 65 61 65 58 61 64 63 57 52 67 67 59Khoyee ‐ No 10 17 20 32 22 11 1 15 3 12 13 15Mullins ‐ No 4 22 50 60 51 71 52 53 53 57 63 56Reidy 35 No 50 49 53 57 52 64 51 45 44 50 55 59
Business Unit 4
Carter 64 No 55 61 67 59 55 57 49 52 46 63 67 63
Leonhardt 50 Yes 45 54 56 51 64 63 53 59 54 63 66 65
Miller Yes0 4 47 40 57 53
Productivity Report
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Trended CDI Coverage Rates Henry Ford Business Unit 2
Percentage of Cases Reviewed YTD
Financial Class 2016 Avg. 2017 Goal Jan Feb Mar Apr May Jun Jul Aug Sept Oct Nov Dec
Medicare 95.52% 80.00% 96.93% 96.27% 96.62% 89.39% 91.01% 90.49% 83.85% 89.23% 90.72% 90.31% 93.63% 91.13%
Medicare Advantage 96.74% 80.00% 95.72% 95.32% 96.83% 88.93% 90.37% 89.02% 83.53% 85.49% 87.97% 91.21% 93.27% 88.45%
Medicaid 66.67% 80.00% 75.00% 75.00% 67.74% 66.67% 69.23% 60.53% 37.50% 54.76% 72.41% 67.86% 82.86% 76.19%
Medicaid HMO 68.66% 80.00% 74.03% 84.42% 70.00% 66.67% 70.73% 54.81% 55.46% 68.32% 62.35% 80.49% 80.68% 61.17%
Blue Cross 82.73% 80.00% 76.63% 83.93% 86.59% 74.30% 80.57% 61.58% 57.55% 65.08% 77.65% 84.90% 86.10% 67.21%
Commercial 82.30% 80.00% 70.77% 83.33% 81.97% 76.67% 76.92% 71.43% 45.71% 74.51% 78.72% 89.58% 72.88% 77.78%
HAP 80.99% 80.00% 76.71% 83.33% 93.65% 74.24% 78.13% 62.96% 61.29% 72.13% 60.61% 69.70% 81.03% 64.06%Medicaid Pending Applications 86.96% 0.00% 100.00% 100.00% 50.00% 0.00% 50.00% 100.00% 100.00% 75.00% 43.75%
Self-Pay 67.83% 0.00% 85.71% 88.89% 83.33% 76.92% 66.67% 62.50% 50.00% 36.36% 0.00% 40.00% 62.50% 57.14%
All Payers 89.53% 79.08% 89.48% 91.91% 91.41% 83.90% 86.37% 79.82% 72.11% 80.05% 83.33% 87.23% 89.23% 81.36%
Goal 79.08% 79.08% 79.08% 79.08% #N/A 79.08% #N/A 80.00% 79.08% 79.08% 79.08% 80.00%
Trended Coverage Rate Report
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Technology Used for OptimizationPrioritization tool
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CHALLENGEHow to increase coverage while expanding to all payers using ICD‐10 with minimal staffing increase
while improving query impact
SOLUTIONUtilize technology & resources for case reviews
while applying triage & dispatch concepts borrowed from ambulance industry
2015HFHS partnered with 3M to operationalize
CDI triage & dispatch concept
CDI Triage & Dispatch
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In 2015, HFHS partnered with 3M to create a tool to triage & dispatch cases based on the likelihood a record would require intervention by the CDI team
The original version is based on utilizing auto‐suggested codes to quickly determine the MS‐DRG without reviewing the case
After they were automatically sorted by the system, a report displays the cases to be reviewed in a prioritized list
Cases were reviewed based on the opportunity to query for additional information
Initial Phase – Manual Prioritization
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Having a tool to assist in identifying the priority cases allows for more effective reviews
While all cases have potential for improved documentation, there is limited time and resources
Autosuggest prioritization integrated directly into program to include prioritization of initial reviews & assign working DRG
Case prioritization enhances the review process and allows time for more in‐depth review when needed
Expanded Phase – Automated Prioritization
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Focus DRGs
Surgical cases without CC/MCC
Review DRG, consider alternate DRG
Medical cases without CC/MCC
Surgical cases with CC, w/o MCC
Questionable admits
Symptom Dx/DRG
Optimal DRG, no need for review/re‐review
Low‐priority cases – minimal change impact
Current Order of Prioritization
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Prioritization Worklist
• Dashboard fields include: – Visit ID– Patient name– MRN– Length of stay (LOS)– Current location– Financial class– Attending provider– Admit date/discharge date– Working DRG– CD priority
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Benefits of Prioritization Tool
Ability to identify cases that have potential for highest impact
Automated tool assigns initial DRG
Builds consistency of case review for CDIS
Assignment of DRG concurrently
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HFHS DRG Analysis
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• HFHS created its own unique methodology used to analyze inpatient DRG CDI performance to isolate the impact of documentation & coding from other factors, such as product line shift, that impact case‐mix index.
• Methodology consists of two components: CC capture & affinity groups.• In both cases, the method compares patterns & ratios at a detailed level
for individual hospitals, by payer, compared to baselines. Baselines can be structured as prior‐period data for each hospital, if desired. CC capture analytics are reviewed at pair or trio level (w/ MCC, w/ CC, w/o CC/MCC).
HFHS DRG Analysis
• Reports created monthly for each business unit & divided by payer groups into 4 sections: —Medicare/Medicare Advantage—Blue Cross—HAP—Commercial
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Henry Ford Business Unit 2DRG Group Analysis Medicare, Medicare Advantage & Sr. PlusDecember 2017
Weights FY16
DifferenceinReimbursementbyCategory ComparisontoBudget%ofIPTechNet
Revenue
MonthMedical CC/MCC
Surgical CC/MCC
AffinityGroups Total Budget
Actual vs.
Budget Budget ActualJanuary $ 101,352 $ 11,337 $ 17,420 $ 130,108 $ 39,230 $ 90,878 0.37% 1.22%
February 114,261 114,119 (17,547) 210,833 37,796 173,037 0.37% 2.27%March 94,014 133,448 54,934 282,396 39,556 242,840 0.37% 2.69%April 89,144 26,497 17,062 132,703 37,391 95,312 0.37% 1.39%May 43,265 (15,609) 79,669 107,325 39,011 68,314 0.37% 1.04%June 139,470 45,102 85,117 269,688 36,992 232,696 0.37% 2.60%July 83,247 (75,475) 118,397 126,168 35,957 90,211 0.37% 1.32%
August 79,363 92,556 79,091 251,010 37,186 213,825 0.37% 2.47%
September 121,088 52,593 34,085 207,767 35,600 172,166 0.37% 1.76%October 104,821 100,698 111,339 316,858 38,879 277,978 0.37% 2.79%November 68,708 72,765 (25,832) 115,641 37,545 78,096 0.37% 1.28%
December 10,146 (44,071) 131,296 97,371 39,550 57,821 0.37% 0.87%Total $ 1,048,879 $ 513,960 $ 685,031 $ 2,247,869 $ 454,694 $ 1,793,175 0.37% 1.82%
Annualized Difference in Reimbursement $ 2,247,869
HFHS DRG Analysis – Summary
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HFHS DRG Analysis – Medical & SurgicalHenryFordBusinessUnit2 MEDICALSUMMARYMEDICALCC/MCCAnalysisBaselineMedicare,MedicareAdvantage&Sr.Plus2016
Net Revenue Impact # of Cases Level I W/O CC or MCC Level II W CC Level III W/ Major CC
Group Name DRG'sDecember
2017
YTD December
2017December
2017
YTD December
2017December
2017
YTD December
2017
Baseline Medicare, Medicare
Advantage & Sr. Plus 2016
December 2017
YTD December
2017
Baseline Medicare, Medicare
Advantage & Sr. Plus 2016
December 2017
YTD December
2017
Baseline Medicare, Medicare
Advantage & Sr. Plus 2016
Acute myocardial infarction, discharged alive 280,281,282 $ (23,223) $ 20,410 26 247 12% 9% 9% 54% 35% 38% 35% 55% 53%
Cardiac arrhythmia & conduction disorders 308,309,310 23,524 28,812 26 235 12% 25% 23% 35% 41% 49% 54% 34% 28%
Cellulitis 602,603 (3,979) (11,113) 16 180 88% 83% 81% 0% 0% 0% 13% 17% 19%
Chronic obstructive pulmonary disease 190,191,192 (3,823) 129,154 6 259 33% 7% 13% 50% 24% 46% 17% 69% 41%
Septicemia w/o MV 96+ hours 871,872 (2,823) (4,398) 110 1,143 21% 20% 20% 0% 0% 0% 79% 80% 80%
Simple pneumonia & pleurisy 193,194,195 (13,264) (47,618) 31 269 13% 11% 7% 42% 36% 37% 45% 52% 56%
SURGICALCC/MCCAnalysis SURGICALSUMMARYBaselineMedicare,MedicareAdvantage&Sr.Plus2016
Net Revenue Impact # of Cases Level I W/O CC or MCC Level II W CC Level III W/ Major CC
Group Name DRG'sDecember
2017
YTD December
2017December
2017
YTD December
2017December
2017
YTD December
2017
Baseline Medicare, Medicare
Advantage & Sr. Plus 2016
December 2017
YTD December
2017
Baseline Medicare, Medicare
Advantage & Sr. Plus2016
December 2017
YTD December
2017
Baseline Medicare, Medicare
Advantage & Sr. Plus 2016
Amputation for circ sys disorders exc upper limb & toe 239,240,241 $ ‐ $ (18,726) ‐ 10 0% 0% 7% 0% 60% 36% 0% 40% 57%Cardiac defibrillator implant w/o cardiac cath 226,227 (2,945) 44,182 2 24 100% 67% 85% 0% 0% 0% 0% 33% 15%
Cardiac valve & oth maj cardiothoracic proc w/o card cath 219,220,221 ‐ 53,851 0 17 0% 0% 15% 0% 76% 77% 0% 24% 8%
Cholecystectomy 414,415,416 ‐ 11,792 0 5 0% 0% 30% 0% 60% 40% 0% 40% 30%Coronary bypass w cardiac cath 233,234 (11,524) (139,254) 2 44 100% 84% 65% 0% 0% 0% 0% 16% 35%Coronary bypass w/o cardiac cath 235,236 (8,635) (27,633) 5 47 100% 91% 87% 0% 0% 0% 0% 9% 13%
Craniotomy & endovascular intracranial procedures 25,26,27 2,226 68,220 2 27 0% 7% 15% 50% 22% 39% 50% 70% 45%
Extensive O.R. procedure unrelated to principal diagnosis 981,982,983 9,021 (26,339) 4 38 0% 3% 2% 25% 42% 38% 75% 55% 60%Heart transplant or implant of heart assist system 1,2 ‐ ‐ 0 0 0% 0% 0% 0% 0% 0% 0% 0% 0%
Hip & femur procedures except major joint 480,481,482 (15,590) 23,172 16 150 25% 18% 20% 63% 55% 55% 13% 27% 25%Infectious & parasitic diseases w O.R. procedure 853.854,855 (11,005) 88,774 10 141 0% 0% 0% 30% 21% 24% 70% 79% 76%
Laparoscopic cholecystectomy 417,418,419 (2,780) (17,169) 3 51 0% 22% 27% 100% 57% 43% 0% 22% 30%Liver transplant 5,6 ‐ ‐ 0 0 0% 0% 0% 0% 0% 0% 0% 0% 0%Lower extrem & humer proc except hip,foot,femur 492,493,494 (873) (47,125) 1 32 0% 41% 32% 100% 50% 42% 0% 9% 26%
Major chest procedures 163,164,165 (8,749) 97,996 1 43 100% 16% 21% 0% 42% 50% 0% 42% 29%
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41
HFHS DRG Analysis
• Affinity groups look at patterns between DRGs that “travel together,” but have different primary diagnoses
• Includes 20 groups• Examples:
– Respiratory failure vs. COPD – Pneumonia vs. septicemia
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42
HFHS DRG Analysis – Affinity HenryFordBusinessUnit2 AFFINITYSUMMARYAffinityGroupAnalysisBaselineMedicare,MedicareAdvantage&Sr.Plus2016
NetRevenueImpact #ofCases CMI %Distribution
Group# GroupName DRG'sDecember2017
YTDDecember2017
December2017
YTDDecember2017
December2017
YTDDecember2017
BaselineMedicare,Medicare
Advantage&Sr.Plus2016
December2017
YTDDecember2017
BaselineMedicare,Medicare
Advantage&Sr.Plus2016
1A STROKEWTPAMCCVS.INTRACRANIALHEMORRHAGEMCC
ACUTEISCHEMICSTROKEWUSEOFTHROMBOLYTICAGENTWMCC 61 $ (586) $ (104,665) 1 7 2.6843 2.6843 2.6843 11.1% 6.3% 11.5%
INTRACRANIALHEMORRHAGEORCEREBRALINFARCTIONWMCC 64 378 67,557 8 105 1.7326 1.7326 1.7326 88.9% 93.8% 88.5%
TOTAL $ (208) $ (37,108) 9 112 1.8383 1.7921 1.8418 100.0% 100.0% 100.0%
1B STROKEWTPACCVS.INTRACRANIALHEMORRHAGECC
ACUTEISCHEMICSTROKEWUSEOFTHROMBOLYTICAGENTWCC 62 $ 17,330 $ (15,755) 3 17 1.8918 1.8918 1.8918 23.1% 11.6% 12.5%
INTRACRANIALHEMORRHAGEORCEREBRALINFARCTIONWCC 65 (9,704) 8,822 10 129 1.0593 1.0593 1.0593 76.9% 88.4% 87.5%
TOTAL $ 7,626 $ (6,933) 13 146 1.2514 1.1562 1.1634 100.0% 100.0% 100.0%
1C STROKEWTPAVS.INTRACRANIALHEMORRHAGE
ACUTEISCHEMICSTROKEWUSEOFTHROMBOLYTICAGENTW/OCC/MCC 63 $ (3,151) $ (25,906) ‐ 2 1.5238 1.5238 1.5238 0.0% 4.5% 10.3%INTRACRANIALHEMORRHAGEORCEREBRALINFARCTIONW/OCC/MCC 66 1,566 12,876 3 42 0.7574 0.7574 0.7574 100.0% 95.5% 89.7%
TOTAL $ (1,585) $ (13,029) 3 44 0.7574 0.7922 0.8367 100.0% 100.0% 100.0%
2 RESPIRATORYFAILUREVSCOPDWMCC
PULMONARYEDEMA&RESPIRATORYFAILURE 189 $ 37,757 $ (549,932) 22 275 1.2265 1.2265 1.2265 95.7% 60.7% 75.6%
CHRONICOBSTRUCTIVEPULMONARYDISEASEWMCC 190 (35,642) 519,128 1 178 1.1578 1.1578 1.1578 4.3% 39.3% 24.4%
TOTAL $ 2,115 $ (30,803) 23 453 1.2235 1.1995 1.2097 100.0% 100.0% 100.0%
3A SEPTICEMIAVSSIMPLEPNEUMONIAWMCC
SEPTICEMIAORSEVERESEPSISWMV96+HOURS,WOMVWMCC96+&WOMV&WOMCC96+ 870,871,872 $ 84,722 $ 863,757 119 1,204 1.8090 1.8090 1.8090 89.5% 89.5% 84.2%
SIMPLEPNEUMONIA&PLEURISYWMCC 193 (66,789) (680,920) 14 141 1.4261 1.4261 1.4261 10.5% 10.5% 15.8%
TOTAL $ 17,934 $ 182,836 133 1,345 1.7687 1.7689 1.7485 100.0% 100.0% 100.0%
2018 Copyright, HCPro, an H3.Group division of Simplify Compliance LLC. All rights reserved. These materials may not be copied without written permission.
43
DRG
Ana
lysis
Mon
thly Review
Compare against our baseline
All payers
Medical and surgical pairs/trios & affinity groups
CC/MCC capture rate
CMI variance by product line
Chart reviews assigned
Opportunities identified: Coding rebills & educational opportunities for CDI
How DRG Analysis Data Is Used
2018 Copyright, HCPro, an H3.Group division of Simplify Compliance LLC. All rights reserved. These materials may not be copied without written permission.
44
3M Data Monitoring ReportsFY: 1/2017–12/2017
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45
Performance MonitoringHFHS CDI leadership works closely with our 3M partner to review data/reports, identify & coach staff on focus areas, improvement opportunities, & review/query strategies for those focus areas.
Ability to drill down to the following levels: ▪Enterprise ▪Facility ▪Physician ▪Patient case
Physician Dashboard Variance reports Case volume Average length of stay MS‐DRG case‐mix index Severity of illness variance Mortality rate variance
Executive Dashboard Financial overview CDIS overview Case‐mix index MCC/CC capture Alternate principal diagnosis Severity of illness Mortality rate
2018 Copyright, HCPro, an H3.Group division of Simplify Compliance LLC. All rights reserved. These materials may not be copied without written permission.
46
Benefits of Performance Monitoring
• Assess CDI performance impact to HFHS organization – You can’t manage what you can’t measure
• Decision management utilizing performance data reports• Sustain momentum through continued process improvements• Reduce retrospective inquiries by shifting to concurrent process• Consistently monitor discharge data & measure improvements • Recognize challenges & take corrective action as needed • Expand performance monitoring data points (e.g., all payers)• Share performance trends with CDI steering committee• Combined metrics impacted by CDI process should be used as
educational indicators
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47
Case‐Mix Index
Shows changes in CMI comparing year‐to‐year Subsequent reports will support any changes demonstrated in this graph
Proprietary Data
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48
Overview of Medicare & Medicare Advantage Impact
Shows financial impact with adjusted medical/surgical mix Identifies DRGs that require additional focus Compares year‐to‐year
Proprietary Data
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49
Clinical & Financial PerformanceMCC/CC Capture Rate – Medical
Reflects severity of our patient population Demonstrates yearly comparison between pairs & trios Benchmark is set at 75th percentile Report has medical & surgical components
Proprietary Data
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50
MCC/CC Capture Top Focus Areas (Medical)
Identifies which DRGs require focus Corresponding report to MCC/CC capture rate for medical & surgical
Proprietary Data
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51
Total Population Service Line PerformanceHenry Ford Health System, Business Unit 1
Demonstrates contribution to overall change in CMI by service line
Proprietary Data
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52
Alternative Principal Diagnosis Ratios
Demonstrates how CDI can impact the DRG Compares our performance against benchmarks that identify opportunities (focus here)
Proprietary Data
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53
Financial Impact Related to Queries (Medicare & Medicare Advantage)
The above financial impact is calculated as: Change in final MS‐DRG RW − Baseline impact MS‐DRG RW × Blended rate for each case queried by CDI Cumulative amount is calculated by manually adding the sum of each period Estimated financial impact is dependent on appropriate selection of baseline impact MS‐DRG
Proprietary Data
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54
Coverage & Query Rates
Shows our monthly coverage & query rates compared to benchmark (per business unit)
Proprietary Data
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55
Physician Response
Shows our monthly physician response & agree rates compared to benchmark Report is displayed for each business unit
Proprietary Data
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56
Key Takeaways
• Collaboration is KEY • Provider education & relationships• Getting it right the first time:
– Minimizes queries– Minimizes time spent– Maintains integrity of record
• Leverage technology to enhance CDI operations• Integration of program performance metrics to drive success• The overall goal of a CDI program is to build a multidisciplinary
team that includes CDI nurses, coders, & physician champion(s) focusing on ensuring the documentation accurately reflects the complexity of a patient’s condition & care
2018 Copyright, HCPro, an H3.Group division of Simplify Compliance LLC. All rights reserved. These materials may not be copied without written permission.
57
Revenue Improvement Over 3 Years
Henry Ford Health SystemCDI DRG Impact
Hospital 2015 2016 2017
2017versus2014
Cumulative 3 Year Benefit
Business Unit 1 2,935,000 2,932,000 2,392,000 8,259,000 17,060,000
Business Unit 2 2,209,000 (1,165,000) 2,880,000 3,925,000 7,178,000
Business Unit 3 213,000 272,000 1,525,000 2,009,000 2,707,000
Business Unit 4 1,036,000 167,000 2,437,000 3,641,000 5,880,000
Total 6,392,000 2,207,000 9,235,000 17,834,000 32,825,000
2018 Copyright, HCPro, an H3.Group division of Simplify Compliance LLC. All rights reserved. These materials may not be copied without written permission.
58
2017Jan Feb Mar Apr May June July Aug Sept Oct Nov Dec Total
HFHActual 118,025$ 209,133$ 719,586$ 53,937$ (137,769)$ 358,481$ 173,969$ (201,388)$ (30,894)$ 231,417$ 379,218$ 518,708$ 2,392,421$ Budget 117,213 113,761 120,527 115,781 117,536 115,340 120,185 114,249 117,168 116,229 115,223 116,787 1,400,000 Variance 812$ 95,372$ 599,058$ (61,844)$ (255,306)$ 243,140$ 53,783$ (315,637)$ (148,062)$ 115,188$ 263,994$ 401,921$ 992,421$
HFMHActual 168,172$ 191,897$ 345,747$ 234,161$ 202,871$ 376,721$ 124,936$ 257,021$ 214,610$ 465,146$ 118,317$ 180,726$ 2,880,325$ Budget 60,600 58,208 61,085 57,510 59,929 56,897 55,294 57,095 54,848 59,876 57,588 61,070 700,000 Variance 107,571$ 133,689$ 284,662$ 176,651$ 142,942$ 319,824$ 69,642$ 199,926$ 159,762$ 405,271$ 60,729$ 119,656$ 2,180,325$
HFWHActual 93,045$ 131,225$ 248,061$ 147,533$ 148,218$ 63,424$ 292,850$ 242,010$ 285,321$ 206,683$ 295,877$ 282,843$ 2,437,090$ Budget 57,727 55,995 59,706 58,588 60,575 56,463 59,552 57,950 58,807 60,819 59,381 54,439 700,000 Variance 35,318$ 75,231$ 188,355$ 88,945$ 87,643$ 6,961$ 233,298$ 184,060$ 226,515$ 145,864$ 236,496$ 228,404$ 1,737,090$
HFWBHActual 32,411$ 235,439$ 90,106$ 11,463$ 143,045$ 51,054$ 47,418$ 204,075$ 212,956$ 102,213$ 185,085$ 209,507$ 1,524,771$ Budget 57,111 54,915 59,626 57,889 60,018 57,789 60,737 59,682 58,429 58,057 57,629 58,119 700,000 Variance (24,701)$ 180,524$ 30,479$ (46,427)$ 83,027$ (6,735)$ (13,318)$ 144,394$ 154,526$ 44,156$ 127,457$ 151,388$ 824,771$
TotalActual 411,652$ 767,695$ 1,403,499$ 447,094$ 356,365$ 849,680$ 639,173$ 501,718$ 681,993$ 1,005,459$ 978,497$ 1,191,783$ 9,234,607$ Budget 292,652 282,878 300,944 289,768 298,058 286,489 295,767 288,975 289,252 294,980 289,821 290,414 3,500,000 Variance 119,000$ 484,817$ 1,102,554$ 157,325$ 58,307$ 563,190$ 343,406$ 212,742$ 392,741$ 710,479$ 688,676$ 901,370$ 5,734,607$
CDI DashboardConsolidated
Current Year Dashboard (2017)
Business Unit 2
Business Unit 3
Business Unit 4
Business Unit 1
Success!!2018 Copyright, HCPro, an H3.Group division of Simplify Compliance LLC. All rights reserved. These materials may not be copied without written permission.
59
Appendix
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60
Grouping Metric Description Option Option Name Points Total Weight
Query Metrics Correct DRG Assignment % DESC1 Correct 20
202 Incorrect 0
Query Metrics Correct Query Format % DESC1 Correct 20
202 Incorrect 0
Query Metrics Missed Query % DESC1 No 20
202 Yes 0
Query Metrics Appropriate Query % DESC1 Yes 20
202 No 0
Query Metrics Procedure Query DESC1 No 20
202 Yes 0
Increased Patient Acuity Accuracy & Quality Metrics
Severity of Illness (SOI) DESC1 No 10
102 Yes 0
Increased Patient Acuity Accuracy Risk of Mortality (ROM) DESC
1Yes,
Appropriate Query
10
102Yes,
Inappropriate Query
5
3 Yes, No Query 0
4 No 10Increased Patient Acuity Accuracy MCC Opportunity DESC 1 No 20 20
Quality – Work Sheet (HFHS Designed)
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61
Grouping Metric Description Option Option Name Points Total Weight
Increased Patient Acuity Accuracy CC Opportunity DESC
1 No 20
202 Yes 10
3 Option 3 ‐ Not Active 0
4 Option 4 ‐ Not Active 20
Quality Metrics PSI 15 Opportunity DESC1 No 5 52 Yes 0
Quality Metrics Hospital‐Acquired Condition (HAC) DESC
1 No 10102 Yes 0
Quality Metrics Present on Admission (POA) Opportunity DESC
1 Yes, Appropriate Query 15
152 Yes,
Inappropriate Query 5
3 Yes, No Query 0
4 No 15
Quality Metrics Clinical Indicator DESC
1 Yes, Appropriate Query 10
102 Yes, Inappropriate Query 5
3 Yes, No Query 0
4 No 0
Quality – Work Sheet (HFHS Designed)
2018 Copyright, HCPro, an H3.Group division of Simplify Compliance LLC. All rights reserved. These materials may not be copied without written permission.
62
Thank you. Questions?
sgleaso1@hfhs.org; 313‐874‐4851ssoman1@hfhs.org
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.
2018 Copyright, HCPro, an H3.Group division of Simplify Compliance LLC. All rights reserved. These materials may not be copied without written permission.
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