1 Integrating Analytics Into CDI Operations to Build a Stronger Program Susie Gleason, RHIT, CCDS System Director CDI & Education, Revenue Cycle Administration Henry Ford Health System Detroit, Michigan Sandeep Soman, MD, FNKF Associate Division Head Division of Nephrology and Hypertension Physician Advisor Henry Ford Hospital Detroit, Michigan 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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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
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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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
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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*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
• 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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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
– 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
– 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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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
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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
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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
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
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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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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
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3M Data Monitoring ReportsFY: 1/2017–12/2017
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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
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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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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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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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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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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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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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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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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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Coverage & Query Rates
Shows our monthly coverage & query rates compared to benchmark (per business unit)
Proprietary Data
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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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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
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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
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2017Jan Feb Mar Apr May June July Aug Sept Oct Nov Dec Total
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Appendix
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Grouping Metric Description Option Option Name Points Total Weight
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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Grouping Metric Description Option Option Name Points Total Weight
Increased Patient Acuity Accuracy CC Opportunity DESC
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)
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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.
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