Strategies for a successful CDI program – our story

Strategies for a successful CDI program – our story
April 10, 2015
What does a CDI program do?
 The purpose of a CDI program is to initiate concurrent and, as
appropriate, retrospective reviews of inpatient records for
conflicting, incomplete, or nonspecific provider documentation
 The goal of these reviews is to identify clinical indicators to
ensure that the diagnoses and procedures are supported by
ICD-9/ICD 10 codes. The primary method of clarification used
by the CDI professional is electronic queries
 These efforts result in an improvement in documentation,
coding, reimbursement, and severity of illness (SOI), risk of
mortality (ROM) and value based purchasing initiatives
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What do the experts say a CDI
program should have?
 Tenured and respected RN’s who have years of clinical
experience and excellent communication skills with providers
 A physician advisor
 Established Key Performance Indicators
 Excellent collaboration and communication with coding
professionals
 Effective and easy to use software to enhance the CDI program
 A compliant CDI program with ongoing education and feedback
 An established structure to report on program success and
opportunities for improvement
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The Past
 Began in 2000 at St. Elizabeth Edgewood; added to Florence and
Ft. Thomas when they merged with St. Elizabeth in 2010
 The query process was paper based prior to the EPIC clinical
documentation go live on May 15, 2012
 The program was managed out of Quality Management and
transitioned to Health Information Management in late 2012
 Midas was the software tool used to track CDI progress
 The program did not have a formal Physician Advisor
 Key Performance Indicators were not published
 Success and performance was based upon financial impacts
primarily
 Focused only on Medicare population
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The Present
 Team consists of a CDI Team lead and 6.2 RN FTE’s for a total of
7.2 FTE’s
 Queries are electronically sent through the EPIC in-basket for
physician response
 Transitioned from Midas to 3M CDIS in 2013
 The program transitioned to Health Information Management in late
2012 and team was centralized under our coding division
 Iodine software implemented in October 2014 to assist with all
payers being reviewed
 Physician Advisor hired in March 2015
 Key Performance Indicators reported monthly
 Success and performance is based upon value based purchasing
initiatives first and financial impacts second
 Educated CDI team on documentation guidelines to assist with value
based purchasing in late 2014
 Ongoing education for ICD 10 preparation
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The Future
 Continued collaboration and education for value based purchasing
and ICD 10 working with Coding, Patient Safety, Quality
Management and Infection Control
 Continued evolution of Iodine software in terms of building alerts to
assist with value based purchasing initiatives
 Continued expansion of Physician Advisor program to include 2
additional part time physician advisors
 Provide educational sessions to our providers in a collaborative
effort with our Physician Advisor and other leaders
 Continued education of our CDI and Coding team regarding
documentation guidelines to improve value based purchasing
initiatives
 Continued education of our CDI and Coding team regarding
documentation opportunities pre and post ICD 10
 Exploration of computer assisted documentation tools for providers
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KPI and process review
 Metrics were defined based upon benchmarks from AHIMA, ACIDIS
and HFMA
 These results are calculated monthly and shared with the CDI,
Coding, Physician Advisor and Revenue Cycle leadership
 This process assists us in telling our story over a period of time and
making adjustments to our program as needed or as healthcare
changes
 The premise behind a KPI tool is that you can’t improve or manage
what you don’t track
 Review St. Elizabeth CDI KPI
 Review CDI process
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Questions?
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Contacts:
Jon R. Kemper, RHIA
[email protected]
859-301-2041
Jean Allen Ellington, RHIA
[email protected]
859-301-9190
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