1

To some, the utterance of this classification system produces much trepidation and with this article, I hope to dispel some of the concerns as I recount the undertaking of ICD-10 implementation at one CDI program.

First, please understand that I am not here to de-emphasize the seriousness of ICD-10-CM/PCS, but rather to equip you with a roadmap of tips and hints as you embark on this journey.

It is true that CDI productivity will decrease, mostly due to the sheer volume of queries needed for the added specificity vital for correct code assignment. The act of query writing, no matter how experienced one may be, takes time. I feel, though, that with preparation and open channels of communication, the impact on productivity can be limited.

The CDI program I speak of is housed within the HIM Department at a large Midwestern hospital that holds National ranking as a U.S. News and World Report Best Hospital. The CDI team is comprised of 25 Clinical Documentation Special-ists (CDSs) who work on the units, and 4 Docu-mentation Quality Coordinators (DQCs), who serve as Second Level Reviewers. The unit CDSs have assigned units, which helps with relation-ship building and consistency. The entire team is comprised of consultants with MedPartners CDI, and the success of this team is built on the relation-ships with the clinical care team that they have cultivated, as well as the knowledge and expertise that comes with being a MedPartners consultant. The focus of the CDI team is holistic, meaning that the goal is a complete and precise narrative of the patient encounter documented by the provider in the medical record.

CDI Horizons

ICD-10 CM/PCS Vo

lum

e III, Issue 2

Dec. 2014

Win a $500 Shopping Spree!

Attention all MedPartners Consultants!!!

Here’s your chance to win a $500 AMEX Gift Card to support your Holiday Shopping!!! Each Division (Coding, ODM, CDI & Case Management) is giving away a Gift Card which can increase your chances to win.To qualify, you must complete 160 hours of work from December 8th through January 4th, will be automati-cally entered into our drawing! Please contact your recruiter with any questions, and best of luck! We appreciate all your hard work and being part of the MedPartners Family!You will have another

chance to win a gift card for our December Drawing.

Wishing you a Happy Holiday Season!

2

CDI Horizons

Vo

lum

e III, Issue 2

Dec. 2014

ICD-10 implementation actually began more than a year ago, with the integration of queries that incorpo-rated the specific documentation necessary for code assignment in ICD-10-CM. This served two purposes – one, it began to introduce the necessary elements to the CDI team and two, it began to assimilate language into the provider’s documentation. The end goal for this initiative was that October 1st, 20xx would be just another day to the providers in the hospital setting.

In March of 2014, the CDI team went live with ICD-10 code assignment with the 3M CDIS tool. While the initial plan was to dual code (both ICD-9 and ICD-10); in the end, a decision was made to have the CDI team work solely within the ICD-10-CM/PCS environ-ment. Go-live day began with a team meeting where it was emphasized that this was a time of learning, growth

and discovery, with the expectation that productivity would drop. It was understood that it was more im-portant that the CDI team learn and assist each other as they ventured down this road together. Questions were channeled through the DQCs who analyzed the scenarios, closed the loop with the CDS, then compiled the questions and answers and posted them on the CDI Team Share Drive. Weekly huddles were held to discuss everything ICD-10, from how to navigate the encoder in ICD-10, to query formation and the enhancement of query templates.

It should be mentioned that the CDI team worked mostly in CM, with overall limited exposure to PCS. This was due to the unavailability of the requisite full Operative or Procedure Report in order to assign an ICD-10-PCS code. In a large portion of hospitals, the availability of such reports can lag by several days. The CDI team would code the procedure if they had the report, but the avail-ability of these reports was limited to longer stay surgical cases and in critical care units.

A study of before and after implementation data, while limited, shows a minimal impact on CDI productivity, with an expected slight drop initially, and a rapid rebound to pre-implementation pro-ductivity numbers.

Knowing that PCS encompassed the majority of the ICD-9 to ICD-10 metamorphosis, the impact on CDI productivity increased on those covering surgical and critical care areas, yet, again, rapidly rebounded to pre-implementation numbers. Suc-cess in these areas was embedded in continuity of the covering CDS and the open lines of communi-cation.

My hope is that I have provided you with encour-agement that ICD-10-CM/PCS doesn’t have to be met with apprehension. I don’t profess to know all of the answers regarding ICD-10, but we can all appreciate the journey and grow as we open the channels of communication.

Let us grow together.

Karen Newhouser

Director of CDI Education

MedPartners CDI

ICD-10 CM/PCS con’t

3

CDI Horizons

Vo

lum

e III, Issue 2

Dec. 2014

MedPartners helped implement the Clinical Docu-mentation Improvement (CDI) Program at Daviess Community Hospital. Karla J., a MedPartners CDI Specialist, played a critical role in this process by identifying top DRGs, developing processes, and educating physicians and other key staff to ensure a solid foundation was established prior to launching the CDI program. Below is an article that discusses the launch of the CDI program at Daviess Commu-nity Hospital in more detail. Washington, IN, Times Herald, September 19th, 2014 - Daviess Commu-nity Hospital is pleased to announce the launch this week of our Clinical Documentation Improvement Program. What is Clinical Documentation Improve-ment?

Your health information provides information about not only your current health status but also your past medical history. Accurate healthcare records focus on the well-being of our most valuable asset — you.

Daviess Community Hospital announces launch of CDI Pro-

gram

As the demand for accurate and timely clinical docu-mentation increases, Health Information Manage-ment (HIM) and clinical professionals are using their skills and expertise to improve clinical documenta-tion. Because clinical documentation is at the core of every patient encounter, the information documented needs to be accurate, timely, and reflect the scope of services provided to the patient. Successful Clinical Documentation Improvement (CDI) programs facili-tate the accurate representation of a patient’s clinical status that translates into coded medical data. The coded data is then translated into quality report cards, physician report cards, reimbursement, public health data, and disease tracking and trending. By working together, HIM and clinical professionals can sup-port their organizations efforts to collect and provide meaningful information throughout the continuum of care. CDI is a team effort that aims to ensure that the documentation contained in each patient’s medical record is a complete reflection of the patient’s condition(s). A Clinical Documentation Specialist (CDS) is a specially trained staff member who reviews medical records to assist in proper and accurate documentation of clinical information. If documen-tation lacks the clarity and specificity necessary for proper and accurate medical coding a CDS will query the provider (physician) to gain more information or specificity.

4

CDI Horizons

Vo

lum

e III, Issue 2

Dec. 2014

The MedPartners CDI Team members connected with the Clinical Documentation Improvement (CDI) Team at Kaleida Health (KH) in Buffalo, New York as of August 2013, and continue to provide support to that client today. The CDI program at Kaleida Health is part of their Revenue Cycle Team. One, of the many, initia-tives from the Kaleida Health’s Revenue Cycle Team in the 3rd Quarter 2013 was a Physician Documentation Strategic Plan. With the future transition to ICD- 10, and changes to Medicare’s Pay for Performance programs effecting reimbursement as of October 2014, Kaleida Health’s priority was placed on clinical documentation to impact not only revenue, but also quality. The CDI staff was increased from 9 full time employees (FTEs), KH employed, to 20 FTEs, including both KH employed and agency staff. Kaleida Health’s strategic plan is success-ful, with an increase in physician engagement, ability to meet KH goals, as well as other metrics that are trending in a positive direction. These successes are among the many measurable contributions toward Kaleida Health’s Revenue Cycle Team being awarded the Healthcare Business Insights 2014 Revenue Cycle Award, designed to recognize Academy members for their revenue cycle achievements.

Buffalo, NY is positioned on the waterfront of Lake Erie, in Western New York. Niagara Falls and the Canadian border are just fifteen minutes away. The four seasons in this area are dynamic. With the many large bodies of wa-ter near Buffalo, summer is full of boating and festivals. The fall foliage change is bright and colorful. The lake effect snow in winter is great for skiing. Spring is vibrant with many varieties of flowers and trees, contributing to a bountiful agricultural area.

Success in all seasons for CDI in Western New

York

Many of the CDI team members took opportunities throughout each season for team- building activities together. Some of the activities included jet boating on the Niagara River, group weekend of relaxation at the near-by Finger Lakes, wine tasting tours in New York and across the border in Canada, sightseeing at Niagara Falls, and attending local festivals.

As a cohesive CDI team we work together to continually improve the KH CDI program metrics. Kaleida Health also transitioned from a hybrid medical record to a com-pletely electronic medical record, with a new electronic query process as of May of this year. Each CDI team mem-ber is assigned a unit or units at one of the four Kaleida Health Hospitals including: Buffalo General Medical Center/Gates Vascular Institute; Women’s & Children’s Hospital of Buffalo; DeGraff Memorial Hospital and Millard Fillmore Suburban Hospital. The CDI staff is also assigned to specific service lines. We continually work to develop collaborative relationships with the Physicians/Providers, and when deemed necessary initiate weekly rounding with them to provide education. A “Documenta-tion Tip of the Week” (ICD 10 compliant) is emailed to service line Physician/Provider team members weekly. In addition to daily chart reviews, group chart reviews are done intermittently to identify education opportunities by service line.

The data, from the end of July 2014, predicts that the total impact of CDI driven DRG changes for all inpatient admissions will have a significant improvement over 2013 results. Both Medicare and All payer billed case mix index have increased. The percent of cases with length of stay op-portunity (% of days that are over the expected lengths of stay) have decreased. Per the PEPPER data, the captured CC and MCC rate in both medical & surgical DRGs in-creased, and the percent of DRGs with only a single CC or MCC has decreased. All KH CDI program specific metric measurements are proprietary and held in the Revenue Cycle Department at Kaleida Health.

The collaborative CDI Team at Kaleida Health certainly has made significant improvements in just a year’s time. As part of the Revenue Cycle Team, they are well de-served of the Healthcare Business Insights 2014 Revenue Cycle Award. The MedPartners CDI Team takes pride in contributing towards the positive influence on the Physi-cian Documentation Strategic Plan at Kaleida Health. The Kaleida Health CDI team has been approved to fill the CDI positions with their own employees. So we have some new Kaleida Health CDI staff and anticipate more will be coming for orientation throughout the next few months. The MedPartners CDI Team will be there to share the beautiful Western New York seasons, our knowledge, and the continuing successes with them.

By: Kalena

5

CDI HorizonsV

olu

me III, Issu

e 2D

ec. 2014

CHICAGO, Oct. 23, 2014 /PRNewswire/ -- UHC named Barnes-Jewish Hospital the 2014 recipient of the Rising Star Award during the UHC Annual Conference 2014 in Las Vegas. The award recognizes significant improvements in ranking in UHC’s annual Quality and Accountability Study, which identifies exemplary performance in patient safety, mortality, clinical effectiveness, and equity of care.

The MedPartners Team celebrates its accomplishments at the Barnes-Jewish Hospital

“As the recipient of the UHC Rising Star Award, Barnes-Jewish Hospital exhibits the ethos of continuous quality improvement and accountability that is needed to deliver outstanding patient care in today’s health care system,” said Irene M. Thompson, UHC’s president and chief executive officer. “The fact that this organization was selected from a group of more than 100 academic medical centers is a true testament to its fo-cus on improving quality and patient safety.”

The UHC Quality and Accountability Study was designed to help academic medical cen-ters identify structures and practices that are associated with high performance in quality and safety.

UHC Honors Barnes-Jewish

Hospital with 2014 Rising Star Award