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

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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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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• 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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• 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



December 2017

YTD December

2017



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



December 2017

YTD December

2017


Advantage & Sr. Plus2016

December 2017

YTD December

2017



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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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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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%


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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

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.

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Appendix


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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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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)


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Thank you. Questions?

[email protected]; 313‐874‐[email protected]

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.


Documents

Integrating Analytics Into CDI Operations to Build a Stronger … · Susie Gleason, RHIT, CCDS System Director CDI & Education, Revenue Cycle Administration Henry Ford Health System