Location: Eastern United States
Type: Large, integrated health network
Two years ago, when this health system’s leadership questioned the value of clinical documentation improvement (CDI), the CDI leaders didn’t have the data to defend their program. No current internal quality assurance programs were underway to evaluate the impact of coding and CDI on reimbursement or quality reporting, and it had been five years since the last external coding audit. Their hard work was not reflected in the limited data available.
To make matters worse, physicians were constantly challenging the CDI specialists and coders over their documentation queries and coding decisions. Productivity was also a concern, since the coding team—many of them inexperienced and not yet credentialed—relied heavily on outsourcing.
In short, the organization’s CDI and coding programs needed attention on many fronts, from staff development to physician engagement. And the programs themselves needed to prove their worth to the organization.
To win over skeptical hospital leaders and clinicians, this health network launched a CDI transformation initiative using tangible, actionable data provided by the 3M™ 360 Encompass™ System, enhanced with consulting and education services through the 3M™ Advanced CDI Transformation Program from 3M Consulting Services.
The organization kicked off improvement efforts with a complete analysis of one year’s data from all hospitals in the network, plus more than a thousand in-depth chart reviews. 3M 360 Encompass performance data was analyzed to identify the most pressing issues and priority tasks for each network facility, including metrics on individual physicians, service lines and even specific patient cases.
In the past, CDI specialists had limited documentation review to DRG assignment, but now their review was expanded to include a full assessment of severity of illness and risk of mortality (SOI and ROM), including a careful review of gaps in the medical record and missing comorbidities.
To enhance team collaboration, the organization recruited 60 physician champions and launched a broad education program that included lectures and physician-to-physician training. 3M consultants conducted hundreds of education sessions, providing much-needed training in CDI best practices for physicians and mid-level practitioners.
One year into the program, the health system captured an additional $18 million in revenue through more complete documentation and improved capture of SOI and ROM. The newly educated physicians engaged in CDI with a better understanding of the impact of incomplete documentation on quality scores. As a result, the number of coded complications decreased dramatically: a 59 percent reduction since the CDI transformation program launch. 3M’s advanced software tools helped the CDI and coding teams collaborate to standardize physician queries and increase query response rates across all network facilities.
With a renewed commitment to staff development, the organization increased the number of credentialed coders from an initial 20 percent to 98 percent after the first year, a key factor in boosting coder productivity by 17 percent. The CDI team now provides real-time concurrent documentation support with CDI specialists participating in clinical rounds and joining medical department staff meetings to answer questions. Finally, physicians now have access to a CDI hotline that’s available 24 hours a day.
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