All Entries Tagged With: "CDI"
CMS abandons IPPS payment reduction for now
Though many hospitals feared a 1.9% reduction in payment for 2010, they will actually see a 2.1% increase, according to the fiscal year (FY) 2010 IPPS final rule that CMS released July 31. CMS had originally proposed a documentation and coding adjustment to account for the effect of increases in aggregate payments due to changes in hospital coding practices that it says do not reflect increases in patients’ severity of illness.
The proposed adjustment would have resulted in historically low payments for hospitals and especially penalize hospitals that have yet to develop a clinical documentation improvement (CDI) program, says DeAnne Bloomquist, RHIT, CCS, president and chief consultant for Mid-Continent Coding, Inc. in Overland Park, KS. “I think that means that hospitals can breathe a sigh of relief.”
In the proposed IPPS rule, CMS intended to reduce future payment rates “based on the observed increase in spending due to documentation and coding that occurred in fiscal 2008,” according to CMS’ press release. However, because it does not have a full year of data that would show the extent of documentation and coding effects on 2009, CMS decided not to implement the adjustment until it has a full year of FY 2009 data.
In the next year, hospitals with CDI programs should continue their initiatives, while those who have not implemented one yet should work toward that goal, says Gloryanne Bryant, RHIA, CCS, CCDS, Regional Managing HIM Director at Kaiser Foundation Health Plan Inc & Hospitals.
Nurses fight for rights as CDI professionals
Clinical Documentation Specialist?
I was reading an article (title undisclosed) recently that discussed the importance of hiring a CDI specialist in a certain hospital settings. They gave a glowing account of the attributes of the clinical documentation specialist and the benefits they have on the business side of medicine.
The article went on to describe how to select a trained applicant. It recommended that the hospital “select a clinically astute coding professional with a strong business background.” It went on to say that hospitals should “consider hospital coders with a business background as likely candidates, because they not only posses business experience, but they also have clinical knowledge and competency in IV infusion and other related coding areas.”
I was horribly disappointed with the implication that a (nurse) clinical documentation specialist could not do the job.
Last year our hospital hosted a team of CDI specialists from a nearby hospital who wished to gain information on growing their program. At the conclusion of the day the manager told us that prior to coming to our hospital he would not have hired an RN. He thought they were unable to understand coding rules and concepts. After spending the day with us, he no longer felt that way.
At the Florida Regional ACDIS meeting that same manager introduced us to his team and he was especially proud to introduce his newest team member—a nurse.
When are the walls going to come down? A majority of the ACDIS members who attended the meeting in Las Vegas were nurses, yet most of the resources for clinical documentation improvement are are geared for coders. I am confused!
When I made the transition from case management to CDI, I was excited to enter a new and growing field. CDI was presented as a new opportunity for experienced nurses who had a desire to grow professionally. Our department had no policies or procedures, or standards for recording or measuring success. We developed the program from scratch.
I am not a coder but I worked very hard to learn the little bit I have learned about coding. I read many books, have taken many courses and asked many questions. I am a Clinical Documentation Specialist. Why is it, that I am the only person who thinks so?
Draft a holistic approach to CDI program development
Clinical documentation improvement (CDI) programs have evolved over the last few years as
Could it really be so simple?
hospital interest in implementing these programs has grown exponentially. Such interest and evolution seems obvious given the healthcare economic climate and Medicare’s decision in the 2010 IPPS proposed rule to factor in a “behavioral adjustment” for supposed increase in hospital’s case mix absent an increase in patient severity and acuity.
Nevertheless, the field of clinical documentation improvement is relatively new and continues to evolve with the growth of CDI programs.
The fundamentals of CDI programs consists of physician education on the merits of complete, accurate, and effective clinical documentation that can be translated into the most clinically appropriate ICD-9 codes in support of patient acuity, patient severity and risk of morbidity, mortality, and readmission. Different approaches to affecting positive change in physician patterns of medical record documentation may be used by CDI specialists. Typically, educational sessions, handouts, documentation tip sheets, written clinical queries, verbal queries, and monthly newsletters are used as part of CDI programs for this purpose.
However, one important item to consider in any program is the definition of “clinical documentation improvement.” To most, the definition consists of ensuring complete and accurate documentation of clinical diagnoses throughout the record in reflection of patient presentation to the hospital, physician treatment and management of the patient, hospital resource consumption and ultimate MS-DRG assignment.
What is missing in CDI programs is a holistic approach. What do I mean by the “holistic approach?” Holistic documentation improvement entails reviewing physician documentation beginning in the emergency room and continuing with the history and physical (H&P), progress notes, consult notes, and discharge summary to ensure complete, accurate, and effective documentation to complement efforts at capturing all reportable diagnoses associated with an inpatient encounter.
ACDIS Chapter updates: New Jersey meets 4/24!
New Jersey’s fearless leader Deborah Gardner-Brown, RHIT, CCS, C-CDI, hosts the gathering at her facility in East Brunswick, Friday, April 24, at 2 p.m. This time the group will focus on the importance of Recovery Audit Contractor preparation in the CDI program. There’s only a limited amount of room around the conference table, so if you plan on attending please give her a call at 732/238-4511or drop her a quick e-mail Deborah@RRA-INC.Com.
Over in the New York City area there’s been a bit of talk about starting a local chapter but as any visitor or life-long resident knows, the Big Apple is a really big city. A so-called local meeting in downtown Manhattan might take residents of the city’s Queens neighborhood an hour or more of travel time to attend. That’s why Ann-Marie Carducci, RN, MPA, CPHQ, CPUR, CPC, CCS, director of utilization management at the Montefiore Medical Center in the Bronx plans to join up with Deanna Holowczak at Riverside Healthcare System in Yonkers. Anyone in the New York City/Westchester County area of New York interested in joining them can e-mail acarducc@montefiore.org or dholowczak@riversidehealth.org.
Michelle L. Callahan hopes to start a segment of ACDIS over in Minneapolis, MN. A nurse by background, Callahan now works as the lead specialist in the HIM housed CDI program at the Hennepin County Medical Center. “I have been working with the program here at HCMC since its inception in 2005,” she says. “It is very challenging to find other programs in local hospitals, as the programs all have different names/titles and are housed in different departments.” If you are a CDI specialist in the Viking state (my big brother used to be on the Vikings in Pop-Warner football) please reach out and e-mail Michelle at Michelle.Callahan@hcmed.org.
Susan Tiffany RN, CDS, pulled out all the stops to organize an all-day regional CDI symposium Friday, May 29, 8 a.m.-2 p.m., at Pinnacle Health System at Harrisburg (PA) Hospital. On the agenda are
- Physician Documentation Criteria for Congestive Heart Failure
- RAC Risk Stratification
- Evolution to Paperless CDI Process through Automated Documentation
- Present on Admission
- How CMS Changes Impact Reimbursement for Pressure Ulcers
For information, e-mail her at Tiffany_Susan@guthrie.org.
Appropriate investment in CDI helps programs bloom
Changes in the IPPS (Inpatient Prospective Payment System) led hospitals to develop clinical documentation departments to assist with these changes. Some hospitals hire consultants to initiate their novice CDI staff. They provide generous budgets to facilitate education and growth.
In many cases, the documentation departments outgrow the consultant firms hired to teach them as its staff members become more savvy about the ins and outs of their particular hospitals. As these departments expand, the hospital case mix index grows.
CDI programs need to be nurtured in order to bloom.
Some hospitals hire CDI staff members and provide only minimal education. They keep a tight budget and provide minimal flexibility. These programs grow with the help of available audio conferences and through networking. The staff struggle and grow slowly.
Other hospitals are reluctant to start clinical documentation programs. They hired one or two nurses or add new responsibilities onto their already busy coders. These hospitals provide little in the form of incentives or budget. The CDI staff members are simply told to go out and find MCC’s. These hospitals are often disappointed with the results.
Hospitals must realize that in every successful business, you get what you pay for. A successful clinical documentation improvement program can potentially bring in a great deal of otherwise lost revenue, as well as increase the case mix index.
While appropriate documentation for appropriate documentation’s sake is the clinical documentation improvment team’s mantra, hospitals must do more than plant a seed for documentation improvement results to grow. Similar to a garden, they must water and fertilize their programs in order to see them bloom.
On the 12th day of Christmas. . .
. . . my true love gave to me.
Bonnie Epps of Emory HealthCare in Atlanta just sent over this CDI specialist version of the song, penned by Clinical Documentation Specialist Jamie Doster. If anyone makes this a caroling tradition in your department, please, please record it and send it to me!
The lyrics are simple, just replace the traditional gift items with the following:
“On the first day of Christmas my CDI manager gave to me. . . one CDI program.
One the second day Christmas my CDI manager gave to me. . . two POA’s. . . and one CDI program. . .”
Get the gist of it? The rest of the countdown follows: