- The CDI profession has evolved and is no longer about capturing a single CC or MCC, but rather the true clinical picture of the patient
- West Tennessee Healthcare saw an increase in query volume after implementing Iodine accompanied by a financial return 3x more than expected
- Leveraging Interact allowed West Tennessee to improve physician response times and rates even while simultaneously increasing query volume
Iodine Intelligence tackles a new challenge in healthcare’s mid-revenue cycle every month, shedding light on problems and solutions and sharing valuable insights from industry experts. Listen to Episode 6: Achieving ROI at Speed to learn more.
The Clinical Documentation Integrity (CDI) profession has evolved along with documentation requirements, and it’s no longer about capturing a single CC or MCC, but rather an accurate and complete record of everything that happened during an inpatient encounter. Technology provides a unique opportunity to enhance the CDI workflow. Rather than CDI specialists aiming to review all cases (and wasting an inordinate amount of time reviewing cases with no opportunity) the technology reviews 100% of cases, and prioritizes those with the greatest likelihood of opportunity for specialists to review to validate the clinical information and confirm the query opportunity.
Historically, one of the biggest challenges within CDI is knowing when to review a cases. “So, I looked at it [a case] today, but how soon will something change? Whether it be additional clinical information for a condition I looked at today, or a whole new condition that develops during the patient encounter. The only way, historically, that CDI had an opportunity to identify that, was to review every case every day, which is impossible” Fran Jurcak explained, “At Iodine, we allow ourselves, through technology, to identify when something has changed of significant value that then requires a re-review.”
West Tennessee Healthcare has six facilities in the West Tennessee area, the largest being Jackson-Madison County General with 740 beds. Their CDI team encompasses 11 CDI reviewers (some of whom are general, some of whom are specialized), a CDI manager and educator, and CDI director.
Several years ago their program shifted to focus on quality and improving their CMS star rating which led to West Tennessee implementing a variety of products in Iodine’s AwareCDI suite: Forecast which automatically predicts final DRG and GMLOS, Concurrent which prioritizes cases in CDI specialist’s workflow for review, Interact (formerly Artifact) which is a physician engagement tool that eases the query response process, and Retrospect which prioritizes post-discharge, post-code, pre-bill review. In the words of Denise Humphreys, their Director of CDI, “I think this product, in total, has helped us evolve as just a day to day CDI program to something that really specializes in: can we help our facility, our whole system, in attaining the goals that we have.”
Industry recommendation for a seasoned CDI team is a query rate of 20%-25% if you’re reviewing all charts; after implementation Denise’s team reviewed only prioritized cases and their query rate went up to 35%-38%. This resulted in increases in their case mix index, CC and MCC capture rates, and a financial return on investment that was 3x more than expected, allowing West Tennessee to pay off the full cost of Iodine within 3 months.
While increased query volume could be cause for concern in some physician circles where administrative burden is already high, Denise stated that the largest impact she saw to her program after implementation was physician satisfaction. Pre-Iodine, they regularly had physicians on suspension lists for taking more than 14 days to respond to queries. After implementing Interact, their biggest offender responded to a query within 40 seconds of receiving it – and he hasn’t been on the suspension list since.
Interact creates a quick and easy workflow that is intuitive, doesn’t interrupt physicians during their standard patient process and allows them to communicate in a fashion that works best for them – within the EMR or via a mobile app. Discussing the advantages of Interact, Denise stated, “One of the main things we’re looking for, and we have experienced already, is an excess of additional time during our day. We’re not chasing queries like we were before.” The additional time during the day enables Denise’s team to expand their scope, and focus on impacting their O:E ratio, improving their star rating, physician engagement and education, increasing SOI and ROM and more.
West Tennessee is going live with Iodine’s Retrospect this July. Retrospect – a post-charge, post-code, pre-bill tool that helps CDI and coders identify discrepancies between the clinical evidence documented and the final code and capture additional leakage – will help West Tennessee monitor their backend and make sure their coding and documenting correctly. Having Iodine products end-to-end will help West Tennessee ensure documentation accuracy across all medical records.
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