- Documentation integrity is the foundation of good quality rankings
- OhioHealth was able to expand their scope and implement new workflows even at historically low staffing levels due to efficiencies introduced by Iodine’s Concurrent
- Improving documentation accuracy and capturing all patient conditions led to improvements in SOI, ROM, and Vizient quality rankings, including OhioHealth jumping from 112th to 14th in the nation for Trauma Care
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 14 Triumphing with Tech: Empowering Staff and Maximizing Results to learn more.
In the world of healthcare, hospital quality rankings hold immense weight, guiding consumer decisions on where to receive care, impacting hospitals’ reputations, and influencing the language healthcare providers can include in contracts with payors. Ultimately, the foundation for achieving good quality rankings lies in capturing accurate and complete documentation. Documenting patient care and medical procedures accurately and comprehensively directly impacts the assignment of codes, which, in turn, affects risk adjustment and external metrics.
As CDI programs shift their focus to quality, they must also shift their processes and workflows. Whereas in the past CDI specialists might have focused exclusively on capturing CC’s and MCC’s, it is now increasingly important to capture all conditions and treatments, regardless of whether they qualify as a CC or MCC, because many of these conditions ultimately impact risk adjustment. “It becomes important to know not only did it happen, but when did it happen?” said Fran Jurcak, Iodine’s Chief Clinical Strategist “Was it something the patient brought in with them, either from a previous encounter or something that happened to them in the outside world of the hospital? Or is it something that actually happened during the inpatient encounter? Which is what we’re really trying to capture with some of these quality metrics.”
Tonya Motsinger is the System Director of Clinical Documentation Integrity at OhioHealth, and her program has instituted a variety of workflows with the intent of completely capturing all patient conditions and improving their quality. She echoed Fran’s sentiment, relating that her CDI department found instances where HACs and PSIs were being driven by documentation, not the care being give. “If we could change the words in the chart, there wasn’t really a PSI or a HAC that happened” said Tonya, “It was just that it was documented incorrectly.” In today’s world, it’s not enough for health systems to provide good care, they also need to document the care they’re giving accurately.
OhioHealth is a nationally recognized, non-for-profit health system based out of central Ohio, composed of 14 hospitals and over 200 outpatient and physician offices, and has been recognized as one of the top five large health systems in America by IBM Watson Health six times. The CDI program at OhioHealth has 54 full-time positions, including a director, two managers, an educator, and an informaticist, although currently the program has positions open and is down ten staff. They originally invested in Iodine out of a desire to increase the efficiency in their workflow; they had found that they were performing a lot of re-work and weren’t seeing a ton of benefit from that work. Continuing, and improving upon, the success that they had seen in the financial and quality spaces was also key – around three to four years ago OhioHealth’s CDI program had ramped up their focus on quality, including instituting some new processes and workflows, and wanted to sustain that progress. OhioHealth felt that Iodine’s product Concurrent, with it’s artificial intelligence and prioritization, could help them achieve their goals without comprising their already established success.
As a quality focused program, it’s very important that Tonya’s team is not only accurately capturing the patients’ severity of illness and risk of mortality, but also ensuring the chart is explicit on what occurred with a patient so coders can accurately capture all diagnoses and treatments. As part of this effort, OhioHealth has a number of workflows in place, including an extensive second review process for expirations, DRG mismatches, and low acuity which can help ensure complete capture of how sick a patient truly was. “I believe that these practice are really essential growth avenues to drive the success of any CDI program, and I think Iodine really helped us to expand on these” said Tonya.
We’re about ten CDS down…but we’ve been able to, even at our very lowest staffing ever in the history of our department, take on more work and meet the organization’s board goals as a result of the help that Iodine’s provided for us through the prioritization.– Tonya Montsinger
While post implementation OhioHealth’s overall review rate has stayed the same, their query rate, especially among high priority cases, has increased. Despite spending time writing more queries, their workflow is so much more efficient they’ve been able to maintain their collaboration with coding, and took on even more work from a quality perspective, implementing additional workflows. This led to an improvement in their O:E ratio, their SOI and ROM, and their Vizient ranking. In 2019 OhioHealth was ranked 112th in the nation for trauma care, and they knew that wasn’t reflective of the care they were delivering. Today they are 14th in the nation, and number one in the state of Ohio.
Tonya noted that job satisfaction has improved as well. By enabling CDIS to review the right case at the right time and saving them from unnecessary review, OhioHealth has freed up staff for additional workflows like using the Vizient calculator, performing mortality reviews, and collaborating with coding and other departments. Describing the impact of the increased efficiency and effectiveness of their program due to having a prioritization tool, Tonya said, “I believe it creates a higher competence level in the CDS team, a little more of a strategic lens, because they can see the impact of their work beyond just case review, and they can sometimes even connect it with patient care.”
This expansion of skillset also gives CDI specialists opportunity for career advancement. As Fran noted, “We now have clinical ladders in the CDI space where five, seven years ago, there was no such thing.” In a world where hiring new staff can be challenging, retaining the staff you already have is key, and ensuring CDI specialists are satisfied and have room to grow within your organization can entice them to stay within your program.
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