Key Takeaways:
- Corewell instituted a new initiative in 2021 in an effort to reduce CMS financial penalties
- They implemented a new, specialized workflow coordinating across multiple teams focusing on four specific PSIs
- Corewell found that deep reviews of the medical records by clinical experts paired with querying providers for exclusions or present on admission status was incredibly effective at preventing billing with inaccurate PSIs coded
- They saw an overall 24% reduction in these four PSIs in 2021, a 27% reduction in 2022, and a 36% reduction in 2023
- The program has been so successful, they’ve expanded its scope to an additional 5 PSIs
Each fall Iodine hosts a client symposium, Iodine Connect, bringing together leaders in CDI, UM, and Revenue to share insights, expertise, and strategies for tackling some of the biggest challenges facing healthcare providers. For this month’s episode, we’re sharing an excerpt from one of this year’s Iodine Connect sessions on Unlocking Excellence and Quality Metrics Monitoring. Listen to Episode 16 Unlocking Excellence: Navigating Quality Metrics to learn more.
Background
Corewell Health is a nonprofit health system based out of Grand Rapids. Formed via a merger between Beaumont Health and Spectrum Health in 2022, Corewell is the largest health system in Michigan, with 21 hospital facilities and over 5,000 beds. Corewell is dedicated to helping people be well so they can live their healthiest lives, and in 2023 multiple Corewell hospitals received national recognition for Patient Safety from Leapfrog.
Corewell’s CDI team has been working in collaboration with Iodine, their quality coding department, physician leadership, as well as their quality, safety, and experience teams to prioritize documentation integrity to drive quality metric improvement. So far in 2023, they’ve had an overall 36% reduction in their top four PSIs and plan to continue stretching their goals with the help of Iodine and prioritized concurrent reviews.
Challenges
In 2021 Corewell launched a new quality initiative with the goal of reducing CMS program financial penalties. They found opportunity with four specific Patient Safety Indicators (PSIs) as defined by AHRQ: PSI-3 Hospital Acquired Pressure Ulcers, PSI-11 Respiratory Failure, PSI-12 Perioperative PE or DVT Rate, and PSI-15 Abdominal Pelvic Puncture. Corewell created a PSI review team encompassing CDI, quality coding, certified nurse specialists, physician leadership, and their quality and safety experience team with each discipline bringing their own set of expertise to collaborate and review for accuracy.
Process
This PSI Review Team implemented a new workflow where if a PSI was triggered, it would automatically populate into their EHR for a pre-bill review by their coding quality team and a DNB would be placed so they could complete the review prior to billing to ensure accuracy. After coding quality reviews the case and updates code assignments, if warranted, they summarize their findings in a shared workbook and tag the PSI Review Team to review. All members of the PSI Review Team review the case to look for exclusions. If no opportunities are found, the case is finalized and billed. If there is a potential query opportunity, the record is sent to an assigned Medical Director for a final review. If the Medical Director agrees, then simultaneous to CDI sending a query to the physician the medical director will send the physician a PSI education flyer.
“We’re extremely proud of our efforts. Corewell Health plans to continue stretching our goals with the help of Iodine technology, and priority concurrent reviews.”
Brooke Twomley, Inpatient CDI Supervisor, Corewell Health
They found that these deep reviews of the medical records by clinical experts paired with querying providers for exclusions or present on admission status has been most effective at preventing billing with inaccurate PSIs coded.
Successes
Since its implementation in 2021, the program has seen enormous success. In 2021, the team reviewed 63 PSI-3s, and were able to remove 12, resulting in 19% reduction. Overall, for 2021 across all four monitored PSI measures, they reduced PSIs by 24%.
Their success continued in 2022 where, overall, they reduced these four priority PSIs by 27%, with a 31% reduction in PSI-12 alone. So far, in 2023, there has been a 36% reduction across the original four PSIs, including a 44% reduction in PSI-15, which has limited exclusions, finding that focusing on provider education on using terms such as “integral,” “inherent,” and “necessary” to reiterate a planned laceration having the biggest impact.
The program has been so successful, Corewell has expanded its scope to review an additional five PSIs: PSI-6, PSI-8, PSI-10, PSI-13, and PSI-14. So far in 2023 they have already seen a 14% reduction in these five additional PSIs, and are looking forward to continued growth in Q3 and Q4. They’re planning on expanding to reviewing all of PSI-90 in Q4 of this year and are in the process of creating a PSI task force to develop and strategize system wide education for physicians, coders, and CDI surrounding PSI nuances. Going forward, Corewell is also looking to fully leverage Iodine’s prioritization to flag these key PSIs concurrently, enabling them to shift from reviewing cases retrospectively pre-bill, to in the moment concurrently; hopefully resulting in having conversations with providers in the moment and preventing prolonged bill holds.
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