Malnutrition Diagnosis and Outcomes GISELE LEBLANC, MS, RDN, LDN, CNSC, FAND

Transcription

1 Malnutrition Diagnosis and Outcomes GISELE LEBLANC, MS, RDN, LDN, CNSC, FAND October, 2017 Disclosures No disclosures to report Objectives Establish a quality assessment process to demonstrate patient outcomes from the implementation of the malnutrition coding process Identify the essential components of monitoring the malnutrition coding process Demonstrate the financial outcomes for the C Suite executives. 1

2 Why is this necessary? HITECH Timeline President Bush Issues Executive Order HITECH Act Passed Stage I MU Polices Created Stage 2 MU Begins Stage 3 MU Begins Electronic Health Record Adoption Image from: CMS.gov 6 2

3 Image from: CMS.gov Image from: CMS.gov 3

4 Hospitals are measured on quality The RDN cannot manage and improve what he or she does not measure. Academy of Nutrition and Dietetics 4

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6 ecqms Infographic source: ecqi Resource Center ecqms ecqi Resource Center What is the Malnutrition Quality Improvement Initiative (MQII)? MQII Objectives Develop malnutrition quality measures that matter Improve malnutrition care with an interdisciplinary care team roadmap (toolkit) Advance tools that can be integrated into EHR systems to improve care quality The MQII is focused on older adults (ages 65 and older) given the significant impact malnutrition has on this patient population and the opportunity to improve care among these patients 18 6

7 Proposed Malnutrition ecqms Completion of a malnutrition screening within 24 hours of admission Completion of a nutrition assessment for patients identified as at risk for malnutrition within 24 hours of a malnutrition screening Nutrition care plan for patients identified as malnourished after a complete nutrition assessment Appropriate documentation of malnutrition diagnosis The MQii Will Use a Toolkit to Support Improved Malnutrition Care The Toolkit provides a clear workflow, as well as associated tools and resources, to support quality improvement and best practices in the screening, assessment, and treatment of older adults admitted to the hospital with or at risk of malnutrition. toolkit.html MQii Tools 7

8 Setting up data collection 8

9 Monitoring Malnutrition 9

10 Review of the basics: Malnutrition Example: MS DRG Example MS DRG Relative Weight (RW) DRG without CC or MCC DRG with CC but without MCC DRG with at least one MCC 195 CAP without CC or MCC Average Payment for US hospitals for CAP based on MS DRG (based on Base Rate of $8,800) $6, CAP with CC $ CAP with MCC $12,197 * Additional factors that affect payment: penalties and incentives Relative Weight Table Monitoring Malnutrition In order to track the financial impact of this initiative, the following information must be requested from the coding/billing department. Phillips, W. Support Line 39;3, June, 2017 Monitoring Malnutrition 10

11 Tracking and Quantifying Payment 2016 Incremental Revenue YTD $300, $250, $200, $150, $100, $50, $ Months Tracking and Quantifying Payment Tracking: Continued Audit denials can occur after the bill is submitted Auditors can claim inadequate documentation for ICD 10 code described at discharge Denial of coding is reported to the facility s coding department Ask that the coders contact you with all malnutrition denials Conduct regular chart audits and evaluate the appropriateness of the malnutrition diagnosis. Check for any diagnosis that may trigger a red flag such as: Kwashiorkor (E40) Marasmus (E41) Marasmic kwashiorkor (E42) 11

12 Tracking Tracking: Quality Indicators Outcomes Average length of stay for patients receiving malnutrition care since implementation Readmission rate of patients receiving malnutrition care since implementation Percentage of patients receiving malnutrition care who developed hospitalacquired infections following malnutrition care implementation Conclusion Quality.. Doesn t just happen! Outcomes show the true picture! It s imperative to measure outcomes with new interventions to demonstrate the impact. Clinical dietitians can demonstrate their value by demonstrating both patient and financial outcomes. Many resources to assist you. Take advantage of any technology you have at your disposal. 12

13 References K. Davis et al. Mirror, Mirror on the Wall, 2014 Update: How the U.S. Health Care System Compares Internationally, The Commonwealth Fund, June Centers for Medicare & Medicaid Services, EMR/HITECH and Education/Look Up Topics/EHR and HITECH/EHR HITECH page.html Last accessed: 9/6/17. Centers for Medicare & Medicaid Services, Value Based Programs Initiatives Patient Assessment Instruments/Value Based Programs/Value Based Programs.html Last accessed: 9/6/17. Hospital Compare website Last accessed: 9/6/17. J.A. Price et al. Using Academy Standards of Excellence in Nutrition and Dietetics for Organization Self Assessment and Quality Improvement, J Acad Nutr Diet. 2014;114: R.A. DiMaria Ghalili et al. Standards of Nutrition Care Practice and Professional Performance for Nutrition Support and Generalist Nurses, Nutrition in Clinical Practice :4: References S.L. Brantley et al. American Society of Parenteral and Enteral Nutrition (A.S.P.E.N.) and Academy of Nutrition & Dietetics: Revised 2014 Standards of Practice and Standards of Professional Performance for Registered Dietitian Nutritionists (Competent, Proficient, and Expert) in Nutrition Support, Nutrition in Clinical Practice ;6: A. Tucker et al. American Society of Parenteral and Enteral Nutrition (A.S.P.E.N.) Standards of Practice for Nutrition Support Pharmacists, Nutrition in Clinical Practice ;1: Defeat Malnutrition Toolkit toolkit.html Last accessed: 9/6/17. The A.S.P.E.N. Malnutrition Toolkit Last accessed: 9/6/17. Improve Patient Outcomes: ASPEN s Step by Step Guide to Addressing Malnutrition. American Society of Parenteral and Enteral Nutrition, =improve+patient+outcomes&prd_key= a2dd a01b0 References W. Phillips et al. A Step By Step Guide to Implementing a Malnutrition Coding Program for Adult Inpatients. Support Line ;3:2 9. J. Sporay. There s No Denying the Expanding Involvement of Dietitians in Malnutrition Coding. Support Line ;3: