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1 Catalyst to Multisystem CDI Success: Excellence in Action Robin Jones, RN, BSN, CCDS, MHA/Ed Mercy Health System Director, CDE Edwina Kelley, RN, CCDS Mercy Health Regional Manager, CDE 1 Learning Objectives At the completion of this educational activity, the learner will be able to: Describe standardization processes and policy to unite multi regions Explain how meaningful data, relevant metrics, and measuring outcomes Discuss importance of effective leadership and communication plan List steps in maintaining success into the future 2 Let s Start at the Beginning Robin Jones Credentialing RN 2000, NICU background BSN/CCDS 2009 First ever pen/paper in Vegas SCARY MHA/Ed 2013 Joined Mercy Health in 2004 as CDS at Fairfield Mercy Promotions: 2007: Site supervisor/team lead 2011: Regional manager 2014: System director 3

2 The Beginning (cont.) Edwina Kelley Credentialing RN 40+ years nursing CCDS 2013 Work experience St. Elizabeth CDE program coordinator x 6 yrs Background in L&D/surgery, FP, workers comp, UR, insurance Joined Mercy in 2011 CDS at Jewish Hospital 2012: Site supervisor at Anderson Mercy 2014: Regional manager Cincinnati and Paducah, KY January 2016: Cincinnati, Paducah, Lima, Springfield 4 Past, Present, Future Mercy Health mission Mercy Health extends the healing ministry of Jesus by improving the health of our communities with emphasis on the people who are poor and underserved CDE as a region Regional based North: Toledo, Lorain Northeast: Youngstown, Lima, Springfield South: Cincinnati and Paducah, KY CDE as a system North: Youngstown, Toledo, Lorain South: Lima, Springfield, Cincinnati, Paducah One team approach Comprised of 17 acute care facilities Imperative to engage employees Promote trust 5 Reporting Structure Past Site based HIM Quality Case management Present Revenue cycle HIM umbrella 6

3 CDE Structure Robin Jones System Director Edwina Kelley South Market Manager CDE Amy Kirk North Market Manager CDE Lisa Zellner CDE Educator Karla Gumm CDE Sr. Analyst SWOH Youngstown Paducah Toledo Springfield Lorain Lima 7 Defining CDE Mission statement Improve clinical documentation to accurately reflect the severity of illness, length of stay, quality of care outcomes, and to protect the integrity of the care provided to our patients. 8 Role Expectations Define role CDS CDE site supervisor Regional manager Educator Senior analyst System director Daily expectations Established goals/objectives 9

4 New CDS Onboarding What does a CDS do? Seems like a simple answer; however, is multifaceted and key in success of program Elevator speech 6 12 month orientation Week 1: Shadow a CDS Week 2: Didactic training (4 days) Provided by vendor Remote Week 3: CDE educator training Create worksheet Identify PDX, CC, MCC Concept of SOI/ROM Importance of monitoring LOS Clarification development Week 4 6: Work side by side with designated CDS (preceptor) Week 6 12: CDS to nursing unit for assignment Preceptor reviews worksheet, clarification prior to physician review Training never ends 10 New Supervisor Onboarding Key position on CDE team Gatekeeper Daily oversight Personnel Reports Physician education 12 week orientation period 1:1 training with regional manager Mentorship with site based supervisor 11 Work Space Big question nursing unit vs. office job hours daily on nursing unit Increases physician engagement Ancillary staff support Essential role on patient care team This is NOT an office job! 12

5 CDE Educator Essential to our team Provides education New and seasoned CDS Quarterly updates Organizes monthly CDE/coding meetings Facilitated on a monthly site rotation by region Very effective Tracks information CEU CCDS Degrees Annual learning Annual competency 13 Metrics Metrics are essential Defines and sets expectations Establishes goals and sets direction Monitor program Where do we need to improve? What do we do well? Employee success Increases employee satisfaction Defines purpose Education needs CDS Coder Physician 14 Workflow Review Rate Workflow Staffing ratio 1:1900 annual discharges Review rates Established systemwide expectations > 1 year average daily Individualized goal < 1 year» 30 days 5 charts/day» 60 days 6 8 charts/day» 90 days months 15+ charts/day Define reviews New reviews Concurrent reviews 40% clarifications Coder mismatch reviews 15

6 What Is a Clarification? During transition Used crafted query templates No free thought CDS not using clinical knowledge to formulate After transition Returned to clarification development Clinical and patient based clarifications Risk factors, clinical indicators, treatment modality Allows creativity and clinical knowledge Took additional time initially Impacted productivity Increased employee satisfaction 16 Workflow Clarification Rate Team goal 20% 35% Impacting vs. severity Team effort to ensure clarifications are answered and documented concurrently Post discharge = increased DNFB Supervisors monitor daily 1:1 conversations with physicians/midlevels 17 Workflow Physician Response Rate Team goal Ultimate goal is 100% 2% attained goal 94% are > 90% response rate Physician education High level of support from site based administration Sessions provided by vendor Individualized Group (specialty) Monthly diagnosis information posted in physician lounge Review top 10 DRGs to determine biggest impact 18

7 % 90% 92% 93% 90% 91% 80% 70% 77% 81% 84% 81% 60% 50% Review Rate 40% 30% 41% 41% 36% 39% 20% 10% 0% Oct 11 Nov 11 Dec 11 Avg. Data based on Traditional Medicare Only % 90% 94% 94% 90% 93% 80% 87% 87% 84% 86% 70% 60% 50% 40% 40% 38% 35% 38% Review Rate 30% 20% 10% 0% Oct 14 Nov 14 Dec 14 Avg % 90% 96% 99% 97% 97% 80% 70% 79% 84% 85% 83% 60% Review Rate 50% 40% 30% 20% 10% 0% 31% 30% 31% 31% Oct 15 Nov 15 Dec 15 AVG Clarification Rate Data based on initial reviews only Data based on: ICD 10 Implementation New vendor software 21

8 Reconciliation Reconciliation Performed by all CDSs, daily workflow Ensure that CDS and coding professional agree on DRG assignment Great education tool Validation Performed by all site supervisors Random 10 charts/month Ensure appropriate credit Verify appropriate DRG shift Essential 22 Transition Based Learning Opportunities 23 Factors to Success Physician engagement Establishing a non paid physician advisor Assists with clarification follow up Peer to peer communication Administration support Established monthly steering administration meetings CFO Biweekly meetings Very engaged in site success 24

9 Annual Leadership Summit Attended by Site based supervisors Bring suggestions from CDSs Managers CDE educator What we do Work as a team Listen to each other Review policy/process 18 pages Revamp based on: Learning from the year Restructuring Employee suggestions Management team activity Annual reading and discussion 25 Ancillary Support Case management Communicate daily regarding DRG/LOS assignment Participate in clinical rounds Helps with clarification responses and opportunities Quality Core measures assistance SOI/ROM relation with quality metrics reporting VBP with blended rate payment changes Dietitian initiative Malnutrition BMI 26 Remote Team Established in 2012 Help fill site staffing gaps Assistance with reviews, clarifications Ineffective due to difference at sites Not an office job! Discontinued in fall FTEs disseminated to site based position 27

10 Standardization Attendance Crucial to success Systemwide attendance policy Established guidelines PTO 1 CDS on PTO at a time Allow up to 2 weeks PTO Remote days 7 days per year Caring for a sick child, snow, repair person Huge employee satisfier 28 Employee Satisfaction Annual employee survey Conducted in the fall scores from 2012 to present Performer of the month (formerly known as employee of the month) Revamped in 2015 Employees meeting/exceeding metrics entered into drawing One employee from each region selected Sunshine Recognize birthdays, sympathy, get well Shows individual recognition 29 Future! 30

11 CDE Recognition Program Incentive Plan Purpose To reward performance for eligible employees, based on results of the pre defined measures Eligibility 2016: 8 CDSs and 2 supervisors selected Criteria: Scored > 70% on annual competency (expert level) Successfully completed > 6 months as CDS Good standing with organizations 31 CDE Recognition Program Incentive Plan Projects CDS Point person Presenting research project Supervisor Meeting site based metrics > 6 months Travel to assist supervisor/team outside of region Bonus potential $1,500 with payout end of December Great timing with Christmas 32 ER Pilot What we did Piloted CDS in the ER in 2 locations Springfield Lourdes Experienced ER nurse 3 month time frame (May July) Timing d/t decrease census Staffing struggled despite Interaction with healthcare team Nursing Case management observation vs. inpatient admission ER physicians learning opportunity 33

12 ER Pilot What we learned Experienced ER nurse to navigate the environment Longer pilot time frame 3 months definitely too short Ideally 6 months would be best Hours staffed, day shift vs. evening shift ER documentation (coding) is based on nursing documentation BIG LEARN Little clarification/query opportunities most were withdrawn 34 NICU Pilot What we did 2 days a week 2 months What we learned Need NICU trained nurse Establishing relationship with NP and physicians is essential Speak different language Gaps in documentation Respiratory failure Shock Future opportunity to staff our larger NICU across the system! 35 Denials Work in progress RAC/MAC Designing workflow Offering assistance Clinical feedback Appeal writing Denial management team 36

13 Outpatient CDE Program Brand new concept Started with need from a population health perspective Who will staff RN vs. clinical coder Role development Assist with post discharge query follow up Build relationships with office managers and physicians Reporting structure Will report to a CDE manager Metrics Big question how will we track success? Next steps ER in larger acute facilities Work in progress 37 Top 15 Healthcare Organization Truven Health Analytics Announces 2015 Top Health Systems: 15 Highest Performing Hospital Systems Achieved Higher Survival Rates, Made Fewer Errors All at a 7 Percent Lower Cost Per Episode Than Their Peers Years as top 15: 2012, 2013, 2014, 2015 Key factors: Lower cost per episode Better survival rates Fewer complications Better patient safety and core measures adherence 38 Thank you. Questions? RAJones@mercy.com Dkelley@mercy.com In order to receive your continuing education certificate(s) for this program, you must complete the online evaluation. The link can be found in the continuing education section at the front of the program guide. 39