How CDI Programs Result in Quality Coded Data

Transcription

1 How CDI Programs Result in Quality Coded Data Audio Seminar/Webinar February 19, 2009 Practical Tools for Seminar Learning Copyright 2009 American Health Information Management Association. All rights reserved.

2 Disclaimer The American Health Information Management Association makes no representation or guarantee with respect to the contents herein and specifically disclaims any implied guarantee of suitability for any specific purpose. AHIMA has no liability or responsibility to any person or entity with respect to any loss or damage caused by the use of this audio seminar, including but not limited to any loss of revenue, interruption of service, loss of business, or indirect damages resulting from the use of this program. AHIMA makes no guarantee that the use of this program will prevent differences of opinion or disputes with Medicare or other third party payers as to the amount that will be paid to providers of service. As a provider of continuing education the American Health Information Management Association (AHIMA) must assure balance, independence, objectivity and scientific rigor in all of its endeavors. AHIMA is solely responsible for control of program objectives and content and the selection of presenters. All speakers and planning committee members are expected to disclose to the audience: (1) any significant financial interest or other relationships with the manufacturer(s) or provider(s) of any commercial product(s) or services(s) discussed in an educational presentation; (2) any significant financial interest or other relationship with any companies providing commercial support for the activity; and (3) if the presentation will include discussion of investigational or unlabeled uses of a product. The intent of this requirement is not to prevent a speaker with commercial affiliations from presenting, but rather to provide the participants with information from which they may make their own judgments. AHIMA 2009 Audio Seminar Series American Health Information Management Association 233 N. Michigan Ave., 21 st Floor, Chicago, Illinois i

3 Faculty Amy Gardner, RHIT Amy Gardner, RHIT, is a cardiovascular services documentation specialist with Deaconess Medical Center in Spokane, WA. Ms. Gardner has over 16 years of experience in the HIM profession, with an emphasis on coding in all areas. She has also written courses for AHIMA. Contact info: GardneA@EmpireHealth.org Marilyn Jones, MBA, MN, RN, CCS Marilyn Jones, MBA, MN, RN, CCS, is a manager with KPMG s Healthcare Forensic group in Atlanta, GA. Ms. Jones has over 25 years of nursing and healthcare consulting experience, including documentation improvement and compliance in the acute healthcare setting. Prior to consulting she was a nursing director at a university teaching hospital and practiced as a legal nurse consultant at a major law firm. Contact info: Marilynjones@kpmg.com AHIMA 2009 Audio Seminar Series ii

4 Table of Contents Disclaimer... i Faculty... ii Objectives... 1 What is a CDIP?... 1 Who Participates?... 2 Documentation Specialists... 2 Necessary Skills for DS (Documentation Specialists)... 3 Physician Participation... 3 Other Participants:... 4 Potential Types of CDIPs Is one program type better than another?... 5 Communicating Documentation Needs... 6 Education of Physicians Changes to DRGs... 7 How have MS-DRGs affected documentation?... 8 Examples of MCCs... 8 ESRD Implications... 9 Quality Measures... 9 Vaccination Standards RACs and CDIPs POA and HACs HACs Queries Expansion Opportunities Benefits of CDIP How Current Healthcare Initiatives and Economic Events Are Impacting Hospitals and the Need for CDI Programs The Economic Crisis: Impact on Hospitals Healthcare Reform Medicare Reform Initiatives Medicaid Reform Initiatives Value-based Purchasing (VBP) Hospital and Physician Profiling Clinical Documentation Improvement Programs Resource/Reference List Audio Seminar Discussion and Audio Seminar Information Online Upcoming Audio Seminars Thank You/Evaluation Form and CE Certificate (Web Address) Appendix Resource/Reference List Resources CE Certificate Instructions AHIMA 2009 Audio Seminar Series

5 Objectives Review how clinical documentation improvement programs (CDIP) result in accurate and complete coded data Summarize how accurate coded data is critical to healthcare delivery, research, public reporting, reimbursement, and policy-making Review effective CDI methods that ensures complete, clear, and accurate health record documentation for complete and accurate coding 1 What is a CDIP? Definition of CDIP: Clinical Documentation Improvement Program Importance of a CDIP 2 AHIMA 2009 Audio Seminar Series 1

6 Who Participates? Documentation Specialists Physicians, Mid-Levels (ARNPs, PAs) Nursing Staff Other Ancillary Staff 3 Documentation Specialists Who are they? RHITs, RHIAs, CCSs Education in coding and HIM skills Ability to learn clinical knowledge RNs Clinical Knowledge Ability to learn coding skills 4 AHIMA 2009 Audio Seminar Series 2

7 Necessary Skills for DS (Documentation Specialists) Understanding of Clinical Disease processes Anatomy and Physiology Coding Skills Ability to communicate effectively Verbal and Written Confidence 5 Physician Participation Why do we need their support? Creating Credibility Improvement in Documentation Better Profiles Achieving results in CMS requirements 6 AHIMA 2009 Audio Seminar Series 3

8 Other Participants: Nursing staff Other Ancillary Patient Care Staff PT OT Dietary Assist with BMI documentation 7 Potential Types of CDIPs Case Management Program Typically RN only focus Relies on Case Managers to perform concurrent medical record review Incorporates concurrent DRG assignment with daily duties of discharge planning for patients 8 AHIMA 2009 Audio Seminar Series 4

9 Potential Types of CDIPs (Cont.) HIM Programs Utilizes RHITs/RHIAs/CCSs with strong emphasis on coding background Also utilizes RNs 9 Is one program type better than another? Choose what works best for your facility Both types of programs utilize Inpatient Coders Decide how to approach your medical staff Define your mission and goals 10 AHIMA 2009 Audio Seminar Series 5

10 Communicating Documentation Needs How to communicate with physicians Creating a level of physician buy-in Specificity needs 11 Education of Physicians Best Method of Education Written Verbal Group Presentations Show results/outcomes Encourage participation and question and answer sessions 12 AHIMA 2009 Audio Seminar Series 6

11 Education of Physicians (Cont.) Say it once, say it twice Is one conversation enough to help physician to understand? Remember to present hard facts Coding Clinics Fliers with information Education for documentation specificity requirements 13 Changes to DRGs October 1, 2008 DRGs to MS-DRGs Most expansive change since original inception of DRGs 14 AHIMA 2009 Audio Seminar Series 7

12 How have MS-DRGs affected documentation? MCCs Major Complications/Co-morbidities What is the importance? Why CCs vs. MCCs? 15 Examples of MCCs Acute or Acute on Chronic CHF Systolic vs. Diastolic Renal Failure Acute Renal Failure Chronic Kidney Disease Stages 1-5 Decubitus Ulcers Importance of clear documentation of the stages 16 AHIMA 2009 Audio Seminar Series 8

13 ESRD Implications ESRD benefits provided under Medicare Rules Importance of documentation/acknowledgement of this disease 17 Quality Measures How can DS s help meet standards? Heart Failure Measures Myocardial Infarction Measures Pneumonia SCIP Concurrent Review to meet standards Models for concurrent review: Who performs this review 18 AHIMA 2009 Audio Seminar Series 9

14 Vaccination Standards Meeting Pneumonia and Flu Vaccination Requirements Who requires this vaccination standard? Methods for achieving these standards 19 RACs and CDIPs How can a CDIP help with RACs? Considerations Players involved 20 AHIMA 2009 Audio Seminar Series 10

15 POA and HACs Improving documentation for POA Improving documentation for HACs Defining the need for specificity to physicians Importance of clarity in record for coding staff 21 HACs Importance in UTI clarification Foley vs. UTI Pressure Ulcers Diabetic Ketoacidosis 22 AHIMA 2009 Audio Seminar Series 11

16 Queries AHIMA Practice Brief on Queries Reason for queries Should the DS( Documentation Specialist) query for everything Pick and choose when to query 23 Queries (Cont.) Written queries Concurrent vs. Post discharge What information to include To lead or not to lead or just the facts 24 AHIMA 2009 Audio Seminar Series 12

17 Expansion Opportunities Potential for Documentation Specialists: Growth Education Membership in Associations 25 Benefits of CDIP Specificity in Documentation Better Profiles CMS CORE measure standards met Improved Physician/Mid-Level communication Improved ability to code/bill more efficiently 26 AHIMA 2009 Audio Seminar Series 13

18 How Current Healthcare Initiatives and Economic Events Are Impacting Hospitals and the Need for CDI Programs Economic Crisis Impact on Hospitals Healthcare Reform Medicare Reform Initiatives Medicaid Reform Initiatives Value-based Purchasing Hospital and Physician Profiling Clinical Documentation Improvement Programs (CDIP) The Need Continues 27 The Economic Crisis: Impact on Hospitals Bad Debt and Charity Care Rising unemployment Loss of medical coverage Slowdown in payment by patients Access to Credit and Capital Resources Difficulty in obtaining capital resources Decreased days cash on hand Increased cost of borrowing Negative Investment Income 28 AHIMA 2009 Audio Seminar Series 14

19 The Economic Crisis: Impact on Hospitals (Cont.) Housing Crisis Decreased Demand for Hospital and Physician Services Decline in elective procedures Decline in admissions Possible Cuts to Medicaid and Medicare Provider Payments 29 Healthcare Reform Why is Healthcare Reform Needed? Healthcare spending in the United States is 2.3 times higher than in other developed nations 1 Healthcare expenses are projected to increase 83 percent in the next 10 years 2 30 AHIMA 2009 Audio Seminar Series 15

20 Healthcare Reform (Cont.) Quality Concerns Medical Errors Approximately 48,000 to 98,000 patient deaths each year 3 Medication Errors $3.5 billion annually 4 Access Issues Uninsured Americans million Uninsured for catastrophic healthcare expenses million 31 Healthcare Reform (Cont.) Medicare Solvency and Beneficiary Impact Expenditures up from $219 billion in 2000 to an estimated $486 billion in 2009 Medicare premiums, deductibles, and costsharing are forecasted to consume 28 percent of the average beneficiaries Social Security check in AHIMA 2009 Audio Seminar Series 16

21 Healthcare Reform (Cont.) What s New on Capital Hill President Barack Obama s selection of healthcare team Secretary of Department of Health and Human Services and Director of a new White House Office on Health Care Reform? Jeanne Lambrew, a former aide to President Bill Clinton and a senior fellow at the Center for American Progress Deputy Director of White House Office of Health Reform Director of Centers for Medicare and Medicaid Services (CMS)? U.S. Surgeon General? 33 Healthcare Reform (Cont.) Summary of President Obama s Plan Estimated cost to implement is significant Affordable health insurance Universal coverage is not mandated Healthcare coverage for all children Competitive and regulated private system Establish a National Health Insurance Exchange Establish a new health insurance plan that would be available to uninsured as well as small businesses 8 34 AHIMA 2009 Audio Seminar Series 17

22 Healthcare Reform (Cont.) Large employer mandate two options Contribute to employee health coverage Contribute to the cost of the public plan Expand public payer system Establish a Small Business Health Tax Credit Individual tax credit for premiums Expand eligibility of Medicaid and the State Children's Health Insurance Program 9 35 Healthcare Reform (Cont.) Other Healthcare Reform Plans Senator Edward Kennedy Senate Finance Chairman Max Baucus Special Interest Groups are introducing plans American Medical Association American s Health Insurance Plans Federation of American Hospitals American Academy of Family Physicians 36 AHIMA 2009 Audio Seminar Series 18

23 Medicare Reform Initiatives Medicare Fee-for-Service Program Administrative Functional Environment Medicare Administrative Contractors (MACs) Established under the Medicare Prescription Drug Improvement and Modernization Act of 2003 Focus: customer service, operational excellence, and financial management By 2010 to become the central point in CMS s fee-forservice program Replace fiscal intermediaries (FI) and carriers Nineteen MACs with 15 A/B MACs to process both Part A & Part B core claims processing operations 37 Medicare Reform Initiatives (Cont.) Recovery Audit Contractors (RACs) Qualified Independent Contractors (QICs) Medicare Secondary Payer Recovery Contractor (MSPRC) Zone Program Integrity Contractors (ZPICs) Medicare Administrative Contractors (MACs) Beneficiary Contact Center (BCC) Healthcare Integrated General Ledger Accounting System (HIGLAS) Enterprise Data Centers (EDCs) Quality Improvement Organization (QIO) Administrative Qualified Independent Contractors (Ad QICs) 38 AHIMA 2009 Audio Seminar Series 19

24 Medicare Reform Initiatives (Cont.) Functional Contractors Purpose: To monitor the relationships within the MAC program Zone Program Integrity Contractors (ZPICs) Find, prevent, and deter waste, fraud, and abuse in Medicare Seven (7) zones that interacts with a MAC jurisdiction Perform program integrity functions for Medicare A-D, Durable Medical Equipment, home health, hospice, and the Medi-Medi program Quality Improvement Organization (QIO) Group of practicing doctors and other health care professionals Hired to review and improve the care of Medicare beneficiaries Review complaints regarding quality of health care services provided to Medicare patients Medicare Reform Initiatives (Cont.) Recovery Audit Contractors (RACs) Demonstration project created by the Medicare Prescription Drug, Improvement, and Modernization Act of The Tax Relief and Health Care Act of 2006 made the RAC Program permanent Purpose Find and correct improper Medicare payments paid to health care providers participating in fee-for-service Medicare Provide information to CMS and Medicare contractors that could help protect the Medicare Trust Funds by preventing future improver payments thereby lowering the Medicare FFS claim payment error rate AHIMA 2009 Audio Seminar Series 20

25 Medicare Reform Initiatives (Cont.) RACs are paid a contingency fee based on the amount of the overpayments and underpayments that they detect and correct California, Florida, and New York were selected as the demonstration states because of there high per capita Medicare consumption In 2007, Massachusetts, South Carolina, and Arizona were included in the demonstration project RAC demonstration ended March 2008 Goal is to have RACs fully in place by Medicare Reform Initiatives (Cont.) Four RACs were announced on October 6, 2008 Diversified Collection Services, Inc. of Livermore, California, in Region A, initially working in Maine, New Hampshire, Vermont, Massachusetts, Rhode Island, and New York CGI Technologies and Solutions, Inc. of Fairfax, Virginia, in Region B, initially working in Michigan, Indiana, and Minnesota Connolly Consulting Associates, Inc. of Wilton, Connecticut, in Region C, initially working in South Carolina, Florida, Colorado, and New Mexico HealthDataInsights, Inc. of Las Vegas, Nevada, in Region D, initially working in Montana, Wyoming, North Dakota, South Dakota, Utah, and Arizona 42 AHIMA 2009 Audio Seminar Series 21

26 Medicare Reform Initiatives (Cont.) November 4, 2008 Press Release CMS imposed an automatic stay on the contract work of the four RACs due to a protest filed by two unsuccessful bidders with the Government Accountability Office (GAO). 13 Protest Resolved PRG-Schultz, Inc. subcontractor to HDI, DCS and CGI in Regions A, B & D Viant Payment Systems, Inc subcontractor to Connolly Consulting in Region C 43 Medicare Reform Initiatives (Cont.) Results of RAC Demonstration: Cumulative through March 27, 2008 > $1.03 billion of improper payments - 96 percent collected from providers; 4 percent repaid to providers AHIMA 2009 Audio Seminar Series 22

27 Medicare Reform Initiatives (Cont.) Top Overpayment Items for Inpatient Hospitals Excisional Debridement Inpatient Rehabilitation Facility (IRF) services following joint replacement surgery Heart Failure and Shock Surgical Procedures in Wrong Setting Respiratory System Diagnoses with Ventilator Support Extensive OR Procedures Unrelated to Principal Diagnosis Medicare Reform Initiatives (Cont.) RAC Expansion Schedule 16 D B A March 1, Oct ,2008 March 1, 2009 C August 1, 2009 or later *VT, NH, ME, MA, RI, CT (J14) Part A claims (including Part B of A) will not be available for RAC review until August 2009 due to the MAC transition. Part B claims in RI will not be available for RAC review until August 2009 due to the MAC transition. All other Part B claims are available for RAC review beginning March 1, * 46 AHIMA 2009 Audio Seminar Series 23

28 Medicaid Reform Initiatives Medicaid Integrity Program (MIP) States have the chief responsibility of controlling fraud in the Medicaid program CMS provides oversight, technical assistance, and direction Deficit Reduction Act of 2005 established the MIP Goal: To fight fraud, waste, and abuse in the Medicaid Program 47 Medicaid Reform Initiatives (Cont.) Medicaid Integrity Group (MIG) Responsible for implementing and managing the MIP Goals of the MIG Promote the proper expenditure of MIP funds Improve program integrity performance nationally Ensure the operational and administrative excellence of the MIP Demonstrate effective use of MIP funds Foster collaboration with internal and external stakeholders of the MIP AHIMA 2009 Audio Seminar Series 24

29 Value-based Purchasing (VBP) CMS initiative to align payment policy with the delivery of high quality and efficient care. 49 Value-based Purchasing (Cont.) Quality Reporting for 2009 To avoid the two percent reduction in the payment update, hospitals must submit/allow CMS to report quality data Thirty quality measures are included in the FY 2009 payment. Topics covered are Acute Myocardial Infarction, Heart Failure, Pneumonia, Surgical Care Improvement Project (SCIP), Mortality & Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) 50 AHIMA 2009 Audio Seminar Series 25

30 Value-based Purchasing (Cont.) Quality Reporting for 2010 To avoid the two percent reduction in the payment update, hospitals must submit/allow CMS to report quality data Forty-two quality measures are included in the FY 2010 payment 51 Value-based Purchasing (Cont.) New Metrics for 2010 Surgical Care Improvement Project (SCIP) SCIP Cardiovascular 2 Surgery Beta Blocker Nursing Sensitive Measures Failure to Rescue Readmission Measures Heart Failure Readmission (Medicare only) Agency for Healthcare Research and Quality (AHRQ) Quality Indicators: Inpatient Quality Indicators and Patient Safety Indicators 9 measures Cardiac Surgery Measures Participation in systematic database for cardiac surgery One measure from 2009, PN measure Oxygenation Assessment, will be retired and not reported by hospitals 52 AHIMA 2009 Audio Seminar Series 26

31 Value-based Purchasing (Cont.) Quality Reporting for 2011 and Subsequent Years COPD Complications of Vascular Surgery AAA, Carotid Endarterectomy and Lower Extremity Bypass Inpatient Diabetes Care Measures Healthcare-associated Infections (Central Line-associated Bloodstream Infections and Surgical Site Infections) 53 Value-based Purchasing (Cont.) Timeliness of Emergency Care Measures SCIP Cardiovascular 3 Beta Blockers Complications Measures (Medicare patients) Healthcare-acquired Conditions (HACs) Hospital Inpatient Cancer Care Measures 54 AHIMA 2009 Audio Seminar Series 27

32 Value-based Purchasing (Cont.) Serious Reportable Events in Healthcare ( Never Events ) Average Length of Stay Coupled with Global Readmission Measure Preventable HACs Value-based Purchasing (Cont.) HACs Hospital-acquired infections add nearly $5 billion per year to U.S. healthcare costs 19 In 2002, 1.7 million hospital-acquired infections were associated with 99,000 deaths 20 A survey by Leapfrog Group determined that 85 percent of hospitals did not always follow guidelines to prevent many of the hospital acquired infections AHIMA 2009 Audio Seminar Series 28

33 Value-based Purchasing (Cont.) Selection of HACs High cost High volume Results in a higher-paying DRG when existing as a secondary diagnosis Condition could reasonably be avoided through the application of evidence-based guidelines Effective October 1, 2008, the higher-weighted DRG is not assigned when a secondary diagnosis listed as a HAC was not present on admission 57 Value-based Purchasing (Cont.) HACs Selected Effective October 1, 2008 Foreign Object Retained after Surgery Air Embolism Blood Incompatibility Catheter-associated UTIs Vascular Catheter-associated Infections Pressure Ulcers (Stages III and IV) Falls (complications from) Fractures Dislocations Intracranial Injury Crushing Injury Burns Electric Shock Surgical Site Infection, Mediastinitis following CABG Manifestations of Poor Glycemic Control Diabetic Ketoacidosis Nonketotic Hyperosmolar Coma Hypoglycemic Coma Secondary Diabetes with Ketoacidosis Secondary Diabetes with Hyperosmolarity Surgical Site Infection following Certain Orthopedic Procedures (Spine, neck, shoulder, elbow) Surgical Site Infection following Bariatric Surgery for Obesity (Laparoscopic gastric bypass, Gastroenterostomy, Laparoscopic gastric-restrictive surgery) Deep-vein Thrombosis and Pulmonary Embolism following Certain Orthopedic Procedures (Total Knee Replacement, Hip Replacement) 58 AHIMA 2009 Audio Seminar Series 29

34 Value-based Purchasing (Cont.) Candidate HACs Surgical site infection following device procedures Failure to rescue Death or disability associated with drugs, devices, or biologics Dehydration Malnutrition Water-borne pathogens Surgical site infections following procedures orthopedic and other Ventilator-associated pneumonia Clostridium difficile-associated disease Hospital and Physician Profiling What is profiling? Extrapolation of information about hospitals and/or physicians, based on known data What is being profiled? Severity of Illness Expected Risk of Mortality vs. Actual Quality of Care Measures Cost Efficiency/Effectiveness Length of Stay Readmission Rate Complication of Medical Care 60 AHIMA 2009 Audio Seminar Series 30

35 Hospital and Physician Profiling (Cont.) Who is Profiling Hospitals and Physicians? CMS VBP Demonstrations and Pilots VBP Programs HACs and Present on Admission Indicator Reporting Physician Quality Reporting Initiative Medicare and Medicaid Contractors/Auditors State Agencies The Joint Commission 61 Hospital and Physician Profiling (Cont.) Internet profiling sites HealthGrades Leapfrog Group Trade magazines and newspapers U.S. News & World Report s Best 100 Hospitals Consumers Employers Commercial Payers Managed Care Organizations Physician Practice Groups Hospitals 62 AHIMA 2009 Audio Seminar Series 31

36 Clinical Documentation Improvement Programs The need for CDIP continues Accurate and complete physician documentation is critical to accurate profiling and appropriate reimbursement in an ever-changing healthcare environment Implement or revitalize CDIP Utilize a multidisciplinary approach with your CDIP. Involve Hospital Administrators, Compliance Directors, Revenue Cycle Managers, Physician Leaders, Health Information Management, Nursing, Case Management and Clinical Documentation Specialists in navigating through healthcare initiatives 63 Clinical Documentation Improvement Programs (Cont.) Educate physicians regarding the importance of accurate documentation on public profiling and appropriate reimbursement Educate physicians and staff on regulatory reform/initiatives Educate coding staff and Clinical Documentation Specialists on new coding guidelines, clinical topics, and medical technology Do a risk assessment to determine key areas of vulnerability and determine action steps to correct Provide ongoing monitoring, maintenance, and corrective action of your CDIP 64 AHIMA 2009 Audio Seminar Series 32

37 Resource/Reference List Kennedy MD, James S., A Minute for the Medical Staff, Medical Records Briefing, February 2009: Define and document acute Kidney injury and chronic kidney disease Bryant BS, RHIA, RHIT, CCS, Gloryanne, Hirschl BS, CCS, Nancy. Improve Documentation and coding now, before recovery audit contractors go national in 2010, Briefings on Coding Compliance Strategies, April 2008 Bowman RHIA, CCs, Sue et al., AHIMA, HIM Body of Knowledge, Managing an Effective Query Process. Pages Audio Seminar Discussion Following today s live seminar Available to AHIMA members at Click on Communities of Practice (CoP) icon on top right AHIMA Member ID number and password required for members only Join the Coding Community from your Personal Page under Community Discussions, choose the Audio Seminar Forum You will be able to: Discuss seminar topics Network with other AHIMA members Enhance your learning experience AHIMA 2009 Audio Seminar Series 33

38 AHIMA Audio Seminars Visit our Web site for information on the 2009 seminar schedule. While online, you can also register for seminars or order CDs, pre-recorded Webcasts, and *MP3s of past seminars. *Select audio seminars only Upcoming Seminars/Webinars Managing the Clinical Documentation Improvement Program (CDIP) March 5, 2009 Coding for Hematology April 2, 2009 Coding for Multi-System Trauma Patients April 9, 2009 AHIMA 2009 Audio Seminar Series 34

39 Thank you for joining us today! Remember sign on to the AHIMA Audio Seminars Web site to complete your evaluation form and receive your CE Certificate online at: Each person seeking CE credit must complete the sign-in form and evaluation in order to view and print their CE certificate Certificates will be awarded for AHIMA Continuing Education Credit AHIMA 2009 Audio Seminar Series 35

40 Appendix Resource/Reference List Resources CE Certificate Instructions AHIMA 2009 Audio Seminar Series 36

41 Appendix Resource/Reference List pubs/p pdf AHIMA 2009 Audio Seminar Series 37

42 Resources 1 OECD health data 2007: Statistics and indicators for 30 countries. Organization for Economic Cooperation and Development. July 18, Poisal, John A., Christopher Truffer, Sheila Smith, Andrea Sisko, Cathy Cowan, Sean Keehan and Bridget Dickensheets. Health spending projections through 2016: Modest changes obscure Part D s impact. Health Affairs. February 21, Kohm, Linda T., Janet M. Corrigan and Molla S. Donaldson. To Err is Human: Building a Safer Health System. Washington DC: National Academy of Sciences. 2007

43 Resources 4 Aspden, Philip, Julie A. Wolcott, J. Lyle Bootman and Linda R. Cronenwett. Preventing Medication Errors. Committee on Identifying and Preventing Medication Errors, Board on Health Care Services. Washington, DC: National Academy of Sciences Income, poverty, and health insurance coverage in the United States: U.S. Census Bureau. August Available at: pubs/p pdf 6 Schoen, Cathy, Michelle M. Doty, Sara R. Collins and Alyssa L. Holmgren. Insured but not protected: How many adults are underinsured? Health Affairs. June 14, 2005

44 Resources 7 CMS, CDC, & Prevention Agency for Healthcare Research and Quality. Transcript of Hospital-Acquired Conditions & Hospital Outpatient Healthcare-Associated Condition Listening Session. Thursday, December 18, Available at: Resources.asp#TopOfPage 8 World Health Care Congress Forum on the Changes Ahead. Available at: 9 Ibid 10 CMS s publication: Functional Contractors Overview Available at: /FunctionalEnvironment.pdf

45 Resources 11 RAC Permanent Program. Available at: 12 Ibid 13 Ibid 14 The Medicare Recovery Audit Contractor (RAC) Program: Update to the Evaluation of the 3-Year Demonstration. January Available at: pdatethrough83108ofracevalreport.pdf CMS RAC Status Document FY 2007: Status Report on the Use of Recovery Audit Contractors (RACs) in the Medicare Program. February Available at: 007%20RAC%20Status%20Document%20vs1.pdf

46 Resources 16 RAC Expansion Schedule March 1, Available at: ansion%20schedule%20web.pdf 17 Comprehensive Medicaid Integrity Plan of the Medicaid Integrity Program: FYs June Available at: s/fy08cmip.pdf Hospital Inpatient Prospective Payment System Final Rule. Available at: 19 Centers for Disease Control and Prevention: Press Release, March Available at: 20 Klevens et al. Estimating Health Care-Associated Infections and Deaths in U.S. Hospitals, Public Health Reports March-April Volume 122

47 Resources Leapfrog Group Hospital Survey. The Leapfrog Group Available at: og_hospital_acquired_infections_release.pdf 22 CMS, CDC, & Prevention Agency for Healthcare Research and Quality. Transcript of Hospital- Acquired Conditions & Hospital Outpatient Healthcare-Associated Condition Listening Session. Thursday, December 18, Available at: ducationalresources.asp#topofpage

48 To receive your CE Certificate Please go to the AHIMA Web site click on the link to Sign In and Complete Online Evaluation listed for this seminar. You will be automatically linked to the CE certificate for this seminar after completing the evaluation. Each participant expecting to receive continuing education credit must complete the online evaluation and sign-in information after the seminar, in order to view and print the CE certificate.