Beyond the Chart Auditing Process: What s Next?

Transcription

1 Beyond the Chart Auditing Process: What s Next? Cris Huerta, MBA-HCM, RN, CRRN AVP Rehab Services Division - HCA, Inc UDSMR Annual Conference August 2015 FIM and UDSMR are trademarks of Uniform Data System for Medical Rehabilitation, a division of UB Foundation Activities, Inc.

2 Disclosure Statement

3 Rehab Services Division (RSD) HCA, Inc. HCA operates 58 inpatient acute rehab programs, providing services in 17 states. 4 New Programs planned for 2016 HCA is the largest provider of unit based inpatient rehab services in the country, and is the second largest provider of acute rehab services in all settings. (IRU/IRF)

4 Anchorage, AK (Northwest Market) IRF Beds by Market San Jose 15 beds SoCal 20 beds Northwest 24 beds Las Vegas 77 beds El Paso 63 beds Denver 72 beds Utah 14 beds San Antonio 67 beds Austin 110 beds Corpus 15 beds DFW 53 beds Kansas City 41 beds ii Houston 119 beds Terre Haute 12 beds Chattanooga 12 beds Lafayette 9 beds NW GA 20 beds 4 Pinellas 50 beds Nashville 81 beds Panhandle 78 beds New Orleans 17 beds ATL 20 beds Sarasota 48 beds Richmond 72 beds Mid-GA 44 beds SWVA 35 beds Charleston 14 beds Treasure 34 beds Dade 15 beds Other GA 25 beds Orlando 13 beds

5 Our Chart Audit History Prior to 2012, programs were randomly selected to self-audit and submit a POA based on their findings. The audit tool was based off the 2010 IRF criteria and was intended to audit, as well as, educate the rehab program director. Meditech is the primary platform for the medical record. Numerous VERSIONS of rehab documentation are used in electronic and paper documents. Increasing RAC / MAC activity continue to drive this initiative. 5

6 Seeking Expert Advice Partnered with UDSMR s chart auditing team to develop a plan for a deeper enterprise-wide assessment. Goal was to develop a corporate wide process to identify High Risk areas and Best Practice models which could be duplicated consistently within all programs. 6

7 Charter Objectives Drill down into the Criteria and identify our company exposure Quantify the data by taking a weighted approach; assigning a score to set criteria Unbiased auditors remove the audit externally Focus on Medicare population Report outcomes to program, division, and corporate levels Involve various clinical members of the rehab team; Program Director, Medical Director, PPS Coordinator, rehab nurses and therapy staff Serve as an educational opportunity

8 Collaboratively Developed a Weighted System Amended 2014 Pre-Admission Screen Coding Post-admission Physician Evaluation (PAPE) Individualized Overall Plan of Care (IOPOC) Interdisciplinary Team Approach to Delivery of Care (Team Conference) CMG Placement Physician Supervision Intensive Level of Rehab Service FIM Ratings and Documentation Appropriateness of the IRF Admission Therapy Documentation Rehab Nursing Documentation IRF-PAI UB-04 Review Admission Orders 15 points 12 points 10 points 10 points 10 points 8 points 5 points 5 points 5 points 5 points 4 points 3 points 3 points 3 points 2 points

9 Further Refinements in 2014 Based on Outcomes Coding 12 points Correct IGC Correct Etiologic Diagnosis Identification of Comorbid Conditions Tier Presumptively Compliant Complications CMG Placement 8 points Appropriate CMG on the IRF PAI FIM Ratings and Documentation 5 points

10 Chart Submission Requirements Records submitted would include: CVA Fractured Hip Debility Neurological TBI/NTBI/SCI/NTSCI Sample for each attending physician Medicare / Managed MCR Only Discharged within last 6 months

11 Rollout Schedule UDSMR Chart Audit Schedule RVP HCA Rehab Programs by Division Submission Date Flannery DEL SOL MEDICAL CENTER 2/1/2015 Flannery LAS PALMAS MEDICAL CENTER 2/1/2015 Flannery NORTH AUSTIN MEDICAL CENTER 2/1/2015 Flannery ROUND ROCK MEDICAL CENTER 2/1/2015 Flannery ST DAVID'S GEORGETOWN 2/1/2015 Flannery ST DAVID'S REHAB 2/1/2015 Central West Texas Division Vacant GOOD SAMARITAN HOSPITAL 3/1/2015 Vacant LOS ROBLES HOSPITAL 3/1/2015 Vacant MOUNTAINVIEW HOSPITAL 3/1/2015 Vacant SUNRISE 3/1/2015 Far West Kitchen COLISEUM MEDICAL CENTERS 4/1/2014 Kitchen DOCTORS HOSPITAL OF AUGUSTA 4/1/2014 Kitchen FAIRVIEW PARK HOSPITAL 4/1/2014 Kitchen COLLETON MEDICAL CENTER 4/1/2014 South Atlantic Harrison CENTRAL FLORIDA REGIONAL HOSPITAL 4/1/2015 Harrison FORT WALTON BEACH MEDICAL CENTER 4/1/2015 Harrison WEST FLORIDA HOSPITAL 4/1/2015 North Florida

12 Patient Profile Summary 12

13 Snapshot of the Action Plan 13

14 What Worked? Recognition / validation of the problem by: Corporate Leadership Rehab operators Business Partners* Registration Coding Billing

15 Relationship with Business Partners Rehab dedicated closed record queue Trained rehab coders narrowed the field Location / Use of part time staff drives me crazy! Focused rehab specific education ICD-10, PPS Coordinator 101 course, ERROR management

16 Where are you? 3 Time Zones Away!!

17 What Worked? Year End 2014 resulted in an 8.4% improvement over 2013 Trending 4% 2015 As of June 2015

18 High Priority Items 2014

19 What Worked - Focus on Critical Positions is an Investment! Although turn over of Rehab Program Directors continues need for more support, redistribution of duties has been achieved in most larger markets 2 Part Educational Series for Clinical Rehab Specialists (CRS) has improved outcomes in PAS

20 What Lingers. Documentation system!!!! Identification of a rehab-specific doc system has been problem-prone!!

21 IRF-PAI: Therapy Information New IRF-PAI Therapy Information Section: O0401A-C and O0402A-C requires the total number of minutes provided by each therapy discipline, and by each mode of therapy, during weeks 1 and 2 of the IRF stay This new CMS regulation impacts all patients discharged on or after 10/1/15

22 Additional Ongoing Efforts. CRRN Development 2015 Offered 2 HCA sponsored CRRN Review Courses (Dallas and Orlando) Goal to reach 100 CRRNs year end PPS Coordinator Increased attendance to PPS Coordinator Boot Camp Promote PPS Coordinator Certification Increase FTE count of PPS Coordinators

23 CRRN Development

24 2015 Corporate Plan Monitor regulatory changes to documentation requirements Therapy Mode Minutes Continue to partner with UDSMR to measure effectiveness of individual plans across the enterprise Continue to identify documentation alternatives to Meditech move toward an all e-version - specific to acute rehab criteria Launch Pilot for enterprise wide doc system Q Manage standardization

25 2015 Corporate Plan Continued collaboration with our Coding corporate partners to bridge gaps inherent to external coding process Corporate-wide focus on CRRN pathways to achievement Continued onsite education and action plan implementation Remain committed to our Corporate charter to educate and improve knowledge base for key rehab operators

26 Thank You!