MARGIN MANAGEMENT Cracking the Code on Documentation Improvement Jason Jobes Director Mary Siegel Director
2 Biographies JASON JOBES Jason Jobes is a Director within The Advisory Board Company s Consulting and Management Services division. As a Director, Mr. Jobes partners with hospitals and health systems to improve their overall revenue cycle performance and operations by assisting in strategic consulting engagements, rooted in evidence-based research. Areas of concentration include engaging physicians in documentation improvement initiatives and system-wide readiness for ICD-10. Prior to joining The Advisory Board Company, Mr. Jobes worked as the Director of Performance Excellence for a hospital and medical practice in Louisiana. In this role, Mr. Jobes leveraged Lean and Baldrige principles to help identify points of opportunity in areas such as clinical and nonclinical quality, patient and stakeholder engagement, revenue cycle performance, and strategic planning. Mr. Jobes emphasis was placed on improving and leveraging analytics to sustain organizational success, drive stakeholder value, and maximize return on investment. He also served as the co-chair of the organization s 3 rd Party Performance Excellence steering council, a group that drove partnerships with payers to implement risk based and shared savings contracts. Mr. Jobes holds a Bachelor of Arts from The University of Hawai I Hilo, where he graduated Summa Cum Laude with a degree in Economics with a minor in Business Administration. He is currently pursuing his Master s in Science of Predictive Analytics from Northwestern University in Evanston, IL. He is also serving his fifth term as a member of the national Malcolm Baldrige Board of Examiners.
3 Biographies Mary Siegel Mary Siegel is a Director with The Advisory Board Company s Revenue Cycle division. Ms. Siegel has assisted hundreds of partner hospitals and health systems in increasing revenue, optimizing margin, improving clinical documentation and preparing to adopt ICD-10. In this capacity, Ms. Siegel focuses on improving hospital financial performance through best practice research and consulting. Ms. Siegel has helped her clients achieve substantial increases in documentation accuracy, revenue capture and improved quality metrics. Across her tenure at The Advisory Board Company, Ms. Siegel has also worked within the Cost and Operations division. Ms. Siegel leveraged performance technology platforms to drive enhanced performance in the OR through improved spend, utilization, and block management. She has served academic medical centers, specialty hospitals, community hospitals and large health systems. Prior to joining The Advisory Board Company, Ms. Siegel worked in private client banking helping manage $1.8 billion AUM. Ms. Siegel earned her Bachelor s degree in Economics from the University of Virginia in Charlottesville, VA.
4 Tackling a Long-Term Issue Revenue Loss from Missing Documentation Average 250-bed Hospital 2015 2020 2025 ($7.1M)? ($12.8M)
5 CMS Penalties Amplify Losses 6.1% 6.0% 5.9% 5.8% 5.7% 5.6% 5.5% 5.4% 5.3% 5.2% % Inpatient Medicare Reimbursement At Risk 5.50% 5.75% 6.00% 2015 2016 2017! 44% Hospitals receiving multiple P4P penalties in 2015 8% Hospitals receiving a VBP bonus large enough to offset penalties
6 Increasing Burden On CDI Team CDI Specialist Workload Quality focus/vbp reductions 100% Payment reform % of CDI Specialist Workload Querying for greater specificity Expanding to new service lines Expanding to all payer model 0% Ongoing Physician education
7 Managing the Future in the Rearview Mirror Revenue Over Time Revenue? Coding errors? Documentation? Denials? Who is driving the problem? Time Available Resources Offer No Insight Current Systems PAS EHR Data Warehouse ICD-9 Data 2015 ICD-10 Conversion March 2017 CMS Benchmarks available
8 Assess Areas of Greatest Need Measure how your hospital stacks up Determine which physicians are struggling the most with documentation US Hospitals VS Your Hospital 60-80% 10-20% Total Physicians Total Documentation Opportunity
9 Optimizing Analytics: Cohort of 400+ Hospitals Gain Visibility Review Real-time Benchmarks Assess Early Warning Signs and Physician Documentation Opportunity Prioritize Efforts Assign accountability and build action plan
10 Motivate Poorest Performers First Exclusivity One-on-one meeting Individual data Expertise Clinical knowledge Unbiased Effective messaging Evidence Impact on quality Real life examples Trend identification
11 Proven Methodology St. Joseph Regional Health Center 310-bed medical center in Bryan, TX $3.1M in annualized return from 9% increase in case mix index Trinity Health System 240-bed acute care facility in Steubenville, OH 3.6% increase in expected readmissions 20% increase in expected mortality rate Baptist Beaumont Hospital 325-bed community hospital in Beaumont, TX $8M in annualized return from 6% increase in case mix index Used by Hospitals Nationwide 110+ Cohort Partners 2,300+ 1,300 Trained Physicians MD 1:1s performed
Academic Medical Center Sees Gains Through Education 20 Providers Educated at 2 Facility Academic Medical Center in the South Sees Significant Returns from Providers Attending 1:1 Sessions 12 Significant Gains 12.3% Increase in case mix index 16.9% Increase in expected complications 9.3% Increase in expected readmissions 9.9% Increase in expected LOS
13 Driving Broad Based Improvements in CMI Education of 20 Providers Increased Case Mix Index and Helped Drive Significant Financial Returns. Pilot Efforts Now Spread Across Health Systems. Case Mix Index November 2014 to August 2015 1.56 1.54 1.52 1.5 1.48 1.46 1.44 1.42 1.4 1.38 1.36 8.7% Increase in case mix index despite 25% drop in surgical cases in post education period. Performance Shift Breakdown 9.57% Increase in medical case mix index 16.67% Increase in surgical case mix index 0.12 Overall increase in case mix index post education after 1800+ cases
14 Targeted Training, Sustained Success Highly Rated Average GPA 3.9 Average Physician Rating of Session Quality Improved Revenue Increased Average Increase in Expected Post Training CMI Increase by Specialty Post Training 6.7% 4.4% LOS Readmissions 28% General Surgery 21% Critical Care 25% 8.3% Mortality Complications 18% Cardiology 8% Internal Medicine 14.2 Average ROI
15 Immediate Next Steps Use Data to Focus Your Efforts Review Charts Motivate Physicians to Change Habits Sustain Improvements 2 months 1 2 months 3 months Ongoing Analyze data using Revenue Optimization Compass Benchmark performance Interview stakeholders Identify target physicians with documentation opportunities Thoroughly review 7-10 charts per MD Identify documentation and coding inaccuracies Customize education packets for each physician Conduct one-on-one education sessions with clinicians led by Advisory Board clinicians Show impact of documentation on quality metrics Identify physician champions Conduct refresher and train-the-trainer sessions Share best practices in documentation improvement Post ICD-10 assessment showing performance post go-live Physician Refresher Meetings Train the Trainer Sustainability Offerings Why Words Matter Behind the Scenes of PDI CDI Best Practices Lessons Learned 1 Timeline varies based on number of physicians, readiness of member data, etc.