DART Hits the Bullseye - A CDI Coding Collaborative
DART Hits the Bullseye A CDI Coding Collaborative R Cynthia Navarro, RHIT, CCS Coding Auditor- Inpatient JPS Health Network, Fort Worth, TX Madhura Chandak B, FACHE, MSPT, RHIA, LSSBB Executive Director Clinical Integration JPS Health Network, Fort Worth, TX
Getting to know us Cynthia Navarro, RHIT, CCS Coding Auditor- Inpatient JPS team member since March 2016 Loves to bake, play kickball and watch baseball Busy life with 2 boys, a husband, 2 dogs and a fish named Iron man Madhura Chandak B, FACHE, MSPT, RHIA, LSSBB Executive Director Clinical Integration JPS team member since January 2014 Loves to travel, dance and sing Busy life with a husband, 4-year old twin boys and a big family overseas! 3
JPS Health Network $950 million tax-supported healthcare system serving residents of Fort Worth and surrounding communities in Tarrant County, Texas. John Peter Smith Hospital 121,000+ emergency room visits 1 million+ patient encounters per year Nation s largest Family Medicine Residency Patient Care Pavilion at John Peter Smith Hospital 4
The JPS Brand! ü 2015 Press Ganey Commitment to Excellence Award for significant improvements in employee engagement during a two-year period ü 2016 Dallas Morning News Top 100 Places to Work ü 2017 Modern Healthcare Best Place to Work 5
Purpose and Objectives The purpose of this presentation is to share a spectacular tale of teaming success showcased by CDI and Coding by collaboratively engaging in the DRG Analysis and Review Taskforce (DART). ü Strategizing for collaboration ü Anticipating and planning for team development Psychological safety ü Teaming for success ü Sustaining the gain for long term success 6
Start of our Journey 7
HIM Internal Audit Year 2015 Credibility at stake ü ü ü Health Information Management (HIM) department s operations were highlighted during 2014 annual risk assessment for JPS An operational review of the HIM was included in the 2015 Annual Internal Audit Plan approved by the Governance Committee of the Board of Managers (BOM) In August 2015, issues and findings were presented to the Board of Managers (BOM) 8
Opportunity in Adversity 9
Alignment HIM & CDI = Quality 10
Strategizing for Collaboration Tactical needs HIM Internal audit CDI as the top improvement opportunity CDI return on investment (ROI) Strategic needs Protecting the JPS Brand via Quality Cultural instability resulting into a state of unrest in the team Revenue integrity (DRG assignment, Post Pay denials and lost reimbursement) Provider risk stratification based on patient acuity (case mix index) 11
DRG Mismatch Meeting 12
People First, Process Second 13
Brain Storming with CDI & Coding CDI facts Coding facts What s working well? Opportunities for improvement Next steps Task assignments 14
Voice of the Customer and Business Lacking communication between CDI and Coding Ownership Physicians copying and pasting leaving coders unsure who to query Better understanding of ICD-10 PCS Query process Need escalation process More positive approach to mismatch meetings Remove coder/cdi name from case studies New leadership to conduct the meeting- may decrease feelings of hostility 15
Action plan for successful Teaming ü ü ü ü ü ü ü ü Coders and CDI to participate in the Medical Records Committee (MRC) Meaningful frequency of DART meetings Include managers and coding auditor to facilitate mismatch conversation and resolution Present blinded data at DART meetings Process map the ideal workflow between CDI and Coding Develop coding and CDI buddies Implement coding, CDI and EMR taskforce ICE taskforce Propose a new name for the mismatch meeting 16
Re-alignment CDI Team: Clinically driven Concurrent chart review Rounding with medical staff Provider education GOAL: Working DRG CDI Quality & Financial stewardship Coding Team: Coding guidelines driven Retrospective chart review ICD 10 Code assignment GOAL: Final DRG Coding No blame game, Focus on the Purpose 17
Standard Operating Procedure 18
Escalation process for mismatch ü Post discharge if the working DRG and Final DRG don t match, teams must follow the escalation process as outlined in the SOP DRG opportunity Identified Coding member communica tes via email to CDI Coder and CDI don t agree on Final DRG Coding Auditor reviews and recommend s DRG CDI and Coding Manager review; Coding Manager has the final say on DRG assignment 3M Reason Codes Optimal selection Subsequent documentation Coding guideline CDI educational opportunity Coding opportunity 19
Value of Re-branding Branding is the strategic ascribing of words, a name, term, sign symbol or design, or a combination of these, so that a user may easily identify the product or service so that the user will regard the product or service as the solution to their problem and motivate them. DRG Mismatch Meeting Defensive Guarded Tense DRG Analysis and Review Taskforce Shared goals Psychologically safe Engaging team dynamics 20
New-age DART ü Monthly Meeting led by CDI Lead Educator and Inpatient Coding Auditor ü Coding and CDI Buddies Topic specific education Deference to expertize for questions Alternate buddies quarterly ü Platform for education and discuss pain point DRGs De-identified education ü Guest speakers- Nephrologist, wound care nurses, cardiac nurses Thank you so much for the wonderful DART meeting Not only did I learn more about NSTEMI I learned that sometimes we don t know as much as we think we do, so James offering to set up a speaker for that subject brings expectations that we will have another great DART soon. Thanks much to our great team. - Inpatient coding team member 21
DART Pride! 22
Shared goals Coding Increased coding accuracy Increase productivity Optimize DRG assignments Identify trends & target high risk DRGs Maximize reimbursement Reduce denials CDI Achieve high quality clinical documentation Streamline documentation process Optimize templates Optimize utilization of EMR liaison and training resources Quality Improve publicly reported data Core Measure improvement Accuracy in reporting to UHC, AHRQ and other entities Improve on HAC/PSI capture Optimize outcomes Team! JPS Rules of the Road - Own it! Seek joy and Don t be a jerk Employee engagement Team growth with top talent recruitment Education including query process
Critical Milestones 2012 CDI program started Fall 2015 - DRG mismatch meeting started Summer 2016 Inflection point and rebranding to DART Summer 2015- HIM Internal Audit Early 2016 - Change in HIM leadership 2017 Better alignment across enterprise DART has boosted the teams morale, mutual respect & empowerment 24
Celebrate your Success 25
Key Takeaways Radar on, antenna up Expect the unexpected Question the status quo Engage in high intensity, critical interventions Regroup, reassess and bridge the gaps Ownership and accountability Courageous & Servant Leadership It s never too late The choice is Yours! 26
Wrap up Thank you! Questions? Cynthia Navarro cnavarro@jpshealth.org Madhura Chandak B mchandak@jpshealth.org 27