Physician Engagement and New Resident Training in CDI Emory Healthcare, Atlanta, Ga.: Bonnie I. Epps, MSN, RN Manager, Clinical Documentation Improvement Brenda Bell, RHIA Director, Health Record Integrity 2 Learning Objectives Emory Healthcare Discuss Emory Healthcare s seven methods for physician engagement Describe best practices to enlist support for CDI from administrative and physician leadership Develop appropriate education and metrics to ensure ongoing physician participation Market your CDI program to ensure ongoing physician participation 3 As the largest, most comprehensive healthcare system in Georgia, Emory Healthcare includes: Emory University Hospital Emory University Orthopedics and Spine Hospital Emory University Hospital Midtown Emory Johns Creek Hospital (new acquisition) Saint Joseph s Hospital of Atlanta (new acquisition) The Emory Clinic Emory Children's Center Wesley Woods Center of Emory University Emory Adventist Hospital Emory Specialty Associates 4 For questions please contact HCPro customer service at 800-650-6787. 1
Emory University Hospital Emory University Hospital Midtown Emory University Hospital, acclaimed as one of America's Best Hospitals by U.S. News & World Report, specializes in the care of the acutely ill adult Top 10 in UHC s (University i Health Systems Consortium) Quality and Accountability Scorecard, 2011, 2012 Among highest CMI in UHC Among lowest (best) mortality index in UHC Emory University Hospital Midtown, a leading community-based and acute care teaching facility, top 11 in UHC s Quality and Accountability Scorecard 2011, top 10 in 2012 Top 10 in mortality index in UHC 5 6 Scope of Emory s CDI Program Emory CDI Program 1,830 licensed beds; 50,000 discharges annually 28 specialties 1,750 physicians 1,156 residents and fellows 450 midlevels 19.5 FTEs (23 folks) Jan 2008 Started CDI program 3M Consultants May 2008 Started using 3M DocMS without an ADT feed Jan 2009 3M DocMS with an ADT feed May 2010 Converted to 3M CDIS (encoder) Late 2011 to current Paper to paperless (CDI queries integrated into Cerner Power Chart) 7 8 For questions please contact HCPro customer service at 800-650-6787. 2
CDI Program CDI Program Targets Active integration for improvement of documentation to accurately describe the severity of illness (SOI) and risk of mortality (ROM) of the hospitals inpatient population Focused approach involves concurrent review of the patient records to identify clues and cues of all conditions, which need to be stated in clear, diagnostic terms Total electronic process (Anesthesia preop/certain ICUs progress notes) 85% of all eligible admissions 86% target met (34,603 initial reviews) 35% communications with MD to # of patients reviewed 27.5% query rate target not met (9,474 queries) 90% physician response rate 95% response rate target met 85% agree rate 95% agreement rate target met 9 10 Physician Engagement I always answer my CDI queries! Physician Engagement: Leadership As healthcare was moving towards more direct accountability for physicians and hospitals on overall quality, it immediately became clear that having the most accurate information about the clinical status of patients was essential to measuring our go-forward quality and safety metrics. Emory Healthcare made a decision to commit new and significant resources to our overall clinical documentation effort. We also made sure we had strong leadership engagement, both physician and nonphysician, in this issue to ensure maximum effectiveness. Again, our goal is simply to have the most accurate information we can have about the clinical conditions of our patients. Overall, our effort is going extremely well, but it is one of those things where the job is never done and being constantly refined. John Fox, president and CEO of Emory Healthcare 11 12 For questions please contact HCPro customer service at 800-650-6787. 3
Physician Engagement Clinical Documentation Improvement Physician Engagement Action Plan 5/31/09 Action plan: 7 key tools for success Administrative support Communication Education Publications Collaboration Post-discharge process Program/process 13 14 Administrative Support Administrative Support Full support from administrative and physician leadership President and CEO sent letters to chiefs of services introducing the CDI program and asking for their support COO sent personal handwritten thank-you notes to chiefs of services who scored 100% on response rate each month Top leaders and physician champions address poorperforming services and individual physicians Query response data is communicated widely and poor performers are held accountable for performance Response rate is tied to physician profile and incentive programs 15 Physician champions Advise and assist Physicians who hold high credibility among peers to ensure organizational cooperation Act as liaison between administration and medical staff Physician-to-physician communication and collaboration Focus on quality of care; the message to the medical staff is to improve the care, not the bottom line of the hospital 16 For questions please contact HCPro customer service at 800-650-6787. 4
Benefits of CDI Physician Benefits But what s in it for me!!!?? Improves quality of care by enhanced communication with healthcare team Thorough documentation enhances profile accuracy Establishes a collaborative approach to capture appropriate SOI and ROM Supports patient LOS and resources utilized Reduces potential compliance risks by documenting all patient conditions 17 Accurate and complete documentation supports physician professional billing and profiles E/M 18 Focus Is on Quality Communication Most physicians believe they provide high quality of care to their patients. The CDI program is all about getting g credit for this high-quality level of care done on a daily basis at bedside. Dr. Valeri Akopov, MD CDI update is standing agenda item at medical staff & administrative meetings Data reports to key administrative & medical leadership on a monthly basis and posted on our intranet website CDI scorecard (monthly) YTD summary Response rate trend report by service (12 rolling months) Response rate trend report by service by MD (12 rolling months) Response rate trend report by MD (alpha) (12 rolling months) Ad hoc reports upon request Escalation for outstanding responses 19 20 For questions please contact HCPro customer service at 800-650-6787. 5
CDI Metric Reports Are Posted on Our Intranet Site Data Reports Are Communicated Widely 21 21 22 Trending Reports Are Published on the Intranet Site Education CDI Trend Report Response Rate by Attending Service Rolling Trend >> 12 months ended January 2013 Response Rate GOAL is to be at 90% or better Total Patients Eligible for Review = All Inpatients discharged per month, excluding patients discharged from MHSD, R3, R4 These Attending Services are part of the 8 Product Lines for UHC Efficiency Metrics sorted by Rolling 12 months Rolling 12 months February February March 2012 March 2012 April 2012 April 2012 # May 2012 % May 2012 # June 2012 TOTAL % MD TOTAL # of 2012 % MD 2012 # of % MD # of % MD of MD of % MD Response Communications Response Communic Response Communic Response Communic Response Communic Response Attending Service Rate w/md Rate ations Rate ations Rate ations Rate ations Rate 471 421 403 492 Total 98 5,874 98 98 99 97 99 HMS HOSPITAL MEDICINE 98 1,488 100 109 100 134 98 128 100 140 99 CRD CARDIOLOGY 96 837 100 62 98 60 100 67 94 83 96 SUR GENERAL SURGERY 98 692 100 41 95 44 100 40 100 41 100 HEM HEMATOLOGY 97 335 94 18 100 12 100 15 100 48 100 Medical staff: Have received over 60 educational sessions in staff meetings, service meetings, and one-on-one New physician: CDI manager presents to new physician orientation every month MED INTERNAL MEDICINE 97 323 100 10 100 11 100 20 100 17 98 MON MEDICAL ONCOLOGY 96 287 90 41 100 18 96 27 94 16 93 PUL PULMONARY DISEASE 98 237 100 12 100 14 100 13 100 22 100 NRS NEUROSURGERY 94 215 95 22 91 22 100 5 83 48 100 ORT ORTHOPEDICS 99 215 100 17 100 14 100 4 100 3 100 GI GASTROENTEROLOGY 97 200 100 21 88 25 100 11 100 10 100 NEU NEUROLOGY 99 176 100 24 100 7 100 12 100 11 100 CVS CARDIOVASCULAR SUR 100 169 100 18 100 12 100 9 100 13 100 Residents/fellows/midlevels: Educate current residents by educational sessions, grand rounds, and one-on-one education by CDS URO UROLOGY 98 151 91 11 100 10 100 8 100 8 100 NPH NEPHROLOGY 97 140 100 11 100 5 100 11 100 6 75 24 For questions please contact HCPro customer service at 800-650-6787. 6
Education Incoming residents & fellows: CDI manager developed Blackboard course for university Web-based learning on clinical documentation. All new residents & fellows must complete course and pass with 80% as a mandatory requirement for in-processing. Chief quality officer introduces CDI at new resident orientation given a packet of material. Educational materials are given out at all educational meetings and posted in charting areas. 25 Educational Material Is Posted in Charting Areas Linking in your Documentation denotes Cause and Effect In order to capture the Severity of Illness and Risk of Mortality for your patients, you must Link manifestations to the primary cause, indicating the relationship between the cause and the effect. Diabetic coma non ketonic DKA: w/wo coma Hypoglycemia w/wo coma Causative Disease Example documentation: PVD due to uncontrolled diabetes Gastroparesis secondary to DM Cellulitis Ophthalmic Manifestations Retinopathy Blindness Cataracts Glaucoma Hyperosmolar coma Diabetic Impotence Diabetes Mellitus Cardiac Manifestations Sinoatrial Dysfunction Paroxysmal V Tach CHF Acute Kidney Failure due to Acute Tubular Necrosis Fluid Overload due to ESRD 26 New Residents Are Required to Complete Documentation Course Publication Clinical documentation module Present on admission module Dictation module Modules to be added: Core measures Patient safety indicators Readmissions Continued communication and education through publication Quarterly medical staff update newsletter Physician online hot tips Staff news beat Homepage of intranet John Fox blog Brochures Be creative! 27 28 For questions please contact HCPro customer service at 800-650-6787. 7
Collaboration Post-Discharge Action Collaboration with any group that will listen! Market your service. Physician/service lines/midlevels Nursing Care coordination UR, CM, quality, core measures, PSI/RAC Administration Others Post-discharge action: A philosophical decision What are the overarching drivers of the program? Where is the emphasis placed? Who looks at the monthly stats and Who cares? ($$$ vs. quality outcome or both) What targets are considered most important? What are you trying to achieve? 29 30 Post-Discharge Process Program and Process Staff leaves all unanswered queries as pending All pending post-discharge queries are on open query discharged patients work list Work all CDI post-discharge open queries Call, email, alpha-mate resident/midlevel/attending Use as opportunity to educate Two attempts then refer to physician advisor Contact coding to add information to abstract (if appropriate) 31 Program and process Development and implementation Develop your mission Develop your philosophy Develop your program Develop your process Implement and refine Continuously refine and redefine it is one of those things where the job is never done! 32 For questions please contact HCPro customer service at 800-650-6787. 8
So, Ask Yourself Physician Benefits of CDI Do we have a relationship with and guidance from senior administrative and medical leadership? Do we have a relationship with and guidance from a physician champion? Do we have ways to communicate, educate, and publish our efforts? Do we collaborate/assist with other groups in the organization? Do we have a good solid program and processes that are standardized? And finally, Does our mission guide our purpose? Now I understand!! CDI is really cool! 33 34 Thank you. Questions? Bonnie.epps@emoryhealthcare.org, 404-712-4550 Brenda.bell@emoryhealthcare.org, lth 404-712-7215 7215 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 workbook. 35 For questions please contact HCPro customer service at 800-650-6787. 9