EDITOR’S NOTE: This the final installment in a two-part series on the clinical documentation integrity department at Essentia Health, a health system that serves Minnesota, Wisconsin, North Dakota, and Idaho.
Becker’s Hospital Review recently named Essentia Health one of the top Accountable Care Organizations (ACOs) in the country. To validate that honor, we must ask ourselves if we are providing the very best healthcare and track our quality of care through risk score data.
Essentia has worked hard in a short period of time to implement an outpatient clinical documentation improvement (CDI) program touching more than 60 clinics in its four-state healthcare network. The initiative has shown how coded data translates to reportable outcomes. Part II of this series takes a deeper dive into implementing an effective CDI program within physician practices. Readers should gain a sense of the importance of data mining and how to approach hiring, policies and procedures, query examples, and much more.
The next level of implementation is taking notes. Record what is going well and what is not. We found that the types of visits populating within the work queues were not an efficient use of CDI coders’ time. Many visits were single-focus encounters that did not warrant a holistic view of the patient’s entire health picture, such as a visit for strep throat for example. Be mindful of what visits will allow a close look into the integrity of the patient’s clinical picture and offer true severity of illness and mortality metrics.
Do you have any expectations regarding how many reviews each CDI coder should complete in a day, week, or month? Are you focusing on total reviews or total coverage of a patient population? Essentia’s practice is looking at patient populations within payor groups. Each CDI coder has an “alpha split” of patients to follow for the entire calendar year. Essentia has an average number of reviews established; however the number today may not be the same number at the beginning of the calendar year.
What do you think the most common query will be? Look back at gap analysis; did you perform one? Essential prepared a list of the top 10 most common queries based on the original gap analysis done prior to implementation of the program. From this list, Essentia developed compliant queries to be housed in the electronic medical record (EMR) and a hard copy saved on a shared drive.
Are your queries compliant? Does your outpatient CDI team know how to craft a compliant query? Chances are, if they are traditional coders, they may need support in crafting a compliant query, including pertinent clinical criteria, appropriate choices, etc. Currently, Essentia Health has more than 30 queries templated for each team to utilize.
At the end of the day, as outpatient CDI specialists, reviews can be done and queries can be crafted and answered. But how are you delivering the education messages to the entire health facility? Essentia Health partners with an established coding and education team. The team has boots on the ground and works closely with the physician advisor to deliver clear, consistent messaging across the entire healthcare organization. Education is key to a successful outpatient clinical documentation program, no matter where the focus is.
Physician advisors: Do you have one? Essentia utilizes the same physician advisor (PA) as the inpatient CDI team. The PA works within an already comfortable relationship with the medical team to share new concepts regarding outpatient clinical documentation and why it matters to the medical practitioner. If your CDI program is well-established with a dedicated PA, look to expand his or her experience to the outpatient arena.
How can inpatient CDI teams help? Perform a time study centering on actual time spent reviewing records. The Essentia CDI team has embraced the outpatient team, developing four inpatient/outpatient teams within the inpatient team to include the four coders. The team atmosphere offers a great approach and support to a new and challenging program.
To date the outpatient CDI program has reviewed nearly 5,500 visits, educated more than 25 clinics with several one-on-one education sessions, and sent and received compliant queries. The program not only recognizes the great care delivered by Essentia medical practitioners, it also portrays the integrity of each patient’s overall health.
PROGRAM NOTE: Listen to Tracy Boldt describe the outpatient CDI operation at Essentia Health today on Talk Ten Tuesdays, 10-10:30 a.m. ET. Register to listen.
Last week I mused about how clinical validation queries do not appear to be keeping up with the volume of clinical validation denials. Perhaps one
Clinical validation queries have been recommended for almost a decade, yet many clinical documentation integrity (CDI) and coding professionals continue to struggle with crafting these
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