Joining Forces: How Ambulatory CDI Can … [email protected] [email protected] [email protected] In order to receive your continuing education certificate(s)

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Joining Forces: How Ambulatory CDI Can Collaborate With Inpatient CDI Staff

Jennifer Boles, CPC, CRCSystem Manager, Ambulatory CDIBaptist HealthLouisville, KY

Lori Ganote, MSN, RN, CCDSSystem Manager, Inpatient CDIBaptist HealthLouisville, KY

Caryl Liptak, MSHAI, RHIASystem Director, Home Health/Hospital Coding and CDIBaptist HealthLouisville, KY

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Learning Objectives

• At the completion of this educational activity, the learner will be able to:

– Define ambulatory and hospital clinical documentation integrity (CDI)

– Explain ambulatory/hospital CDI universal message approach

– Recognize our ambulatory/hospital CDI prioritization of initiatives

– Demonstrate benefit of strategizing educational efforts between departments

– Identify ambulatory CDI initiatives

– Identify hospital CDI initiatives

– Demonstrate benefit of sharing CDI resources to achieve system initiatives to improve physician documentation

2019 Copyright, HCPro, a division of Simplify Compliance LLC. All rights reserved. These materials may not be copied without written permission.

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Where We Are

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Defining Ambulatory and Hospital CDI at Baptist Health

• Historical background of departments

• Ambulatory CDI– BHMG/PB

• FTEs

• Hospital CDI– Inpatient

• FTEs– Outpatient

• FTEs

• Home health CDI• FTEs


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CDI Organizational Structure

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Polling Question 1

• Which department does CDI report to at your organization? a. HIM

b. Rev cycle/finance

c. Quality

d. Case management

e. Other (ACO, population health, etc.)

*By submitting this poll, we are merely seeking further clarification of the response to accurately reflect all conditions that you are monitoring, evaluating, assessing, or treating that extend to this presentation. Please use your independent CDI judgment when addressing the question above.

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Polling Question 2

• Health systems with both ambulatory (physician practice) CDI and hospital CDI, do you report to different directors?

a. Yes

b. No

c. Other (please specify) _________

d. Clinically undetermined

*By submitting this poll, we are merely seeking further clarification of the response to accurately reflect all conditions that you are monitoring, evaluating, assessing, or treating that extend to this presentation. Please use your independent CDI judgment when addressing the question above.


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Universal Message

• Mission – CDI collaborates with our clinicians to improve documentation to accurately reflect the complexity

of their patients and to support their length of stay, the resources used, and the quality of the care delivered

• Vision – CDI establishes a cohesive communication line between the clinical and HIM staff to improve

documentation, resulting in improved quality of care

• Values – CDI will live out its Christian mission and achieve its vision of quality, succinct documentation by

using compliant methodologies resulting in accurate code assignment, quality measures, and maximized reimbursement of documented care

• Message agreed upon by multiple departments (ACO, compliance, coding, CDI, quality, etc.)– HCC/risk adjustment diagnosis capture at every pertinent patient encounter to the highest level of

acuity and specificity

– Satisfying the MEAT criteria

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Prioritizing Initiatives

• Assigning tasks per resources and relations– EMR view and access (hospital vs. ambulatory capability)– Joined forces to work on specialty preference list (hospitalists vs. PCP individual providers)– Sharing contacts and physician advisors– IT tracking and analysis

• Reports and EMR tools • IP CDI software program reporting

• Value‐based purchasing – HCCs and risk adjustment documentation education– Quality reporting and measurements

• HAC/PSI/infection data education• Mortality measures• Readmissions


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Strategizing Educational Efforts Between Departments

• Ambulatory CDI is providing outpatient guideline education to hospital CDI• Hospital CDI is providing clinical and disease process education to ambulatory

CDI• Resource counsel data governance

– Includes: HIM departments, CFO, CMO, CEO, CM, COO, quality, ACO/CIN, revenue cycle, risk, compliance, VP of physician(s), operations, etc.

– Share efforts, minimize silos, and close gaps to improve documentation integrity

• Documentation improvement committee – CDI, IT, and physicians working to build better notes/templates

• Query committee – Includes: Ambulatory CDI, hospital CDI, coding, compliance and home health CDI– Shared education library access

• AHIMA/ACDIS resources

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Ambulatory CDI Initiatives

• Regional leadership and service line meetings– HCC/risk adjustment buy‐in

– Service line, quality, and contract

• Primary care service line goal– Practice pilot program

• 1:1 provider education, EHR assistance, and chart reviews

• Goal of 90% or higher

• EHR tool development– Prospective query work queue build

– Common diagnosis button enhancements

– HCC reports, best practice advisory, schedule notification

• Provider data validation audits and education

• Medicare Advantage condition reviews – Work as a team with ACO/CIN

education team

– BHMG providers and facilities


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Ambulatory CDI Initiatives (cont.)

• PAF/AWV

– Template development

• Coder and compliance department training

– Compliant query process

– HCC/risk adjustment identification

• ACO/CIN HCC education

– Non‐BHMG providers and facilities

• Clinical indicator tip sheets

– Ambulatory/OP coders

• Provider education tip sheets and laminated cards

• Quality and population health

• Onboarding HCC education

– Provider

– Coder

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Hospital CDI Initiatives

• Patient Safety Indicators (PSI‐90) education

– Incorporated risk‐adjusted/HCC education

• Patient Safety Indicators for OB population

• Medicare Spending Per Beneficiary collaboration

– Emphasis on risk‐adjusted/HCC education

• Operation FaceTime

• Attending multidisciplinary meetings

• Onboarding staff

– Manuals

– CDI checklist


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Hospital CDI Initiatives (cont.)

• Onboarding physicians

– Fast facts

• Who we are, what we do, what we need from you, why it’s important, and how we can help

• Physician education “tip sheets” for specialties

– Including risk‐adjusted definitions

• Assisted in building service line–specific “preference lists”

– Hospitalists, cardiology, CT surgery, orthopedics, OB/GYN, anesthesia

• Malnutrition collaboration

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Sharing Resources

• FTEs

• Inclusion in organization chapter groups (leadership exchange, auditor educator chapter)

• Policies

• Steering committee regional meetings

• Meeting of the minds (ambulatory CDI/coding and hospital CDI/coding meet)

• Joint physician education

• Contacts

– Physicians

– Ancillary department leaders

– IT connections (DSA)

• Educational resources

– Boot camps

– Online learning (webinars)

• Tip sheets

– Clinical indicators

– Inpatient vs. ambulatory guidelines


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System Collaboration on Initiatives

• Heart failure mortality reduction initiatives

– Operation Mammoth

• COPD

• Monthly planning meeting

– Includes: CDI, coding, ACO, quality, IT, contract leadership, revenue cycle

• ACO/CIN

– Provider and team education

– United Medicare Advantage member condition analysis

• Quality

– Contract participation

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Future Plans

• Ambulatory CDI/OP software for dashboard, query, and reporting capabilities

• Contract negotiations

• Expanding collaborations for Value‐Based Purchasing measures

• Collaborative education


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Thank you. Questions?

[email protected]@[email protected]

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 of the program guide.


Documents

Joining Forces: How Ambulatory CDI Can … [email protected] [email protected] [email protected] In order to receive your continuing education certificate(s)