Case Studies: Clinical Documentation Improvement (CDI) Program Dramatically Boosts Cash Flows and Regulatory Compliance for Virginia Health Care System
Valley Health turned to Precyse Solutions to train and launch their own
Clinical Documentation Improvement team. Positive results realized just months
into the effort.
THE CHALLENGE
When Valley Health’s Senior Vice President of Finance and CFO, Craig Lewis,
first crunched
the financial projections in 2007, he forecasted a potential $1+ million loss
based upon the
CMS requirement to implement the new MS-DRGs. Valley Health’s executive team
proactively
approached the issue. Instead of depending on outside contractors and
consultants, they wanted to develop an offensive strategy that could help them
mitigate some of this reimbursement loss, while creating a sustainable
capability within the organization.
Lewis worked with the Director of Care Management, Rosemary Connor, to fund and form a Clinical Documentation Improvement (CDI) department — a team of clinical professionals who could work closely with Valley’s physicians at the point of care.
The CDI team reports to Rosemary, who quickly realized that in order to maximize the talent of the team, Valley Health would need an expert vendor partner to deliver MS-DRG training and tools, and to share best practices on how to improve the institution’s clinical documentation. After evaluating five different companies, Valley Health selected Precyse Solutions for the job. Rosemary explained the deciding factors that led to the unanimous vote for Precyse: “Precyse consultants delivered excellent presentations which made us feel comfortable that they understood our issues, were great communicators and listeners, and demonstrated they had deep expertise in this particular area. We also sensed a real opportunity to partner with Precyse, to have a relationship that was much more dynamic than that of the traditional vendor/client. Precyse also was the only vendor who included a physician on their team– it was a real differentiator to us.”
THE SOLUTION
In January 2008, Precyse kicked off the training with the Valley CDI specialists
and HIM coders.
Thereafter, using a combination of weekly conference calls and onsite training
programs, Precyse
helped with concurrent record reviews and provided advanced coding education.
The training
helped Valley Health prioritize which patients the CDI specialists should focus
on and review first.
Precyse also supported Valley’s needs for updated policies and procedures and
supplied updated
job descriptions.
In July 2008, based upon a request by Valley Health, Precyse beta tested a
new tool —
PrecyseTrac™ — a proprietary web-based solution that enabled Valley staff to
track patient
severity of illness, reimbursement accuracy, staff productivity and quality
outcomes of the CDI
team. Of great benefit to the Valley CDI specialists was the tool’s ADT
interface, which reduced the
CDI specialists’ clerical workload and improved their overall productivity. As
is often the case with
newly formed departments, Valley Health quickly realized that they had
overestimated the volume
each CDI specialist could handle, and PrecyseTrac has been a big help to these
stretched resources.
(Valley Health will now be adding two more CDI specialists to its current team
of three.)
Rosemary Connor and the Valley CDI team quickly realized that the physicians
were the key
constituency to influence. Because Precyse had their own physician on the team,
Precyse was
able to help Valley physicians by enabling substantive peer-to-peer level
discussions on the need
to change behaviors and comply with the new regulations. Precyse’s physician
trainer also knew
the importance of understanding the political landscape of the institution and
by listening,
was able to tailor presentations that would resonate with the various medical
specialty areas. Dr. Robert Tucker, Vice President of Medical Affairs, describes the process
that unfolded: “Precyse’s
physician trainer asked a lot of very good questions upfront, listened carefully
and thoughtfully to
our answers and used this information to deliver content that resonated with
each of the different
medical specialty groups. What you say to the cardiology team needs to be
delivered differently to
internists. The trainer’s sensitivity enabled the potentially negative message
of process and behavioral
change to be turned into a positive one by focusing it on institutional goals
for patient care
and financial improvement.”
THE RESULTS
CFO Craig Lewis outlined Valley Health’s goal with CDI as “a way to capitalize
on the right time to
maximize our opportunities to fully bill for our services through better
documentation and coding.
The effort has received complete top down support.” Valley Health began the
effort with a focus
on Medicare patients and plans to add commercial payers in early 2009.
Here is a snapshot of Valley Health’s results at the conclusion of Phase III of
the CDI implementation:
| Month | Case Mix Index |
| January 2008 | 1587 |
| September 2008 | 1710 |
| Total | +7.8% |
For 2008, Valley Health averaged a CMI of 1.65, and the trends are upwards. In
terms of the
dollars associated with the CMI increase, Valley projects they will average
$6,000–$10,000 per
bed annually in additional billing potential because of the enriched
documentation now provided
in the charts. Rosemary Connor projects that with the addition of two more CDI
specialists in
2009, the results for 2009 will be even stronger. “We really couldn’t get to all
of the target
patients with just three CDI specialists. We anticipate that the team’s ability
to conduct and
complete more patient reviews, and to do them thoroughly and not just upon
admission, will
drive our cash increases higher.”
Valley Health’s executive team is very satisfied with the results realized to date and is planning to roll the effort out to all of its facilities. As Craig Lewis pointed out, not only is Valley Health able to improve its bottom line with CDI, it has also prepared itself for future compliance audits and RAC by reducing its future overpayment exposure with completely documented and reviewed charts.