Clinical Documentation Integrity Provider Education MCF Inpatient CDI

Clinical Documentation Integrity Provider Education MCF Inpatient CDI How we ‘ACTION’ Analytics Razvan Chirila, MD, CCDS Jeff Mueller, MBA Luanne Lentz, MHA, RN, CCDS

Topics • CDI Key Performance Indicators (KPIs) – USNWR DRGs / All Payor DRGs • • • Observed to Expected (O/E) Mortality Ratio Service Line CC/MCC Capture Clinical Denials Service Line Engagement Malnutrition Evaluation Provider Education 2

Clinical Documentation Integrity Mission (Inpatient or Outpatient) • Competently ensure the EMR reflects the clinical care supporting appropriate coding and billing • Decisively confer with the Practice to decipher and support clear, consistent, complete, and/or non-conflicting patient record entries • Incorporate and improve risk adjusted Severity of Illness & quality outcomes supporting accurate and validated reportable data 3

MCF CDI KPIs 1/16/20 Notes: * Not all claims are reported *CMI impact per case affected by dilution of case type 4

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MCF Overall Mortality O/E Ratio 2019 7

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CC/MCC Capture by Service Line 9

Service Line Engagement • • • Request by Department Chair Review of data Identified opportunities Developed interventions Implementation • Nest steps – Review results 10

MCF Orthopedics Service Line Severity of Illness 2 Q 18 - 2 Q 19 11

MCF Orthopedics Service Line Risk of Mortality 2 Q 18 - 2 Q 19 12

MCF Orthopedics Provider Metrics SOI / ROM 2 Q 18 - 2 Q 19 2018 Q 2 -2019 Q 2 Risk of Mortality Severity of Illness 13

MCF Orthopedics Provider Metrics CDI Queries Jan – Sept 2019 Query Types by Attending Provider Top Queries: ABLA and High BMI Response Rates by Attending Provider 14

Orthopedic Interventions • Met with Orthopedic Providers – Surgeons, Residents and APPs – Shared opportunities and interventions • Rounded and provided “at the elbow” observation and concurrent documentation suggestions – Physicians, APPs with high query volumes • Implemented quarterly monitoring of provider data – Provided more frequent 1: 1 and group coaching, as needed • Conducted focus review of DRG 470 (total joint replacement) – 40 cases reviewed only 1 opportunity for added MCC • case had not been concurrently reviewed by Service Line CDIS 15

Evaluation of Most Frequent Query Malnutrition (E 440) Capture Rate of All Secondary Codes Large Specialized Complex Cohorts 16

Malnutrition Interventions CDI and Nutrition Services • MCF Provider Education – CDIS and Physician Advisors provided education to Physicians, APPs, Residents • Including use of smart phrase “. malnutrition 1” which imports dietitian assessment – Removed “well-nourished” from templates • MCF Nutritional Services – Transitioned to ASPEN Criteria • Dietitian Tech screens all inpatients, about 50% referred to RD – Multiple independent and collaborative efforts: education, audits X 3, joint presentations • MCF CDI Huddles – Sharing of case examples, standardization of query templates • CDI internal Quality Assurance – 10 charts per quarter (5 queries, 5 diagnosis capture) – reviews demonstrate compliance • Internal Compliance Audit – Reviews with Malnutrition as a Secondary Dx – Results showed significant improvement after implementation of interventions – Baseline - Sept. /Oct. 2018, Remeasurement – Jan. 2019 17

MCF CDI Provider Education: 2019 14 25 87 Service Line Presentations APP Orientation Group/Service Line / All Service Line encounters in office Large group residents/APP meetings Multiple 1: 1 by CDI Physician Advisors Inpatient Service Lines • • • Colorectal Gastroenterology General Surgery Otolaryngology Gynecology Nephrology Ophthalmology Orthopedics Kidney Transplants • • Urology Neurosurgery Family Medicine Hospital Internal Medicine Rheumatology Hematology / Oncology Bone Marrow Transplant • • • Liver/Pancreas Transplant Radiation Oncology Pulmonary Medicine Heart Transplant Lung Transplant Thoracic Surgery Vascular Surgery Cardiology Critical Care Medicine 18

Provider Education • Service Line presentations • Rounding • At the elbow support • CDI Website • Modules • Risk Adjustment Basics • Specialty specific • Guides • Adult Clinical Documentation • Specialty specific • Neurosciences • Pediatrics • Conference spots • Diagnosis specific documentation tips • Quarterly Newsletters 19

CDI Quarterly Newsletters • Top three query diagnoses • Documentation tips • Query response rate • CDIS contact information • Other tips • Standardize across Service Lines and across Mayo Clinic 20

CDI Quarterly Newsletters • Previous quarter top 10 queries • USNWR data • SOI and ROM • CC/MCC Capture Rate 21

Questions?