Meaningful Practice A VPMA Perspective Medbiquitous Conference May

Meaningful Practice: A VPMA Perspective Medbiquitous Conference May 16, 2016 Redonda G. Miller, M. D. , M. B. A. Senior Vice President, Medical Affairs 1

The Problem • So many competing priorities – Possibly over 1200 quality measures – More 15 educational mandates (internal, licensure CME, MOC, etc. ) • Current technology solutions are wellintended – Try to be all things to all people (clinicians, compliance officers, billing personnel, etc. ) – Prevailing mantra of “just add it on” 28 November 2020 2

How Can We Win Over Physicians? • Align motives with truly trying to improve patient care • Develop meaningful measures (not just process measures) • Focus on data • Pay attention to workflow and unanticipated consequences • Engage physicians in the design from the ground up 28 November 2020 3

Ongoing Professional Practice Evaluation (OPPE) • Joint Commission standard to monitor competency and performance of medical staff • Peer review of competency in an “ongoing” fashion (more frequent than annually) • Complex structure in place for over 3200 medical and allied health staff 28 November 2020 4

OPPE Process Medical Board Approve measures and privileges Credentials Committee Process PPE data into files and recommend privileging decisions Central Steering PPE Committee Vet modifications to measures and determine remediation plans Departmental PPE Committee Chairman (Appointed by Dept. Chair) Quality Team Leader Department Committee 5

Ongoing Professional Practice Evaluation (OPPE), cont. • Global indicators – UHC data: LOS, mortality, readmissions – Process/professionalism measures: documentation completion • Department-specific indicators – Tend to be more clinical and more robust – Ex: antibiotic timing, blood transfusion, etc. • Based predominantly on administrative data with resultant limitations 28 November 2020 6

Sample OPPE Data 7

Regulatory Demands • CMS Face-to-Face encounter – Requirement to document an encounter within 90 days prior to the start of home health services – Must forfeit payment if not done • Joint Commission annual education – Mandated topics – Need improved delivery modalities 28 November 2020 8

Query Responses for Quality Rankings • Quality indicators often require clarification – Present on admission? – Known complication or accidental mishap? • Accurate documentation to reflect true level of patient morbidity – Impacts measures with O/E calculations • Coder and clinical documentation specialists generate queries to clinicians to resolve/clarify 28 November 2020 9

Physician Query Workflow Query? Patient Physician documents CDI Specialist and Coder review Response 70% physician response rate Code assigned Quality Scores Reimbursement

Queries Affect Reimbursement Hospital system with 115, 000 admissions/yr. 70% response rate 95% response rate + $27 Million/yr.

Queries Affect Quality Reporting Sepsis Mass General Hospital Mayo Clinic Johns Hopkins Hospital 5 -Star Rating ***** * Actual Mortality 24. 04% 12. 16% 26. 32% Predicted Mortality 22. 66% 21. 84% 20. 70% 1115 1587 323 # of cases reported Source: http: //www. healthgrades. com Mortality In-Hospital figures. Mar. 2016.

PARTNERSHIP WITH ARTIFACT HEALTH Admission Concurrent Review & Education Discharge Query Template Library • Compliant • Customizable • Attach documentation Query Response & Individual Education Query Management Retrospective Review & Coding Final Bill/Hold • • • Work lists Review process Query Activity Feed Escalation process Reassignment/Co-assignment Education • Provider tips • CDS/Coder Guidelines Analytics • Query tracking • Performance tracking • Comprehensive reporting Second Level Review E M R Auto-Generated Addendum

MAKE IT FASTER & EASIER § Single platform § Consistent query format § Any device § ‘One-step’ workflow § Targeted education to reduce future queries § Scorecard with peer comparisons

Artifact: Anticipated Benefits § Create structure and accountability, no more chasing-down physicians § Provide automated query tracking and reporting § Foster collaboration between CDI & coding § Complement existing systems (3 M, EMRs) § Handle the future increase in query volume 28 November 2020 15

Final Word: Key Physician Motivators Design IT solutions that: • Improve patient care or clinical outcomes • Lead to increased efficiency • Enhance reputation / quality rankings 28 November 2020 16