Remodeling Your Organization with the ICD-10 Catalyst

Transcription

1 Remodeling Your Organization with the ICD-10 Catalyst ICD-10 and Other Regulatory Changes as Catalyst for Transformation John W. Stanton (Senior Healthcare Consultant, Dell Global Healthcare Services)

2 Speaker Introduction John W. Stanton Dell Global Healthcare Services Consulting Areas & Team s Focus ICD-10 Program Management CDI Implementation Workflow Optimization & Improvement HIM/Coding Optimization Revenue Cycle Improvement Personal Background Federal Financial & Compliance Regulator / Auditor Financial Analyst IT Consultant (Financial, Oil & Gas, Healthcare) CIO and CFO for Health Care Entities Practices, Hospitals and Tertiary Organizations

3 Remodeling Your Organization

4 Remodeling Your Organization ICD-10 and Meaningful Use Messaging Regulatory National Action, Not Local We have to do this Not the only one s affected all affected Necessary Opportunity to Improve patient care through better documentation Improve physician and clinician engagement Improve provider / patient communication Enhance and improve our systems Improving Our Processes Patient Access & Communication Clinical Flow & Documentation Revenue Cycle

5 Foundations of Transformation People Training, Documentation, Communications Processes Workflows, Forms Transformation Meaningful, Lasting Change Technology EMR, Ancillary, E-Documents

6 Remodeling Your Organization Continued Transformation to Adoption 3 Projects Clinical Documentation Improvement People: Training Refocus, Focused Provider Feedback Process: Increased Specificity and Metrics Technology: Program Tracking, Automated Queries Broken Processes & Forms People: Full Staff / Departmental Engagement Process: Best Practices Technology: Enhanced, Collaborative Workflows & Forms Clinical & Revenue Cycle Analytics People: Knowledge Driven, Enabled Staff Process: Metrics Driven Technology: Dashboards, Informatics, Data to Information

7 Clinical Documentation Improvement Perfect Combination of People, Processes, Technology Patient Care Provider Documents Care, Responds Timely to Queries, Focused Training Rev Cycle & Reporting Coding, Physician Specific Metrics & Feedback, Focused Training Create Custom Aids Coding, Audits, Reports Collaboration Concurrent Review CDI Program Concurrent Review, Bridge with Providers / Coding / Case Management

8 I-10 Process Flow Impacts Diagnosis Upon Admission Clinical Documentation ICD-10 Impacted Forms

9 Broken Processes & Forms Forms Redesign IS Process Redesign Forms Redesign as Foundation for Process Change People: Full Staff Engagement People: Working Sessions Process: Best Practices Process: Reduce Redundancy Technology: CPOE, Progress Notes Technology: IMO, EMR, etc. Steps Inventory (Hardest Step) Evaluate for I-10 Specificity / Codes Clinical & Departmental Leadership Engagement Document Departmental Processes around Forms Fix & Adopt by August 1, 2015

10 Clinical & Revenue Cycle Analytics Use Data Trapped in Systems to Enable Change Easier: Length of Stay vs. National Geometric Mean People: Case Management, CDI, Reimbursements Process: Case Management, CDI, Coding, Contracting Technology: Data from PM System, Excel Why? Potential Documentation Deficiencies Case Mix Needing More Case Management Attention Missed Reimbursement Opportunities

11 LOS Analysis Example Length of Stay vs. National Geometric Mean Example Cesarean w/o Complications LOS = 3.6 Days, National = % Cases Over the National Yellow = LOS over National Mean, Pink = >65% Cases over National Mean

12 Clinical & Revenue Cycle Analytics Use Data Trapped in Systems to Enable Change Harder: Revenue Cycle Dashboard People: Revenue Cycle, Reimbursement, Finance, IT Process: Denial Management, Contract Management Technology: PM System, Clearing House, Finance Systems Why? Early Identification of Contract Problems Better Transparency / Metrics in Revenue Cycle Process

13 Revenue Cycle Dashboard

14 Revenue Cycle Dashboard

15 Revenue Cycle Dashboard Eighteen (18) Reports on Dashboard Documentation and Coding Case Mix DNFB Backlog DNFB Days (DOD DOFC) Coder Productivity Claim Submission DNFB to DOCS Acceptance Rate Clean Claim Rate Edits and Rejects Goal = Better Transparency / Advanced Warning & Metrics for Revenue Cycle Process Insurance Response DOCS to DOP Payment Processing No Response Waterfall Quality Review Denial Rate Under Payment Payer Comparison DRG Trended Analysis LOS to DRG (SOI / CC,MCC) LTD Retrospective Edit Analysis

16 Remodeling Your Organization Summary & Key Points Keep Up Momentum but Change Messaging ICD-10 to Clinical Transformation Repackage ICD-10 Tools and Training Focus on Foundational Change that Make Meaningful Use Adoption and ICD-10 Easier in 2015 People, Process, Technology Foundation CDI, Forms & Workflows, Analytics Careful of Projects Initiated Due to Delay No Delay in Meaningful Use Phase II! Only 16 Months to ICD-10 Adoption! Adoption cycle timing still in place IT Resources are STILL Scarce

17 Closing Remodeling Your Organization with the ICD-10 Catalyst John W. Stanton