Keep it simple stupid.
According to the KISS principle, most systems work best if they’re kept simple. Simplicity is the key goal in design, and unnecessary complexity should be avoided.
Clinical documentation improvement and ICD-10 preparation are no exception. In a final rule issued July 31, 2014, HHS formally set an October 1, 2015 compliance date for conversion to ICD-10 diagnostic and procedure codes. And incorporating the absolute minimum delay imposed by Congress when it ordered HHS to roll back the conversion date previously set for October 1, 2014.
“ICD-10 codes will provide better support for patient care and improve disease management, quality measurement and analytics,” said Marilyn Tavenner, administrator of the Centers for Medicare & Medicaid Services (CMS). “For patients under the care of multiple providers, ICD-10 can help promote care coordination.”
In the midst of preparing for the ICD-10 transition, many organizations are finding opportunity in improving documentation to show care being rendered and reflecting on severity of illness with the well-known ICD-9 diagnostic codes. The KISS concept applied here is to ensure timely, precise, consistent and complete documentation in a patient’s chart.
Sounds simple, right?
The tricky part is making sure providers understand what exactly constitutes precise, consistent, timely and complete documentation.
To keep it focused and meaningful to providers, consider using the following CDI metrics. Their focus is on what’s being displayed on Healthgrades, PQRS measures and Physician Quality Scores which populate the Physician Compare website.
They’re also honing in on:
- DRGs
- CCs/MCCs
-
Mortality scores
- Severity of illness (SOI)
- Risk of mortality (ROM)
- Case cix index (CMI)
- RAC denials
- Query volume
- Query response rate
- Query agreement rate
This “scorecard” will help you keep it simple. But even this scorecard seems a bit extensive, so it’s important to focus on what we need.
But what do we need?
Simply put – providers must be educated on which principal diagnosis is associated with the DRG that’s most relevant to their specialty.
Using historical data, you can identify just that. Focus on specific diagnosis (in terms of precise and consistent terms) that need to be documented and the clinical conditions for consideration associated with each principal diagnosis. Focusing on specific terms helps you see the most appropriate DRGs, along with all other metrics important to the provider.
Something as simple as education impacts quality scores, mortality scores, CMO, RAC denials and query volume rate.
Create a cycle of assessment, education, application and reassessment to keep ICD-10 adoption simple and focused.
This post appeared first at Action for Better Healthcare.