Children’s Medical Center in Dallas, with two-thirds of patients covered under Medicaid, used to be paid on a fee-for-service basis and life was good, says Katherine Lusk, senior director of information management and exchange.

The three-campus, 595-bed system had the money for new technologies and more. Then, the state of Texas informed Children’s that it would move to an inpatient prospective payment system in September 2013 with reimbursements cut considerably--and the hospital already was giving away $40 to $60 million in charity care annually. With the reimbursement cuts, the organization put a hard freeze on hiring--employees could transfer to new positions but no new FTEs were permitted. Further, an outpatient prospective payment system is coming in September 2014. Consequently, a primary goal the past couple of years has been to identify ways to get as much payment as possible.

One way was to implement a clinical documentation improvement program with a goal of associating severity of illness and risk of mortality to reflect the complexity of care being given, said Katherine Lusk, senior director of information management and exchange, during an education session at the American Health Information Management Association’s annual conference in Atlanta. “We needed to improve on documenting medical necessity.”

The CDI program started with Lusk and one other staff member setting the groundwork and spreading the word across the campuses, and now it includes a physician, nurse and a case manager from the payer community. They used the hospital’s electronic health record to work smarter, running reports on specific subjects--such as low sodium, low hemoglobin, transfusions and body mass index--to identify opportunities for more precise documentation.

The program also involved redesigning EHR templates to ask physicians for specific words to capture treatment specificity and patient acuity, improving the quality of information to support billings while easing the burdens of documentation. Now, the hospital is getting the best payment levels it can get from the prospective payment system and physicians are completing their notes quicker, Lusk says.

CDI training first started in four units that cover up to 50 percent of the patient population--hematology/oncology, pulmonary, NICU and gastroenterology--and now covers the entire organization.



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