Archive: 4 August 2016

Morning musings from a CEO

Here are 10 questions to ask before you buy CDI software

Aug 4, 2016 by Raghu Vir 0 Comments

blog_2015_08_25-11)      Does the software minimize data entry? If your CDIS have to enter all the codes and DRGs manually and also analyze that data for reimbursement manually it severely hampers their productivity. You want your team to be more efficient and productive.

2)      Does it come with built-in ICD-10 compliant query templates or do you have to manually enter them? Manually creating query templates is a time consuming task and you need to spend a lot of time and resources in creating these queries and making sure that they are ICD-10 compliant. You also need to ask if the vendor updates the provided queries periodically to incorporate all the changes like sepsis definitions etc.

3)      How easy is it to customize the query templates to meet the needs of your hospital? Can you do it yourself or do you have to depend on the vendor? Many times the queries that are available out of box do not meet the needs of your hospital. In such cases, you want the process of query template customization to be easy and quick. You do not want to depend on the vendor to do this for you because that will be too expensive. Also once you customize the templates you should have the ability to roll it out to the entire CDI department.

4)      Does the software provide for education and training of CDI staff and the physicians? Ideally whenever you query a physician the relevant educational information should be included as part of the query so that the physician can document better going forward. Similarly, the CDI specialists and the coders also need to be continuously informed and kept up to date about CDI information.

5)      How easy is it to run any reports that you want – CDIS productivity, CMI, CC/MCC capture rates, Query Response Rate, HACs, Physician compliance etc.? As a manager you want to run all type of reports to monitor performance, productivity and efficiency. Such reports should be available easily and on-demand.

6)      Can you run the reports or do you have to depend on the vendor to run the reports? You do not want to wait on the vendor to run the reports and then get on a conference all so that they can explain the reports back to you. You want the reports to be informative, insightful and easy to understand.

7)      How easy is it to navigate the software? Is the workflow intuitive or too cumbersome? The more complex the software the slower the learning curve and lower the productivity. If a new CDI cannot become productive in a couple of days, that software is too cumbersome. If the software has limitations on browsers, operating system versions etc it is not easy to manage.

8)      Does the software support in-house as well as remote CDI specialists? Many hospitals have hybrid work environments – some of the staff are in house while others work remotely. You want to make sure that your software can easily adapt to such an environment.

9)      Can the software be integrated with our EHR? Many hospitals want the queries to be pushed into the inbox of the physician in the EHR. Make sure your software is capable of doing that.

10)     How much does it cost and what is the total cost of ownership? The upfront cost of software is only one aspect of total cost. You also need to look at implementation costs, integration costs, IT infrastructure costs, annual maintenance costs etc.

If you are in the market looking for CDI software or if your current software license is expiring, please watch this 5 minute video that gives you an overview of Doc-U-Aide, the industry’s most intuitive, insightful and intelligent CDI software. Doc-U-Aide comes in three flavors – Enterprise, Lite and Network editions, to meet the budgetary needs of hospitals and health systems of all sizes.

Morning musings from a CEO

Four reasons why hospitals have to start outpatient CDI programs now

Aug 2, 2016 by Raghu Vir 0 Comments

graph1-hospital revenues are shifting from inpatient ot outpatientHere are four reasons why hospitals have to start their outpatient CDI programs now and not later.

1) Hospital revenues are shifting from inpatient to outpatient
Historically, 92 percent of Medicare revenues to hospitals have come from inpatient and outpatient services. Over time, however, the share of revenue coming from the outpatient setting has increased, and the share coming from the inpatient setting has decreased.

From 2010 to 2014, the share of revenues coming from the outpatient setting increased from 21 percent to 27 percent. The increase resulted from several changes: a shift in services from the inpatient to the outpatient setting, a general increase in beneficiary outpatient service use, a shift in the billing of physician office services from the physician fee schedule to the OPPS, and changes made to the outpatient payment system that packaged many lab services into outpatient payment rates that were previously paid on a fee schedule rather than the OPPS

The share of revenues coming from the inpatient side fell from 71 percent in 2010 to 60 percent in 2014. This decline results from (1) a shift in services from the inpatient setting to the outpatient setting, as just discussed, and (2) changes in Medicare DSH payments.

As hospitals see increased revenues from outpatient services, they need to put in processes and procedures in place to protect their revenues.

2) Rate of growth of outpatient visits far outpaces inpatient discharges
CMS data shows that between 2006 and 2014 outpatient visits per beneficiary have increased by a whopping 44% while inpatient discharges per beneficiary have decreased by almost 20%. And projections show that this trend is going to continue well into the future.

As hospitals see a faster rate of growth in outpatient visits, they need to put processes in place to maintain revenue integrity.

graph2

3) Hospitals have aggressively acquired physician practices to offset the decrease in inpatient revenues.
This is resulting in increase in hospital revenues as payments shifted from Physician Fee Schedule to OPPS which generally pays higher. Now CMS is working aggressively to streamline the payments and make the payments equal for Hospital Outpatient Departments and Physician offices. CMS has already moved some of the clinical laboratory fee schedule services into OPPS resulting in a saving of $2.4 billion in a year. Now CMS is also working on bundling more services into Comprehensive-APC to further reduce reimbursements under OPPS.

As hospitals see the outpatient revenues get more and more streamlined, and as they lose the advantage of seeing increased revenues from OPPS compared to Physician Fee Schedules, they need to focus on outpatient CDI programs to protect revenues.

4) The HCC Risk Adjustment Model under the Affordable Care Act
The Hierarchical Condition Categories for risk adjustment has also become complicated from jumping from 3000 codes in ICD-9 to over 11000 in ICD-10. This degree of specificity requires appropriate documentation and as the CMS moves to value based reimbursement models, this aspect of documentation becomes critical for revenue integrity.

Hospitals have to out in place outpatient CDI programs to ensure that the physician documentation is truly reflective of the acuity and the chronic conditions of its patient population.

Most of the hospitals have a mature CDI program in place to take care of their inpatient population, but over 90% of the hospitals still haven’t put in an outpatient CDI program. Outpatient settings is where all the action is. Hence the time to think of outpatient CDI is now and not later.

PracticePerfect CDI from Saince is the industry’s first fully featured outpatient CDI solution that integrates, CMS and HHS HCC capture, risk score calculation, integrated querying, dedicated ER workflows, PQRS measures and many more.