When US News and World Report Downgrades Hospital, CDI is Quick to the Rescue

When the University of Michigan Health System’s U.S. News and World Report ranking fell sharply—from number 9 in 2003 to off the rankings in 2013 and 2014—the organization’s administrators knew many things needed to change. Luckily for them, the health system’s HIM department was ready to help.

In the presentation, “Data Analytics and Integrity: Unleashing the Power of Data Analytics to Improve Clinical Documentation,” Gwendolyn M. Blackford, BS, RHIA, director of coding and billing at the University of Michigan Health System (U of M), explained that the CDI program there launched in 2006 with very little support from leadership, so it was built “from the ground up.”

The clinical documentation improvement (CDI) program, up until it was asked to help with the U.S. News scores, was doing regular reviews for metrics such as case mix trends, risk of mortality, present on admission, hospital-acquired conditions, and severity of illness. Clinical documentation specialists did face-to-face rounding with physicians for key service lines such as cardiology, general medicine, burn units, trauma, and surgery, and did education with tip cards, monthly meetings with new residents, department chairs, and mid-level providers.

When the U.S. News rankings slipped, the clinical services department reached out to Blackford. She was able to hire a consultant and financial analysts to help determine what metrics needed to be captured to start improving the health system’s scores.

They then implemented a secondary review process to start tracking metrics including complication comorbidity/major complication comorbidity (CC/MCC); clinician response rates (action rates, rates by recipient roles, query reason trends); and clinical documentation specialist-specific metrics such as coverage rates, review rates, and query rates.
The HIM department now has coders that can track their own metrics, and the CDI dashboard will soon be complete as well.

The Proof is in the Pudding

Yvonne Karolski, RN, RHIT, CDI specialist at U of M, says she’s seen exciting changes since the CDI department redoubled their efforts in light of the rankings drop. Karolski took charge of the cardiology, orthopedic surgery, and vascular surgery service lines, and has been impressed with the enthusiasm surgeons have demonstrated for CDI.

When she started working with cardiology, their query response rate was 63 percent. So they decided to start a pilot program devoting two clinical documentation specialists working only in the cardiology department. This sprang from concerns about low severity of illness and risk of mortality scores. After tweaking their rounding process and working to develop cardio-specific tip cards, the cardiology department quickly saw all their metrics improve and increased their query response rate to 78 percent.

“You have to get creative in your approach to surgeons,” Karolski advised, adding that surgeons typically feel they don’t need to do their own documentation. However, “the chairman invited us to present at the departmental meeting. Director of residency program arranged for a mandatory in-service for residents to be educated on documentation… A lot of the frequent queries started to go away,” she said.

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