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SUNY NY B OARD M EET ETING NG A UGUST 3, 2015 C ONCERN CERNS /I /I - - PowerPoint PPT Presentation
SUNY NY B OARD M EET ETING NG A UGUST 3, 2015 C ONCERN CERNS /I /I - - PowerPoint PPT Presentation
SUNY NY B OARD M EET ETING NG A UGUST 3, 2015 C ONCERN CERNS /I /I SSUE TO B E A DD UES TO DDRESSED RESSED Provide an explanation of why the Downstate CMI is low compared to Upstate and Stony Brook Clarify, specifically, what has been
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Case mix index (CMI) is a relative value assigned to a diagnosis-related group
- f patients in a medical care environment. The CMI value is used in
determining the allocation of hospital resources to care for and/or treat the patients in the group plus to determine relative weights by government payors for payment rates.
Case Mix can be quoted differently for two reasons: First, all payors do not use the same weighting system Second, all patients are not included in some CMI reporting requirements;
in particular, case mix is often reported without newborn nursery Patient 1 Patient 2 Patient Diagnosis Heart Failure and Shock Artificial Lung/Trach Code in ICD-9 System 428.33 440.24 Medicare DRG 291 003 Medicare Weight 1.5031 17.6369
CASE
SE MIX IX BACK CKGROUND OUND
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CORREC
RRECTI TION ON OF OF UHB
B CASE
SE MIX IX INDE DEX NUMBER BER PRESE ESENTE NTED ON ON
JUNE 15, 2015
3
FY12
Actual
FY13
Actual
FY14
Actual
FY14
Projected
FY15 FY15
Budget
As Disclosed June 15, 2015 1.4175 1.2435 1.2853 1.2264 1.2300
(Projected)
1.2264 As Corrected And Updated 1.2478 1.2435 1.2853 1.2264 1.2347
(Actual)
1.2264
Medicare weights with Nursery
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Overall Hospital Case Mix Index Mean 1.745 Minimum 1.259 25th 1.602 Median 1.753 75th 1.907 Maximum 2.430 SUNY Downstate 1.259* SUNY Stony Brook 1.774* SUNY Upstate 1.619*
* Case Mix Index has been calculated using Medicare DRG weights
Source: COTH Annual Survey of Operations & Financial Performance – Autumn, 2014
COMPARIS
RISON ON WITH OTHER ER ACAD ADEMIC MIC MEDI DICAL CAL CENTER NTERS
HOSPIT
PITAL AL CASE SE MIX IX INDICES DICES BY BY PRIMA IMARY PAYOR OR
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UHB has the lowest CMI among all AMCs Function of patient population and competitors:
- Stony Brook and Upstate
are Level I Trauma Centers and UHB is not
- UHB has a Level I Trauma
Center competitor across the street
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WHILE
LE THE CMI HAS REMA MAIN INED STABLE ABLE,
, OTHER CHANGES
NGES IN IN UHB’S SERVICE VICE MIX OF OF PATIENTS TIENTS HAVE VE HAD A NEGATI TIVE VE IMPACT CT ON ON CMI
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The service mix has shifted away from higher-CMI services such as Surgery and Neonatal to lower- CMI services such as Medicine
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WHILE
LE THE CMI HAS REMA MAIN INED STABLE ABLE,
, OTHER CHANGES
NGES IN IN UHB’S SERVICE VICE MIX OF OF PATIENTS TIENTS HAVE VE HAD A NEGATI TIVE VE IMPACT CT ON ON CMI
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Similarly, the intensity of inpatient surgeries has moved from higher-CMI specialties such as Cardiothoracic to lower- CMI specialties such as Otolaryngology
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UHB B CASE
SE MIX IX SUMMA MARY
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Negative Influencing Factors
- More discharges with lower
resource utilization
- More surgical discharges with
lower resource utilization
- Continuing Medicare
weighting reductions
UHB’s Counteracting Initiatives
- Improved clinical
documentation by faculty physicians and residents
- Improved coding quantity and
quality
- Improved billing policies,
procedures, monitoring and staff productivity
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CLINICA
INICAL DOCUME UMENT NTATION TION IMPROVEM VEMENT ENTS IN IN TWO WO PHASE ASES
Phase I
The UHB documentation improvement program was completed in February
2013 with a focus on acute Medicare cases only and included physician and CDI staff education.
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CDI FINANCIAL
NANCIAL IMPROVEM VEMENT ENT
(12/1 /1/12 /12 TO
TO 11/30/1
/14) 4)
9 Exceeded plan by over $2M
(millions)
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CLINICA
INICAL DOCUME UMENT NTATION TION IMPROVEM VEMENT ENTS IN IN TWO WO PHASE ASES
Phase II
Documentation improvement expanded to include not only Medicare cases,
but also other acute cases paid on a DRG basis; targeted are about 1/3 of total cases; full implementation is expected in September 2015
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6.3% actual improvement 3.5% targeted 3.1% actual improvement 3.5% targeted
Excludes psyc, rehab, OB/newborns, one-day stays, Medicaid and Medicaid HMO.
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Phase II Continuing
Plan includes improving clinical documentation to increase the CMI by 3.5% Financial impact on RAP2 of CDI on CMI projected to be $1.28 to 1.45M UHB CDI issues to achieve these improvements
CLINICA
INICAL DOCUME UMENT NTATION TION IMPROVEM VEMENT ENTS IN IN TWO WO PHASE ASES
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Number of trained and effective clinical documentation specialists Extending contract with outside CDI vendor for additional interim experienced staff Physician and Resident education and training Additional follow-up training this fall for Physicians and Residents Number of cases reviewed Improving processes for expanded case review
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IMPROVING
VING CLINIC INICAL AL DOCUME UMENT NTATI TION IS IS NOT OT THE END ND
Coding – checking a variety of sources within the patient’s medical record to
verify the services provided, abstracting the information from the clinical documentation, assigning the appropriate codes, and creating a claim to be paid
Billing (and collecting) – getting an accurate and timely claim out the door,
following up on unpaid claims, resubmitting claims when necessary to ultimately get cash in the door
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CODI
DING NG PROBLEM OBLEMS OF OF A FEW EW YEARS ARS AGO GO
Staff - Difficulty in securing services of a sufficient number of coders Training - Lack of initial and ongoing training for coders Inefficiencies within the HIM Department - Tracking and working unbilled
accounts were not structured, resulting in unbilled accounts exceeding the allowable billing timeframe
Inefficiencies outside the HIM Department - High number of unbilled accounts
due to delays, i.e., missing medical records, delayed physician query responses, and decision on patient types from Case Management
Lack of accountability within and outside the HIM Department
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CONTINUI
TINUING NG ACTION IONS RELA LATE TED TO TO CODING DING ISSUES ES
Executed two outside vendor contracts to augment coding staff remotely
Achieved HealthBridge (EMR) access for remote coders and made access more efficient
The current coding turnaround time blended for Inpatient, Ambulatory Surgery, and ED cases is 2.5 days (uncoded total/average daily gross revenue)
Average days in DNFB was 12.1 in March 2013; in May 2015, average days in DNFB was 8.7
Established managerial policy to assign daily tasks to each employee
A daily tracking tool was established allowing close monitoring of coded account volume by employee as compared to the newly established productivity goals
Medical record receipt by the HIM Department is monitored; UHB is experiencing 100% compliance
Paper inpatient and ambulatory surgery records are scanned and available for review within 24-48 hours of discharge
In-house coders are receiving training via the American Health Information Management Association’s on-line training program
An in-house quality control program to review denials is on-going resulting in substantial decline in denials
Recently engaged an outside vendor to perform a medical record review for coding quality
On June 12, the pure uncoded backlog for Inpatient, Ambulatory Surgery and ED was $4.2M, the lowest it has ever been.
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TODAY’S COD
ODING ING ISSUES ES
Maintaining the number of coding staff necessary to perform timely coding of
medical records, while at the same time training the same staff on ICD-10 effective October 1, 2015
Maintaining the extensive process and efficiency improvements Hiring and training permanent coding staff (a new inpatient coder was hired
the week of 7/6/15)
Assessing the quality of coding being performed and developing plans for
improvement
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BILLI
LING NG PROBLE OBLEMS OF OF A FEW EW YEAR ARS AGO GO
Decentralized management structure for Revenue Cycle, in which several
components affect “billing”
Minimal information technology to automate processes and monitoring of
patient accounts operations; most existing reports were manual
Inefficient processes for working patient accounts did not conform to industry
standards and was not efficient
Minimal attention paid to the maintenance of the Charge Description Master No structured denial management program No standards established for late charges, denials, account follow-up, queries,
underpayments, and insurance verification
No point of service cash collections
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CONTINUI
TINUING NG ACTION IONS RELA LATE TED TO TO BILLIN LING ISSUES ES
Restructured the billing department and cross-trained staff so they can
efficiently work both inpatient and outpatient accounts
Implemented workflow software to enable the billing department to better
- rganize, prioritize, assign, and monitor charge capture, billing, and collection
efforts
Contracted with specialized collection agencies to which Downstate can refer
accounts to reduce bad debt write-off and improve cash collections
In process of establishing a formal denial management program Reduced bill lag days from 7 to 5 as of 7/1/15 Reduced net days in AR from 83.1 to 57.2 Improved edit first pass rate from 84% to 92.7% Implemented RelayAnalytics Acuity to identify and reduce denied claims Implemented RelayClearance to verify insurance eligibility and reduce denied
claims; trained billers on using RelayClearance to correct eligibility rejections
Implemented electronic payments for 15 payers Currently training Billing Manager to develop analytical skills to identify trends
and billing issues and how to escalate for resolution
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TODAY’S BILL
LLING ING ISSUES ES
Instilling in patient accounts staff buy-in on the use of recently implemented
technology versus reverting to past manual practices; holding staff accountable for production standards
Re-staffing and providing leadership to the managed care department; making
sure that UHB is receiving the correct reimbursement from managed care companies
Transitioning to ICD-10 Keeping current on information systems releases given the competition for IT
capital
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STATUS
TUS TO TO FILL LL KEY EY UHB
B LEADERSHIP
ADERSHIP VACAN CANCIES CIES
POSITION STATUS
- Senior Vice President of Hospital Affairs
and Managing Director Search underway by KornFerry with recommended candidate to be selected by 8/1/15
- Assistant Vice President of Ambulatory
Care Hired and will start in August
- Assistant Vice President Hospital
Finance/Controller Hired and will start in August
- Director UHB Clinical Practice Physician
Compensation In Process
- Data Analyst UHB Clinical Practice
Physician Compensation Hired and will start in August
- Assistant Vice President Managed Care
Position vacant since February 2015; search underway by Cejka with recommended candidates to be presented in July
- Teaching Hospital Associate Administrator
– Perioperative Services Position filled July 2015
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