Henry Ford Health System adds $20 million in revenue by tightening clinical documentation

Steve Hathaway and Susanne Gleason. Photo from Henry Ford.

While accurate documentation to support the thousands of new codes in ICD-10 will be essential for getting reimbursed, experts says getting it right means physicians and payers will have to be more in sync than ever.

"The language that clinicians use to document for purposes of communicating to one another for care of the patient, is not necessarily the same language Medicare and other payers use to determine how much to pay for services," said Steve Hathaway, senior vice president of finance and chief revenue officer for the Henry Ford Health System in Detroit.

To bridge the gap, a team of nurses trained as Clinical Documentation Improvement specialists act as translators between physician and coder, because they know the language of both, according to Susanne Gleason, director of HIM, clinical documentation and hospital coding for Henry Ford.

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If a physician documents a patient diagnosis of congestive heart failure for example, but doesn't indicate whether it is acute or chronic, the CDI reviewer will query the physician for more information. Precise wording can make a difference into which Diagnostic-Related Group it's coded and the amount reimbursed.

"Coders can only code what a physician writes," Hathaway said. "We're really educating the physician on how to document appropriately, which allows us to be paid appropriately."

CDI is not a new concept. Yet coupled with an analytics program developed by Hathaway and Gleason, Henry Ford Health System has added about $20 million to its bottom line, according to Hathaway.

This represents about 2 percent of targeted inpatient revenue, he said.

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To analyze the effect of the CDI program, Hathaway and Gleason looked at a variety of measures.

"Clinical documentation drives accurate risk of mortality and patient severity scores, and it provides baselines for measuring quality," Gleason said.

Most hospitals use Case Mix Index to gauge success, but Hathaway and Gleason found CMI to be a poor measure for improving clinical documentation. This is because CMI at different hospitals can vary: One provider may serve more complex cases than another.

"You can't just measure your payment levels, or use Case Mix Index as an indicator because different hospitals serve different populations," said Hathaway, who has 20 years of experience as a CFO and who has worked with various CDI programs for over 12 years.

Analyzing the financial effect of CDI required another approach.

Hathaway developed a DRG group analysis methodology to isolate the Case Mix Index variation that is solely driven by documentation improvement.

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"Our DRG Group Analysis is a way of isolating the contribution the CDI program is making financially," he said.

Hathaway and Gleason used concepts borrowed from triage and dispatch in the ambulance industry. Using 3M technology, they developed a prioritization tool that helps CDI reviewers triage daily case assignment to determine which patient cases would most benefit from documentation review.

3M's 360 Encompass System auto-suggests codes and prompts for clinical documentation that captures patient severity in physician documentation. Coders and CDI specialists access a common view of the patient information.

Henry Ford Health System centralized the CDI programs at four acute-care hospitals.

"We have a lot of passion for it, it's how we measure our success and improve," Hathaway said. "It shows where our performance is better or worse than our peers. It shows areas where we have to work. We're trying to advance the science: which patient should we concentrate on for documentation improvement."

Twitter: @SusanMorseHFN