Jennie Stuart Medical Center, a private, not-for-profit organization that comprises a 200-bed acute-care hospital, medical imaging, outpatient surgery, laboratory and rehabilitation services, and an integrated physician network took the technology route to address the upcoming transitions. Starla Stavely, health information management director at the Hopkinsville, KY–based facility, joined the organization in 2010 and quickly added ChartWise CDI software to fix what she says was a glaring problem with clinical documentation.
Stavely says the organization found that the diagnoses and procedures being documented weren't accurately showing the severity of illness or the length of stay of the patients, so the case mix index was below expectation.
"Ailments were being treated but when it came time to code, none of that information was in the charts. It was in the physician notes but no one was getting credit for doing the work. Patients could be very sick, but when it came time to code it didn't look like they were very sick, and we weren't getting paid," she says. "The lower the case mix, the less per case on average you're getting paid [by Medicare]. You could pick up almost any [patient] chart and see obvious [revenue] opportunities."
One month after Jennie Stuart started using the program, the facility calculated a $100,000 profit by coding the correct case mix. The improved clinical documentation is also helping them prepare for the ICD-10 transition by allowing them to gauge the impact the changeover may have on their organization.
Don't wait for 2013 to plan for VBP and ICD-10. By addressing clinical documentation holes now, you can improve your organization's odds of landing on the right side of both of these regulations.