Case Study

Better Documentation, Better Bottom Line

HIPPA files

One Organization’s Journey to Implement a Clinical Documentation Improvement Program

Located in Summersville, West Virginia – Summersville Regional Medical Center (SRMC) has served Nicholas County and the surrounding area for over three decades. Rooted by a deep commitment to deliver high-quality, cost-effective healthcare to its community–SRMC wanted to make sure that its clinical documentation accurately reflected the patient care being provided and that it was obtaining the proper reimbursement necessary to survive healthcare reform and the transition to ICD-10.

The Challenge

SRMC sought to implement a Clinical Documentation Improvement (CDI) Program to help assure compliant documentation and proper reimbursement. The hospital also believed the CDI engagement would result in:

  • Shorter length of stay (LOS)
  • Higher case mix index
  • Increased Medicare Severity Diagnosis Related Group (MS-DRG)
  • Better educated physicians on CDI flexibility for future expansion needs

 

QHR Solutions

To improve physician documentation, coding and patient acuity, QHR consultants began by assessing 30 of SRMC’s records. The next priority was to provide six weeks of on-site CDI education for employed physicians and clinicians. At QHR’s recommendation, SRMC selected a case manager and a registered nurse from the emergency department to serve as the Clinical Documentation Specialists for physician documentation. These two clinicians continue to work directly with the physicians to improve documentation practices.

 

Results

In just six months, SRMC has experienced the following outcomes as a result of its newly launched CDI Program:

  • Increased reimbursement (+$18,000) and quality scores by resubmitting 30 charts with correct clinical documentation
  • Reduced average LOS from 4.5 days to 3.7 days
  • Increased case mix index from 1.16 in 2014 to 1.22 in one year, a five percent increase as a result of improved clinical documentation
  • Increased reimbursement at an annualized rate of approximately $500,000 due to more accurate clinical documentation