Case Study

The Impact of CDI in Capturing Earned Hospital Revenue

doctor reviewing earned hospital revenue

Clarion Hospital

As reimbursement for patient care declines, hospitals’ documentation must accurately record patient acuity and not leave earned revenue on the table. With the right tools in place, improved coding accuracy can lead to improved quality of care for the patient as well as the correct reimbursement for the hospital.

The Challenge

Clarion Hospital, a 77-bed osteopathic teaching hospital in the Northeast, faced challenges similar to those of many other hospitals across the nation. As a teaching hospital, a variety of interns and residents rotated through the hospital, providing care. This constant movement often led to physicians, coders and nurses who did not “speak the same language,” and as a result, the coded data did not always accurately reflect the acuity of the hospital’s patients. Clarion coders were coding non-specific documentation and, as a result, not accurately supporting patient severity of illness and risk of mortality statistics. This nonspecific documentation impacted the Case Mix Index (CMI), causing a downward spiral for the hospital. Clarion Hospital engaged QHR Health Clinical Documentation Improvement (CDI) consultants to help identify opportunities to improve training and communications between the physicians and coders, and to help the hospital be certain that its documentation accurately reflected the high quality of care provided by the hospital.

QHR Solutions

QHR provided the hospital with a certified CDI specialist to work one-on-one with Clarion’s team of physicians, coders and nurses. The consultant:

  • Assessed the hospital’s current documentation procedures by evaluating 30 cases.
  • Focused on technology to support the CDI initiative through new electronic health record (EHR) templates to facilitate improved documentation specificity.
  • Developed a six-week training program customized to the needs of the hospital for the nursing and ancillary leadership, specific to their role within the CDI Program. Met with the physicians and nurses weekly over six weeks to allow the users to ask any questions and to assure the sustainability of the program.
  • Collaborated with and mentored leadership and the CDI staff to ensure effective documentation.
  • Provided recommendations to help achieve project objectives economically and efficiently in the future.

Also during the engagement, QHR’s physician consultant provided educational support to the physicians on the hospital’s medical staff. This allowed the physicians to gain insight from a peer and also helped with physician buy-in.

Results

QHR’s consultant helped the hospital achieve significant improvements. The hospital’s more accurate and specific documentation resulted in increased CMI and inpatient reimbursement of nearly $115,000 during the first nine weeks following the engagement. Clarion anticipates a continuing positive impact on reimbursement from improved documentation.