5/28/2010 Increase Field Staff Productivity, OASIS Accuracy and - PDF document

5/28/2010 Increase Field Staff Productivity, OASIS Accuracy and Resulting Case Weight Mix • Jeff Brittain CTO, EVP, Select Data • Susan Carmichael MS, RN, CHCQM, COS-C, Executive Vice President, Quality and Standards Chief Compliance Officer, Select Data Company History • Previous large group of Home Care providers in Southern California • Have been in business since 1987 • Serving Home Care providers since 1994 S i C id i 1994 • Provide Clinically Driven Revenue Cycle Management for providers throughout US Measurements of Agencies Health • Simple calculations to determine agency health » Average revenue per visit » Average cost per visit » National a erages » National averages • What can productivity do to help? • Efficiencies that allow smaller agencies to act like larger organizations 1

5/28/2010 Where it all begins: Integrated OASIS Assessment • Important that all documentation is captured and that evidence based process are encouraged. • Evidenced based practices mean using the best scientific evidence available as guidance for clinical g decision making. To do so, an in-depth assessment is required. • Different mediums of capturing data » Paper » Point-of-care Efficiency vs Comprehensiveness • Efficiency is a two way street » Getting data to field staff » Getting data back into the office or EMR • Depending on the medium, traditionally you will see standard differences by the various methods Efficiency vs Comprehensiveness • Why is efficiency important? » Cost of field staff » Having the ability to see data real time » Billing ad antages » Billing advantages » Provides agencies to utilize advantages such as scalability » Real time means real intervention 2

5/28/2010 Efficiency vs Comprehensiveness • Why is comprehensiveness so important » More accurate picture of the patient » Higher coding specificity » Allo ing o to capt re all co morbities » Allowing you to capture all co-morbities » Overall higher outcomes with patients » True accurate payment reimbursement for the episode » Reduce audit risk Efficiency vs Comprehensiveness: Accurate Picture of the Patient • An accurate portrait of the patient as well as clarity are needed to establish appropriate care • Need to clearly document the focus of care • That starts with an accurate and detailed h i h d d il d assessment; an assessment that properly states conditions. (prompts and cues) • Goals and interventions must be directed toward those conditions • This leads toward higher coding specificity Efficiency vs Comprehensiveness: Coding Specificity and Co-morbidities • The following are diagnoses/co-morbidites that should be included and coded on a plan of care: • DM • CAD • COPD • CHF • PVD • Blindness • HTN • Upper and lower limb amputation status • Chronic diseases such as Parkinsons, MS, Lupus • Hx of neoplasm if care is directed toward a current neoplasm Source: The Coding Clinic 3

5/28/2010 Efficiency vs Comprehensiveness: The Quality of Your Documentation… • The quality of your documentation will dictate reimbursement. • The quality of your documentation determines if you will survive an audit. if you will survive an audit • It is not the revenue you generate that is as important, as the revenue you will keep. Efficiency vs Comprehensiveness: Reduce Audit Risk • RACs are thought to be targeting… • Services are medically unnecessary or there is delayed implementation ( Focus: Therapy ) • Patients are not Homebound Patients are not Homebound • Services are incorrectly coded and sequenced • Failure to provide claim supportive documentation • Duplicate claims submitted • Medicare secondary pay or improper payments • Lack of order centricity Efficiency vs Comprehensiveness: The Audit • Denials for lack of medical necessity… • Full or partial denial because the clinical documentation: Did not support the medical necessity of the skilled Did not support the medical necessity of the skilled services billed Did not demonstrate a reasonable potential for change (improvement) in the medical condition or Sufficient time had been allowed for teaching or observation of response to treatment in prior episodes of care. 4

5/28/2010 Efficiency vs Comprehensiveness: The Audit � Do therapy treatment plans and progress notes have: -Clear functional goal statements? -Document progress toward goals objectively? � How is care coordinated among therapists? Among all disciplines? di i li ? � How can you support “reasonableness and medical necessity?” What are the patient treatments: diagnoses? Restoration/maintenance of function affected by illness? Frequency and duration of services consistent with home care client’s: medical history, disease, prior to end of episode level of function, and risk identification . Efficiency vs Comprehensiveness: The Audit • Is therapy consistent with the nature and severity of the condition? • Therapy services must be provided, expecting that the condition of the patient will improve in a reasonable p p period of time. • Documentation of medical necessity should be documented through evaluation, treatment plan, and progress notes. • Has your agency identified high risk diagnosis, number of visits, or number of episodes? Critical Thinking Skills • Critical thinking requires logic, relevance, significance, accuracy, and depth. • Clinicians, after assessments, must give due consideration to the evidence gained context consideration to the evidence gained, context of those judgments, with applicable and/or appropriate methods. • Software does not always allow the clinician to raise questions, gather all relevant information, or formulate the problem clearly. 5

5/28/2010 Integrated OASIS Assessment Capture Tool Point of Care / Laptop Point-of-Care Current Challenges • Synchronization (Store and forward) • Internet access availability (Persistent) • Productivity (Ease of use) • Limited assessment questions (Lack of critical thinking skills) • Usability (Computer literacy) • Security (HIPAA) • Cost or Expense (Paying for partial use) HIPAA and HITECH • The Health Information Technology for Economic and Clinical Health Act (HITECH) expands upon HIPAA and holds healthcare organizations to a g higher level of responsibilit y for breach of patient information. 6

5/28/2010 HITECH • Under HITECH, if a breach compromises the privacy and security of the patient’s information and poses a significant risk of financial reputational or other harm patient financial, reputational, or other harm, patient notification is required. Additionally, the Secretary of Health and Human Services and media outlets must be notified under specific circumstances. Side Effects of Point of Care Challenges • Spending capital for devices and licenses • Relying on internet availability (can not enter assessment) • Lower number of visits (productivity) b f i i ( d i i ) • Reduced Critical Thinking Skills (effects outcomes) • Nursing retention rates (positive and negative) • HIPAA risk exposure (what is that worth) • Still necessity of paper chart Integrated OASIS Assessment Capture Tool Traditional Paper Forms 7

5/28/2010 Traditional Form Capture Challenges • Hand keying or entering of data • Timeliness of data into the EMR • Limited integrated OASIS assessment choices • Incomplete data, missing skip patterns or M questions • Lack of forms available or cost of forms from vendor • Worse for the environment (killing trees) Side Effects of Traditional Forms • Additional FTE’s • Data entry errors • Getting RAP payments done in a timely fashion f hi • Cost of forms • Nursing retention rates • Outcome challenges depending on forms What Were Our Goals? • Decrease the cost of deployment • Increase outcomes and document correctly • Increase timeliness • Decrease the need for additional FTE’s • Increase data capture accuracy • Increase clinical retention • Lastly, allow agencies to keep their current infrastructure (if they so choose) 8

5/28/2010 What was the Solution? • We decided to come up with a Hybrid model • Using technology and traditional form capture tools • Challenges included: Ch ll i l d d » Increased number of M questions with OASIS-C » Method of getting written data into electronic data » Integrate with existing systems Must Have Criteria • Outcomes must be maintained • Provide some type of cost containment or savings • Increase Field staff productivity i ld ff d i i • Can not introduce new technology that agency would have to support (IT staff) • Not require replacement of current EMR or billing engine Integrated OASIS Capture Tool • We choose to use forms as this would keep productivity high • Also we can easily deploy them. No technology challenges with field staff or technology challenges with field staff or support personnel • Allowed the clinician to use critical thinking skills 9