Phys ysicia ician Clinica ical Document umentati tion on Imp - PDF document

Putting the Pieces Together: Financial Stability Quarterly erly Phys ysicia ician Clinica ical Document umentati tion on Imp mprovem ement ent A portion of these materials were produced in partnership with the Iowa Department of Public Health for the Iowa Small Hospital Improvement Program (SHIP) Grant FY 18Contract #5888SH01 and the Georgia State Office of Rural Health for the Georgia Small Hospital Improvement Grant FY 18. 1 WEBINAR ETIQUETTE •All attendees are in “Listen Only” mode • Questions or comments? - Open “Questions” pane in dashboard. - Type in comments or questions - Comments will be monitored - Questions will be addressed at end of the webinar 2 1

WEBINAR RESOURCES • This webinar will be recorded and a link will be posted to your dashboard to share with others on your team. • Handouts are available for download in the Handouts pane and will be posted to your dashboard following the webinar. 3 Continuin nuing Educa cati tion As an IACET Authorized Provider, HomeTown Health, LLC offers CEUs for its programs that qualify under the ANSI/IACET Standard. HomeTown Health, LLC is authorized by IACET to offer 0.1 CEUs for this program. In order to obtain these units, you must: • Attend webinar/view recording in its entirety within 30 days • Pass online quiz with 80% or better. • Complete webinar evaluation. Following this webinar, all attendees who have viewed the recording in its entirety will receive an email with a link to the quiz and evaluation. Anyone that misses the webinar can view the recording online, posted on the program Dashboard, for CEUs. 4 2

Continuin nuing g Educa cati tion HTHU provides over 300 courses online, over 100 Webinars a year, and various live training conferences and workshops. Accredited Education from the International Association for Continuing Education & Training (IACET). (Who accepts the IACET CEU? Full list at www.iacet.org) • • American Association of Respiratory Therapy National Board for Certification in Occupational Therapy, • Inc. (NBCOT) American Board of Medical Microbiology • • American Society for Clinical Laboratory Science National Council for Therapeutic Recreation Certification • • American Society for Quality National Registry of Emergency Medical Technology • (EMT) American Speech-Language-Hearing Association • • Board of Certified Safety Professionals National Registry of Microbiologists • • National Society of Professional Engineers The Child Care Development Associate National Credentialing • Program Society for Human Resources Management • Clinician’s View (Occupational, Speech, and Physical Therapy) • State of Georgia, FL and Iowa Board of Professional • Federal Emergency Management Agency Engineers • • Georgia, Massachusetts and Ohio Board of Nursing The American Association of Integrative Medicine • • The American College of Forensic Examiners Institute Georgia Professional Standards Commission • • Human Resources Certification Institute (for their Professional The American Council on Pharmaceutical Education • in Human Resource Designation) The American Psychotherapy Association • • National Association of Rehabilitation Professionals in the The International College of The Behavioral Sciences • Private Sector The National Board for the Accreditation of Occupational • Therapy (NBCOT) National Association of Social Workers 5 ACTION ITEM: Are you on this webinar with a group? If so, please enter: first/last names & email addresses in the question pane. 6 3

AGENDA Welcome & Introductions Stephanie Love, HomeTown Health, LLC Watch an Auditor Audit Dr. James Dunnick, The Dunnick Group, LLC Upcoming Events & Stephanie Love, Resources HomeTown Health, LLC Physician ician Clin inical ical Documen entatio tation Impr mprovemen ement t Series ies 7 Program Goals Clinical Documentation Improvement programs are critical to rural hospitals in providing complete and accurate patient documentation. The purpose of the Physician Clinical Documentation Improvement Series is to provide physician- to-physician training in common areas of clinical documentation improvement (CDI) in order to support physicians in improving their documentation, identifying the value of their role in CDI programs, and identifying opportunities for improvement. Physic ician an Clinical al Documenta entation on Improv ovement ement Series es 8 4

Disclosure of Proprietary Interest The Dunnick Group does not have any proprietary interest in any product, instrument, device, service, or material discussed during this learning event. The education offered by The Dunnick Group in this program is compensated by the HRSA Small Hospital Improvement Program (SHIP) grant from multiple participating states, including Iowa, Georgia and Florida. 9 Speaker Biography James Dunnick, MD, FACC, CHCQM, CPC, CMDP Physician – Boarded in Cardiologist Certified medical coder Certified in Electronic Medical Records Certified in Quality and Utilization Published author Email: jdmd62@gmail.com Website: www.dunnickgroup.com Physician ician Clin inical ical Documen entatio tation Impr mprovemen ement t Series ies 10 5

Quarterly erly Physic ician ian CDI I Series ies: Watch and Au Auditor r Au Audit: t: Vulnerab erabiliti ties es & Oppo portun tunities es in the Medica cal Record Presen sented ed by Dr. James mes Dunnick ick A portion of these materials were produced in partnership with the Iowa Department of Public Health for the Iowa Small Hospital Improvement Program (SHIP) Grant FY 18Contract #5888SH01 and the Georgia State Office of Rural Health for the Georgia Small Hospital Improvement Grant FY 18. 11 Disclaimer 1. Do NOT assume I am correct, I make mistakes. 2. Read and self educate. 3. Government manuals, online resources. 4. Obtain professional teaching, from more than one source. 5. Consultant opinions vary. 6. Auditor opinions will vary. 7. States vary. 8. Payers vary. 9. Rules change. This is meant as general and initial information only. 12 6

Learni ning ng Outcome mes When you have completed this training, you should be able to: Recall Ident ntify Describe Ident ntify fy the the cost of how an ways to find your difference in non- auditor areas of auditors and compliance. approaches a documentation audits. chart. weakness. 13 1 in n 5 rural al hospi pitals tals at high gh risk sk of closin osing, , ana nalys lysis is fi finds nds Manag agem emen ent t con onsu sultancy ltancy firm m Navi vigant ant • operating margin, days cash on hand and debt-to-capitalization ratio • cited payer mix degradation; declining inpatient care driving excess capacity; inability to leverage innovation, Medicare payment reductions; the age of many rural facilities and a lack of capital to invest Beckers Hospital review Kelly Gooch Feb. 20, 2019 14 7

A SUMMARY OF THE 2018 ANNUAL REPORTS Social Security and Medicare Boards of Trustees • Steven T. Mnuchin, • R. Alexander Acosta, Secretary of the Treasury, Secretary of Labor, and Managing Trustee and Trustee. of the Trust Funds. Alex M. Azar II, Nancy A.Berryhill, Secretary of Health Acting Commissioner of and Human Services, Social Security, and Trustee. and Trustee. • https://www.ssa.gov/OACT/TRSUM/index.html 15 Medicare Two trust funds • The hospital insurance trust fund (HI) • Supplemental medical insurance trust fund (SMI) HI ……… MC Part A (hospital, home health, SNF, hospice) SMI …… MC Part B and D • Part B (physician, out patient hospital, home health) and • Part D (drugs and cost sharing for low-income enrollees) • https://www.ssa.gov/OACT/TRSUM/index.html 16 8

Medicare The Trustees project that tot otal al Medicare icare cos osts ts (including both HI and SMI expenditures) will l grow w from approximately 3.7 percent of GDP in 2017 to 5.8 percent of GDP by 2038* Medicare spending growth projected 5% in 2016 and 7.1% thru 2025 *CMS News February 15, 2017 Contact: CMS Media Relations (202) 690-6145 | CMS Media Inquiries 17 Medicare The Trustees project that HI tax income and other dedicated revenues will fall short of expenditures in all future years. https://www.ssa.gov/OACT/TRSUM/index.html 18 9

Medicare is in Trouble The Government is not kidding about cost containment. 19 Medical Need • 323,000,000 people USA • 100,000,000 obese people • 86,000,000 pre diabetics • 30,000,000 diabetics • 3,000,000 baby boomers 20 10

Medicare is in Trouble Payers are in trouble The Government is not kidding about cost containment. The payers are not kidding about cost containment. 21 Payers - 3 rd party or CMS How do they stay solvent? • Increase monthly premiums • Increase co pays and deductibles • Reduce services – cover fewer procedures and medicine options. • Recoup oup prior r payments ts • Ad Add fines es 22 11

The great motivator 23 The Motivator THE PAYERS 24 12

The Evaluator THE AUDITOR 25 THE AUDITOR Who is doing the audit? Why are they doing the audit? How are they doing the audit? 26 13

The Auditor Who is doing the audit? Is this an Internal Audit? 27 28 14

The Auditor Who o is doing the audit? Is this an Internal Audit? Is this s an Exter ernal al Audit? dit? 29 30 15

The Auditor Who o is doing the audit? Is this an Internal Audit? Is this an External Audit? Is this a RAC C Audit? it? 31 32 16