July 2009 | Issue 8

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Navigator 3M Health Information Systems

Clinical Documentation Improvement How organizations combine consulting services and software to achieve and sustain financial returns Are you confident your organization’s physician documentation presents a true picture of your patient mix? Is your facility earning full reimbursement for all services provided?

Heartland reports significant CMI improvement with 3M DRG Assurance Heartland Regional Medical Center, an integrated healthcare delivery system headquartered in St. Joseph, Mo., recognized that patients being treated at its facilities were sicker than indicated by the organization’s quality outcomes data. Knowing that it might not be capturing enough information about patient severity, and foreseeing the potential impact on reimbursement, Heartland turned to 3M Health Information Systems for the 3M DRG Assurance Program. 3M consultants analyzed patient charts onsite to assess coding accuracy and documentation specificity. They looked for signs, symptoms, and treatment plans without a corresponding diagnosis, and also considered secondary diagnoses that might impact the patient’s severity of illness.

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New laws and regulations, ongoing federal reforms, and payer initiatives are increasingly aligning quality outcomes with financial incentives and reimbursement. Medicare and many third-party insurers now consider patient severity of illness and post-admission complications when calculating payment. At the same time, accurate capture of patient acuity and risk of mortality impacts your hospital’s case mix index (CMI), which influences quality outcomes and hospital performance reports made available to consumers. “There’s no question that ongoing changes in hospital payment and quality reporting are having a profound impact on the bottom line for many healthcare facilities,” says Garri Garrison, RN, CPUR, CPC, CMC, director of acute care consulting for 3M Health Information Systems. “How and how much depend on your organization’s ability to analyze its data and address needed changes. Are your physicians documenting all secondary diagnoses? Have they captured all conditions

present on admission? How complete and accurate is your coding given the new regulations?” Over the past 17 years, 3M consultants have worked with more than 750 hospitals to improve inpatient clinical documentation with the 3M™ DRG Assurance™ Program. Based on the knowledge of 3M experts— RNs, physicians, credentialed HIM professionals, and healthcare reimbursement experts—3M DRG Assurance prepares clinical reviewers to query physicians so that a patient’s severity of illness and risk of mortality are fully captured in the documentation. This is accomplished through a coordinated process using a concurrent review team to strengthen communication between physicians, nurses, case managers, and coding professionals. More specific documentation can be captured when a physician responds to clinically driven questions from a well-trained review staff before the patient’s discharge. The return on investment can be significant, with the average facility reporting a two to four percent increase in CMI within the first year, typically resulting in a 4:1 financial return. Heartland Regional Medical Center in St. Joseph, Mo., saw an even greater

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In This Issue Spotlight | 1, 3

Products and Services | 7

Clinical Documentation Improvement

TRICARE implements new OPPS

Customer Profile | 4-5

Event Calendar | 8

Jameson Health System

Conference and trade show schedules

News and Views | 6 International business builds momentum

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3M Health Information Systems

» CONTINUED FROM PAGE 1 | Clinical Documentation Improvement return with 3M™ DRG Assurance™, achieving a CMI increase of 6.8 percent (see sidebar case study).

Industry-changing software to help you sustain improvements As regulations evolve to reflect advances in medical care and to fulfill payfor-performance requirements, the documentation process will become even more complex. Facility and staff changes may also impact the long-term success of your documentation improvement initiative. How will you help new staff learn the skills needed to sustain benefits over time? To help hospitals achieve lasting success with their documentation improvement program, 3M is releasing the 3M™ Clinical Documentation Improvement (CDI) System, a new automated concurrent review tool created exclusively for the 3M DRG Assurance Program. The software is designed to provide clinical documentation guidelines interactively in a concurrent documentation review setting. “Our clients have asked for a tool that will help them continue to be successful after completing the initial 3M DRG Assurance Program,” says Garrison, who led development of the 3M CDI System. “This new leave-behind software is like having a 3M consultant always at your side to help you stay up-to-date and maintain the improvements achieved during your consulting engagement.” The 3M CDI System builds on the power of the 3M™ Coding and Reimbursement System, which has been enhanced with clinical documentation guidelines and edits embedded in the software. This allows instant access to information needed to support documentation decisions, including easy-to-access clinical documentation improvement references. The software provides a concurrent query process to build and

store physician queries and a process measurement tool to report chart review activities and physician query response rates. The 3M CDI System also helps manage workflow by identifying charts that need to be reviewed, so your staff can get the most out of their work days. Comprehensive reports assist the management team in maintaining performance of the 3M DRG Assurance Program. Most reports can be grouped by financial class, clinical documentation specialist, attending physician, coder and service line. Available reports include: • MCC/CC capture rate • Query volumes and response rate • Case mix index • Focused MS-DRG pairs • Working MS-DRG vs. final DRG

The bottom line Your staff members face a learning curve with every regulatory update and at the same time are challenged to implement changes as quickly as possible. The new 3M DRG Assurance Program, now enhanced with the 3M CDI System, can help your facility obtain the most precise and complete clinical documentation possible—and sustain that improvement over time. “The goal is to achieve an accurate representation of the clinical complexity of your patient mix,” notes Garrison. “Most facilities will then see a positive impact on reimbursement. We tell our clients to focus on quality outcomes first and the revenue will follow.”

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| heartland

As part of the 3M DRG Assurance Program, Heartland’s physicians and coders were trained in proper documentation and coding under the new payment regulations. 3M consultants also helped Heartland implement a concurrent documentation review process. “We have two documentation specialists visiting the patient floors each day to review charts and work with physicians on making the documentation more specific,” says Rebecca Hall, RHIT, HIM coding manager for Heartland. The documentation specialists look for missing or inconsistent information in the chart, querying physicians to capture more detail before the patient is discharged and the claim submitted for payment. “The program has been such a great success that we’re currently seeking two more documentation specialists,” Hall reports. Within six months of implementing the 3M DRG Assurance Program, Heartland increased severity-of-illness measures by 4.8 percent and improved risk of mortality scores by 10.9 percent, for an increase to CMI of 6.8 percent. “Using the documentation and reporting methods learned with the 3M DRG Assurance Program, we’ve been capturing a more realistic picture of how sick our patients really are,” notes Hall. The impact on hospital revenue has also been significant now that Heartland’s reimbursement is based on more accurate documentation and coding of patient severity.

For more information about sustainable financial improvements for your organization and a free Documentation Opportunity Analysis, contact your 3M sales representative, call us toll-free at 800-367-2447, or visit us online at www.3Mhis.com/DRGAssurance.

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Customer Profile: Jameson Health System New Castle, Pennsylvania Proven results • Projected savings of $684,000 over the next five years for paper-related expenses • Increased physician satisfaction and responsiveness with immediate, simultaneous access to records both on- and off-site • Eliminated a medical records night shift, an on-call shift, and reassigned staff. Annual FTE savings across the entire organization totaled $43,000, with an additional $581,000 projected over the next four years. • Lowered record deficiency rate to 1% • Electronic record has enabled improved compliance with HIPAA regulations and legal record requirements. • Reduced release of information turnaround time from 44 days to six days, resulting in improved patient satisfaction and a projected revenue increase of $88,000 over the next four years.

3M products used by Jameson Health System • 3M™ ChartScan™ Software • 3M™ ChartView™ Software • 3M™ Patient Financial Services Document Management • 3M™ ChartQ™ Software • 3M™ RAAS DL™ • 3M ClinTrac product suite ™

• 3M ChartFact /ChartLocator Software ™

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Challenge: Jameson Health System is transitioning to an electronic medical record so the organization can improve access to patient information for care providers, improve compliance with HIPAA regulations and legal record requirements, and replace inefficient and costly paper-based processes. 3M solution: 3M’s document management solution, including 3M ChartScan for electronic document imaging and online forms management with its patented scanning and quality control process, 3M Patient Financial Services Document Management solution for patient accounting document capture, and 3M ChartView for facility-wide access to patient records, including transcribed reports, scanned images, and imported data or documents.

The challenge

• 3M™ ChartScript™ Software ™

Services: Jameson Health System serves the community of New Castle and surrounding Lawrence County, Pennsylvania, from the North and South campuses of Jameson Memorial Hospital and additional satellite facilities, including a personal care facility, traditional nursing home, a physical rehabilitation center, three community health centers, a cancer center and cardiac care center. With more than 250 beds, Jameson Memorial Hospital operates as a full-service acute care facility offering a full continuum of health and human services. The organization employs approximately 1,400 full- and part-time employees and is the largest employer in Lawrence County.

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Two years ago, Jameson Health System in New Castle, Pennsylvania, was struggling to manage massive amounts of paper. Nurses had to reserve an hour each day

3M Health Information Systems

just to assemble and label charts for newly admitted patients. Hundreds of forms existed throughout the hospital, printed at great expense, but frequently out of date or missing. With only one official paper chart for each patient, staff had to transport records all over the institution, making the whereabouts of the chart a constant question. Physicians were growing more frustrated as time-consuming and inefficient paper-based processes were distracting from primary patient care duties. In the health information management (HIM) department, process backlogs were frequent since work often had to be set aside in order to help medical staff locate charts or to answer record requests from other departments. But perhaps most disconcerting to HIM Director Jamie McDonough was the low morale of her staff, summed up by one employee who confessed that she “dreaded coming to work.” One of the biggest challenges for Jameson Health System was that process change and technology updates were long overdue. “As an organization, we kept trying to make the paper-based system work,” says McDonough, who was hired to help bring about much-needed change. “No wonder there was frustration. It had reached a point where a complete overhaul was required.”

The solution With a mission to improve physician access to patient data and streamline workflow across the entire organization, the hospital took the better part of a year to research both the issues and potential solutions. “We knew best practices, but we needed to see what was going to work for Jameson,” says McDonough. Ultimately,

“We see 3M’s document management solution as our legal record. It’s our first step towards a true EMR and we plan to use it as the central point for interfacing additional software and systems when the time is right.” – Jamie McDonough, HIM director, Jameson Health System the organization chose 3M™ ChartScan™ Software and 3M™ ChartView™ Software, among other 3M document management and document creation applications, because they offered real-time access to patient records, online forms management, and seamless integration with other 3M software and third-party systems. “3M really understands the HIM environment and their software had features that many HIS system vendors didn’t offer,” McDonough notes. During the selection process, one of the things Project Manager Maria Bocian liked best was the software’s ease of use. “Some of our physicians and nurses didn’t have a lot of computer experience,” says Bocian. “The 3M software was by far the easiest to navigate. Its usability actually helped staff learn more quickly.” Another factor that drove decision-making was 3M’s integrated forms management and barcoding solution with automatic indexing that identifies the patient, visit and document type, page number and orientation. Forms are now printed as needed on all patient care floors, saving time for nurses and making forms redesign and updating a simple process. Physicians were among the key user groups McDonough had to think about. “We were having a lot of problems with our deficiency rate,” she recalls, “and we also knew that our physicians were timechallenged, and that made them resistant to learning a new process. But once they saw the system and how much time it saved, they were very receptive.” With immediate online access to patient records from anywhere on the Jameson campus or from a remote location, physicians can now view patient records and sign off on documents as soon as they are transcribed or scanned. As a result, record deficiency rates have

fallen from 18 percent to one percent in a matter of months. Online access to patient information also has improved billing and collection processes. The Patient Financial Services team no longer depends on the HIM department to track down information contained in the paper chart. Instead, staff members access the electronic chart, making it possible to respond to payer requests immediately for a positive impact on Jameson’s revenue cycle. The turnaround time for release of information has also improved, from a high of 44 days down to an average six days. Tracking records electronically has enabled better compliance with HIPAA regulations and legal record requirements. “We see 3M’s document management solution as our legal record,” says McDonough. “It’s our first step towards a true EMR and we plan to use it as the central point for interfacing additional software and systems when the time is right.”

The results Both McDonough and Bocian agree that the return on investment has been substantial, with the hospital saving $72,000 on forms and paper-based supplies in the first year. In addition, Jameson Hospital has been able to reduce staff by two FTEs, eliminating the need for an inpatient coder and allowing a release-ofinformation clerk to take on other duties. A part-time position in Patient Financial Services has also been eliminated and registration clerical hours have been

reduced. Online access to records has made it possible for the HIM department to discontinue a medical records night shift and an on-call shift, and has led the organization to begin planning for implementation of remote coding to achieve additional time and cost savings. Other departments have also realized significant gains, including Pharmacy, where the use of bar coded forms has replaced manual entry of patient account numbers on prescriptions, a time savings estimated at $36,000 a year. In all, the hospital predicts total savings of more than $1.6 million within five years. While the implementation of 3M’s documentation management solution has had a quantifiable impact on Jameson Health System, there’s a qualitative impact too. “The success of this project is the satisfaction of our end-users,” reports McDonough. “Some of our physicians and nurses were hesitant at first, but now they want to use the system to its full capability. They are very proactive in letting us know what information they want to access online.” And HIM department morale? “Sometimes the most important results are the things that can’t be seen on a spreadsheet,” says McDonough. “Our staff is more productive and we spend less time resolving issues due to departmental backlogs. It also means we have more time to focus on accuracy, quality and efficiency within our HIM department. In fact, our staff retention is the highest it has ever been.”

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For more information on how our solutions can assist your organization, contact your 3M sales representative, call us toll-free at 800-367-2447, or visit us online at www.3Mhis.com.

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News and Views: Product updates, industry insights and more

Regional hospital Down Under converts to electronic medical records 3M Health Information Systems has a solid reputation in Australia and New Zealand. Now, 3M Australia has marked a new milestone. Last November, Goulburn Valley Health, a regional referral hospital, became the first 3M customer in Australia to start converting its medical records from paper to an electronic format. “It’s our first entry into the electronic records management market,” said Jane Saphin, product manager, Health Information Systems, 3M Australia. “We are very excited about it.”

Up-to-date data means better care Goulburn Valley Health began by using several document management and imaging software modules, including 3M™ ChartScan™ Software and 3M™ ChartView™ Software. “3M ChartScan, for example, converts paper to electronic records with a patented barcode process that eliminates a lot of the manual aspects of scanning a document,” Saphin explained. “They saw how easy it was and really liked the process.”

A joint 3M Health Information Systems team from Australia and the United States implemented the program in 90 days. It included special training sessions for all levels of users as well as targeted communications to create awareness and build enthusiasm. “The hospital was very pleased,” Saphin continued. “When you have up-to-date information readily available, you can improve the quality of patient care — and that’s what they discovered.”

Ready to replicate the success The 3M Australia team intends to continue building awareness of 3M electronic records management solutions among other hospitals. “Creating electronic health records is a big issue in Australia and many hospitals are moving in that direction,” Saphin concluded. “Our goal is to replicate our success at Goulburn Valley Health throughout Australia and New Zealand.”

3M Health Information Systems is the global leader in coding, classification, grouping, and performance management software and consulting services. International facts about 3M Health Information Systems: • International business unit created in 1999 • Offices in 10 countries • 145 employees • More than 5,000 clients in over 20 countries • The majority of hospitals in Australia and New Zealand use 3M coding software, grouping software, or both

For more information on our international solutions, call us toll-free at 800-367-2447, or visit our international website for 3M Health Information Systems: www.3Mhis.com/international.

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“We’ve seen our business double in the last five years, through global expansion and new product introduction. We look forward to broadening our reach with our solutions for document management, dictation and transcription.” Dr. Thilo Koepfer International clinical content and marketing manager, 3M Health Information Systems

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Products and Services TRICARE implements new Outpatient Prospective Payment System for services to nine million beneficiaries On May 1, 2009, TRICARE—the Department of Defense health insurance plan for the uniformed services, retirees and their families—implemented a new APC-based outpatient prospective payment system (OPPS) for services provided to more than 9 million TRICARE beneficiaries. This news has important ramifications for U.S. hospitals and health systems that serve large populations of TRICARE-covered patients. HIM departments will need to understand how TRICARE’s OPPS differs from the Centers for Medicare and Medicaid Services (CMS) version to ensure accurate coding and appropriate reimbursement. In 2000, CMS introduced and implemented the first OPPS with the intent of controlling the growth of outpatient care expenses, as well as reducing the growing burden on Medicare beneficiaries for payment of outpatient services under the then existing fee-for-service system. The TRICARE OPPS is modeled extensively on the CMS OPPS model, utilizing Ambulatory Payment Classifications, or APCs, for grouping. However, TRICARE supports a different population base, providing services that are not normally covered by Medicare, such as maternity observation and preventive care services. The TRICARE OPPS includes these differences: • Additional APCs unique to the TRICARE OPPS. • TRICARE APCs are five characters long versus the four characters for CMS. ° TRICARE APCs beginning with a “T” denote APCs specific to TRICARE, while those beginning with a “zero” are unedited CMS APCs. • TRICARE uses the CMS OCE/APC editing logic with some modifications. Some CMS edits are not used, while new ones have been added to address specific TRICARE concerns. • Approximately 26 percent of the HCPCS codes have a different Status Indicator under the TRICARE OPPS versus the CMS OPPS. • The co-insurance and deductible amounts differ from CMS. • There is a transitional payment period (up to four years) to reduce the impact of TRICARE APC payments.

The complexities of outpatient prospective payment are such that the impact of a new OPPS on hospitals cannot be fully understood without detailed analysis and investigation. Healthcare facilities that contract with TRICARE can expect the changes to impact hospital information systems, HIM department processes, claims submissions, and ultimately, outpatient reimbursement. 3M software for TRICARE is designed to help verify coding completeness and correct payment, submit accurate and compliant claims, and manage the services delivered to TRICARE beneficiaries. 3M Health Information Systems offers APC software solutions consistent with TRICARE specifications. The solutions are available on these platforms: • The 3M™ APCfinder™ Software for TRICARE (available with the 3M™ Coding and Reimbursement System) for Microsoft ® Windows®-based PCs • The 3M™ Core Grouping Software runs on Microsoft Windows in either a standalone or networked configuration to provide a batch solution for large volumes of claims • The 3M™ APC Grouper Plus Software offers a batch solution for IBM® z/OS® mainframe environments In addition to outpatient solutions, 3M Health Information Systems also offers inpatient grouping and reimbursement solutions consistent with TRICARE inpatient specifications.

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For more information on how 3M solutions can assist your organization, contact your 3M sales representative, call us toll-free at 800-367-2447, or visit us online at www.3Mhis.com.

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Event Calendar

Events & Trade Shows Virtual HIMSS

June 9-16

online event

Healthcare Financial Management Association (HFMA ANI) June 14-17

Seattle, Wash.

HFMA CFO Session

June 17

Seattle, Wash.

Indian Health Services (HIS) Summit

July 7-9

Denver, Colo.

Association of the United States Army (AUSA) Medical Symposium

July 21-27

San Antonio, Texas

Health Forum and the American Hospital Association Leadership Summit (AHA)

July 23-25

San Francisco, Calif.

Association for Healthcare Documentation Integrity/ACE

July 29-Aug. 1

Nashville, Tenn.

Force Health Protection

Aug. 14-21

Albuquerque, N.M.

Siemens Innovation

Aug. 9-12

Philadelphia, Pa.

McKesson Insight Conference

Sept. 9-12

Orlando, Fla.

Epic Users Group Conference

Sept. 22-25

Verona, Wis.

American Health Information Management Association (AHIMA) National Convention

Oct. 3-8

Grapevine, Texas

National Association of Health Data Organization (NAHDO) Oct. 15-16

Alexandria, Va.

American Medical Informatics Association (AMIA)

Nov. 14-18

San Francisco, Calif.

The Society of the Federal Health Agencies (AMSUS)

Nov. 14-19

St. Louis, Mo.

Radiological Society of North America (RSNA)

Nov. 29-Dec. 4

Chicago, Ill.

For a comprehensive list of events, visit our events calendar on www.3Mhis.com.

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3M, APCfinder, Codefinder, ChartFact, ChartScan, ChartScript, ChartQ, ChartView, ClinTrac, and DRG Assurance are trademarks of 3M Company. The International Statistical Classification of Diseases and Related Health Problems – Tenth Revision (ICD-10) is copyrighted by the World Health Organization, Geneva, Switzerland 1992-2007. CPT is a registered trademark of the American Medical Association. IBM and z/OS are registered trademarks of IBM Corporation. Microsoft and Windows are registered trademarks of Microsoft, Inc., in the United States and other countries.

Please recycle. Printed in U.S.A. © 3M 2009. All rights reserved. Published 07/09 70-2009-9071-4