DRG/Clinical Documentation

The client.

An internationally recognized academic medical center located in the Midwest and its several affiliated hospitals.

The business issue.

This medical center experienced lagging performance indicators, including a case mix index that did not reflect the extraordinarily high severity of illness treated. In addition, it faced pressure to improve its already-excellent quality ratings in an effort to attract patients from across the nation.

The solution.

The project team utilized a proven concurrent review process – one implemented at hundreds of hospitals throughout the country – designed to clarify documentation in the medical record during the patient stay. This included:

• Integrating a focused clinical documentation specialist infrastructure.
• Educating clinical documentation specialists and inpatient coders to ensure effective implementation of the concurrent review process.
• Conducting extensive knowledge transfer and process redesign.
• Educating medical staff related to the benefits of complete and accurate documentation, severity of illness and risk of mortality profiling, and the role of the medical staff in the new process.
• Implementating extensive monitoring and measurement tools to facilitate ongoing management of the program and the sustainability of results.

The results.

This approach enabled the medical center to generate additional net revenue of $4.5 million from one payer during the first year and more than $8 million in the second year as the program was expanded to additional payers.

In addition, the medical center achieved improved quality rating measures, enabling it to stay at the top of many major publication rankings. The company's management team was extremely satisfied with the results and extended the project to three related hospitals, resulting in an additional $3 million of additional revenue annually.