DRG/Clinical Documentation

The client.

Nine hospitals, from rural 100-bed facilities to 600-bed academic medical centers, of a national Catholic health system.

The business issue.

This system's individual hospitals experienced financial, merger-integration or consolidation difficulties. Some had difficulty assessing changes in case mix index. In addition, poor quality ratings made it difficult for some to compete effectively in their markets.

The solution.

Members of The Claro Group worked with the health system to implement 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:

• Assisting with in the merger of two hospitals and a full-scale turnaround effort at another.
• Implementing a focused clinical documentation specialist infrastructure.
• Educating clinical documentation specialists and inpatient coders on effective implementation of the concurrent review process.
• Assisting with steps to achieve greater clinical and medical record consistency across the system.
• Educating medical staff on 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.
• Implementing extensive monitoring and measurement tools to facilitate ongoing program management and to sustain results.

The results.

This approach has generated substantial benefits for the health system:

• Improved financial performance, quality ratings, filing performance and compliance across all hospitals.
• Approximately $10 million annually in incremental revenue.
• Improved competitive position of several hospitals.