Florida Hospital reaps $72.5 million from clinical documentation improvement, achieves ICD-10 compliance

The health system credits clinical and financial improvements to a CDI initiative that resulted in more accurate coding and greater physician engagement. 
By Jeff Lagasse
11:06 AM

Florida Hospital improved its case mix index, reduced mortality rates by 48 percent, achieved ICD-10 compliance and pulled in $72.5 million in increased reimbursement via a clinical documentation improvement program.

The hospital credits the clinical and financial improvements to an increase in the integrity of its clinical documentation, as well as better accuracy and physician engagement.

"Successful CDI programs facilitate the accurate representation of a patient's clinical status that translates into coded data," according to the American Health Information Management Association. "Coded data is then translated into quality report cards, physician report cards, reimbursement, public health data, and disease tracking and trending."

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[Special Report: ICD-10 Report Card: Transition smooth so far but another deadline promises new challenges]

Florida Hospital implemented the CDI program, developed by an arm of Nuance Communications, in summer 2014 and completed an expansion across eight affiliated hospitals by May 2015.

Current plans are to expand the program and leverage the CDI framework to provide clinicians and clinical documentation specialists with a more efficient workflow — one with minimal disruptions. Computer-assisted physician documentation technology is expected to provide automated CDI clarifications to physicians, integrated into Cerner's Document Quality Review platform.

Based on national averages, Florida Hospital aimed to improve its case mix index by eight basis points — or one hundredths of one percent — through more thorough and accurate clinical documentation of the patient care delivered. It exceeded expectations, climbing from 1.59 basis points to 1.88 by the fall of 2015. Case mix index basis points at Florida Hospital are worth approximately $2.5 million a year, resulting in the $72.5 million appropriate reimbursement increase.

Before overhauling its CDI, the hospital's observed-to-expected mortality rates were well above the national average, which it cites as related to gaps in clinical documentation. After implementing the CDI, the hospital claimed it more accurately documented the disease acuity of its patient population, resulting in reduced mortality rates by 48 percent in less than a year. The health system is now tracking toward the top quartile of the industry average, according to Nuance.

Education and engagement of 2,200 medical staff -- only 20 percent employed by the organization -- drove the documentation initiative, said Nuance, with physician response rates to CDI clarifications falling between 87 and 92 percent.

Twitter: @JELagasse

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