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Confidential property of Optum360. Do not distribute or reproduce without express permission from Optum360.
Seth Jeremy Katz, MPH RHIA Associate Administrator, Information Management Truman Medical Centers, MO
Truman Medical Centers achieves all of their financial targets in less than 6 months with CDI 3D
3 Confidential property of Optum360. Do not distribute or reproduce without express permission from Optum360.
4 Confidential property of Optum360. Do not distribute or reproduce without express permission from Optum360.
CMI Trends
5 Confidential property of Optum360. Do not distribute or reproduce without express permission from Optum360.
Fiscal Snapshot
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Our Vision “Leading the way to a healthy community”
TMC Hospital Hill
*Fiscal Year June 2015
TMC Lakewood
$120,000,000 uncompensated care
2 hospitals / 600 Beds (acute, LTC, psych)
51 clinics (primary care and specialty)
Academic medical center supporting UMKC School of Nursing, Medicine, Dentistry and Pharmacy
Level one trauma center
577 medical staff / 235 residents
4,000 employees
19,908 acute care admissions
2,722 behavioral health admissions
3,708 births
338,190 outpatient visits
278,913 behavioral health outpatient visits
97,729 ED visits
7 Confidential property of Optum360. Do not distribute or reproduce without express permission from Optum360.
Mission and Recognition
Mission TMC is an academic health center providing accessible, state-of-the-art quality health care to our
community regardless of the ability to pay.
Recognition
2011-2015 by Hospitals and Health
Networks Magazine
Dual HIMSS Stage 7 accreditation for both inpatient
and outpatient settings across both TMC facilities
AHIMA 2013 Grace Award
CHIME-AHA Transformational Leadership Award
Level III Patient-Centered Medical Home
National Committee for Quality Assurance (NCQA)
2014 HIMSS Enterprise Davies Award Recipient
8 Confidential property of Optum360. Do not distribute or reproduce without express permission from Optum360.
The Action Plan
Move CDI under HIM to better align objectives
Implement software that is integrated with the EMR and is
an all-in-one solution
Choose a partner willing to put skin-in-the-game
Must be able to provide CDI impact on a case-by-case basis
9 Confidential property of Optum360. Do not distribute or reproduce without express permission from Optum360.
Key Metrics
Improvements • CMI improvements on DRG
based payors • Medicare • Blue Cross Blue Shield • United Healthcare
• Physician response rate • Increase in CC/MCC capture • Improved cash flow • Increased number of queries
Diminishing • Inability to track results • Decrease in physician no
responses • Eliminate multiple
application use by CDI team
10 Confidential property of Optum360. Do not distribute or reproduce without express permission from Optum360.
The Holy Grail: The Bi-Directional Query
Confidential property of Optum360. Do not distribute or reproduce without express permission from Optum360.
1
1) CDIS reviews the account in Optum for potential query opportunities
2) CDIS resolves (if necessary) any markers
3) Queries created in application and edited for content to add or remove elements
4) Query sent to EMR via bi-directional interface, no cutting or pasting of text between systems
12 Confidential property of Optum360. Do not distribute or reproduce without express permission from Optum360.
Physician Inbox
13 Confidential property of Optum360. Do not distribute or reproduce without express permission from Optum360.
Physician View of the Query
1
14 Confidential property of Optum360. Do not distribute or reproduce without express permission from Optum360.
Medical Record Review: Physician Queries
1
15 Confidential property of Optum360. Do not distribute or reproduce without express permission from Optum360.
Closing The Loop
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TMC Query Response Rates
Truman Medical Center CDI Data Summary Nov-15 Dec-15 Jan-16 Feb-16 Mar-16 Apr-16
$82,372 $257,303 $332,393 $594,356 $1,054,199 $1,431,689 Physician Query Data
Total Distinct Accounts with Queries 56 100 163 222 199 218 Total Queries Sent 86 180 263 351 319 342 Responded 83 157 198 310 311 310 Total Query Agrees 65 122 129 229 228 247 Total Query Declines 17 31 59 64 71 51 No Response 3 23 65 40 5 23 Remaining Open Queries 1 4 10 18 15 21 Physician Response% 96.51% 87.22% 75.29% 88.32% 97.49% 90.64% Physician Agree% 78.31% 77.71% 65.15% 73.87% 73.31% 79.68%
Prior to go live Physician query data
Query Outcome July August MD Agree 43% 57% No Response 35% 41%
Confidential property of Optum360. Do not distribute or reproduce without express permission from Optum360.
Confidential property of Optum360. Do not distribute or reproduce without express permission from Optum360.
19 Confidential property of Optum360. Do not distribute or reproduce without express permission from Optum360.
32K
1.09 1.14
1.05
1.24
1.29 1.30
1.47
1.17
0.80
0.90
1.00
1.10
1.20
1.30
1.40
1.50
1.60
Sept Oct Nov Dec Jan Feb Mar CMIBase
Lakewood
Change in Medicare FFS Dollars Based on CMI
CI Initiative Dec Jan Feb Mar Dec
49K
47K
Total: $155K
27K
20 Confidential property of Optum360. Do not distribute or reproduce without express permission from Optum360.
What Do You Think?
Seth Jeremy Katz, MPH, RHIA [email protected]
816-404-3355