Amber Harris IHP 430 Milestone 2.docx

4-2 Final Project Milestone Two: Initiative Proposal Amber Harris IHP-430 Healthcare Quality Management Professor: Kerry-Ann Nelson November 14, 2023

Performance Improvement Initiative Medical records documentation is reviewed for accuracy and completeness as part of clinical documentation improvement (AAPC, 2020). CDI initiatives are driven by bridging the gap between clinical documentation and accurate coding, by analyzing diagnostic findings, disease processes, and whatever may be missing from the documentation. With the implementation of Medicare Severity Diagnosis Related Groups (MS-DRGs) in 2007, CDI programs/initiatives became popular. Using the MS-DRG payment model, the Medicare Inpatient Prospective Payment System (IPPS) increases reimbursements and reduces compliance risks by reviewing inpatient medical records documentation and contacting the provider whenever any ambiguities or incomplete information is found before submitting a claim (AAPC, 2020). Healthcare organizations can benefit from CDI by increasing reimbursement accuracy, preventing penalties for non-compliance and default, preventing unsupported diagnoses in claims, reducing readmissions, improving care coordination, improving quality reporting, and improving patient outcomes. For the CDI initiative to be successful, a team leader is responsible for ensuring compliance with policies, regulations, reviewing processes, and training all personnel/stakeholders about reimbursement procedures so that the documentation becomes more specific. Quality Outcome Data By using the Donabedian model, healthcare outcomes/quality outcomes are categorized as structure, process, or outcome. To provide quality care, providers must define their capacity, systems, and processes in relation to structural measures. The availability of board-certified and

qualified physicians in the healthcare organization is a structural measure of providers’ capacity, as are the systems-whether the provider uses an HER or a medication order entry system (MOES), and processes-the ratio of providers to patients. Insufficient physicians can adversely impact efficiency because there are not enough to take care of patients in a timely manner. Quality outcomes are measured according to the processes by which clinical practices are maintained or improved. A provider can evaluate whether the system is working as planned or if more effort can be put into it (e.g., Average clinician availability for appointments) by using process measures. It is also possible to determine the type of treatment a patient should receive based on the diagnosis or disease. In general, these types of quality measures are used for public reporting, and they help in making effective decisions. An outcome measure of quality shows how well the patient's health status/condition changes because of the care provided. In other words, it describes how the healthcare system affects patients' values, health, and wellbeing, as well as the community. An example of this would be the rate of surgical complications/hospital-acquired infections, adverse drug reactions per dose, and ICU fatality rates unadjusted. Implementation of the Plan in the Organization Health care teams should maintain constant communication and operationalize outcomes while instilling provider support to ensure clinical documentation program success (AHIMA, 2016). As part of the CDI program implementation process, CDI specialists arrange meetings and training. The CDI specialist will conduct an educational meeting when presenting the CDI plan to the provider, nurses, and clinical team to help them understand the importance of accurate documentation and how to use appropriate codes according to coding guidelines (AAPC, 2020).

Your preview ends here

Eager to read complete document? Join bartleby learn and gain access to the full version

Access to all documents
Unlimited textbook solutions
24/7 expert homework help

Health care teams should maintain constant communication and operationalize outcomes while instilling provider support to ensure clinical documentation program success. As part of the CDI program implementation process, CDI specialists arrange meetings and training. The CDI specialist will conduct an educational meeting when presenting the CDI plan to the provider, nurses, and clinical team to help them understand the importance of accurate documentation and how to use appropriate codes according to coding guidelines (AAPC, 2020). Most organizations have an electronic health record system through which data is displayed and shared. By improving care and clinical workflow, improving efficiency, ensuring accurate documentation and claims, improving reimbursement, coordinating patient care, and improving quality of care, data exchange within organizations improves clinical workflow, efficiency, and accuracy. Putting this plan into practice will provide providers, clinicians, and other healthcare personnel with the tools and resources they need to ensure proper documentation. This will improve patient care and reimbursement. As part of the hypothetical benefits, a better coordination of care will be provided, better health outcomes will be achieved, provider efficiency will be increased, claims will be processed more efficiently, and reimbursement will be improved. Having all the tools and resources needed to perform their roles and fully understanding their roles will make it easier for healthcare professionals to use appropriate codes for claims. A CDI specialist may be able to detect incorrect/inaccurate codes assigned to diagnoses or procedures, resulting in denials of claims, underpayments, and/or overpayments. A hospital information system (HIS) facilitates the storage and retrieval of patient data, allowing providers to coordinate care and patients to stay aware of their health conditions (ACOG, 2015). This promotes patient participation in their care and decision-making. With HIS,

providers are better able to communicate and coordinate patient care, which promotes interoperability and coordinated care. It also improves medication tracking, reporting, and safety, thereby reducing medication errors and promoting patient safety. Furthermore, HIS enhances patient care by reporting outcomes, managing quality, and monitoring public health diseases (Alotaibi& Federico, 2017). Hypothetical Effect According to the hypothesized impact of the quality or performance plan, the organization may experience a higher level of standard of care as well as a higher level of patient safety. As a result of implementing the performance plan, patient information will be properly charted and documented. When patient information is accurate, medication errors and wrong treatments are less likely to occur. Consequently, care is provided more efficiently/better coordinated. Also, performance plans provide resources to healthcare personnel to contribute to the organization's safety culture so that they can fulfill their responsibilities. Documents that are accurate reduce denials, increase reimbursements, reduce penalties for noncompliance with guidelines, and prevent inaccurate patient bills from being used to deny claims.

References AAPC. (2020, July 20). Clinical documentation improvement, benefits, process, and implementation. https://www.aapc.com/resources/what-is-clinical-documentation ACOG. (2015, January). Patient safety and health information technology. https://www.acog.org/clinical/clinical-guidance/committee- opinion/articles/2015/01/patient-safety-and-health-information-technology AHIMA. (2016, June). Ethical standards for clinical documentation improvement (CDI) professionals (2016). HIM Body of Knowledge. https://bok.ahima.org/doc? oid=301868#.ZF0ifnbMLrc Alotaibi, Y. K., & Federico, F. (2017). The impact of health information technology on patient safety. Saudi medical journal, 38(12), 1173–1180. https://doi.org/10.15537/smj.2017.12.20631

Your preview ends here

Eager to read complete document? Join bartleby learn and gain access to the full version

Access to all documents
Unlimited textbook solutions
24/7 expert homework help