Conference Description:

CDI and Quality Care Measures Boot Camp


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Course Overview

The CDI and Quality Care Measures Boot Camp is an intensive three-day course designed for CDI departments/programs looking to move to the next level of CDI—not just diagnosis review and clarification, but how diagnoses impact hospital quality metrics and influence indirect revenues.

This class covers publically reported quality data and how code assignment affects quality metrics, including but not limited to the Hospital Value-Based Purchasing Program. Students will learn the why and how of reviewing complex cases involving Patient Safety Indicators (PSI) and hospital-acquired infections (HAI), and leave with measurable strategies for improving their hospital profiles and positively influencing their facility’s value-based incentive payments.


CDI and Quality Care Measures Boot Camp
Learning Objectives

At the conclusion of the course, participants will be able to:

Define payment methodologies beyond Medicare’s inpatient prospective payment system (IPPS), including the Hierarchical Condition Categories (HCC) system

Describe the potential advantages and documentation opportunities of expanding CDI beyond MS-DRG review/optimization and CC/MCC capture

Explain the impact of principal diagnosis assignment (i.e., diagnosis sequencing) on indirect revenue, including that affected by quality metrics and medical necessity denials

Define the CDI specialist’s role in supporting medical necessity and working collaboratively with utilization review/case management

Develop documentation strategies to enhance a hospital’s quality metrics without compromising data integrity congruent with official coding guidelines

Describe how additional CDI responsibilities impact individual metrics, including staffing, productivity, and workflow

Discuss how physician documentation impacts various quality metrics through coded data, compared to abstracted data and surveillance data

Conduct reviews and/or develop appropriate review processes to ensure accurate reporting of Patient Safety Indicator (PSI) 90

Develop strategies to leverage collaboration within the revenue cycle, including CDI, coding, infection control, quality, and case management (utilization review) to promote consistency in the reporting of metrics associated with Hospital Value-Based Purchasing (HVBP) and other quality indicators



CDI and Quality Care Measures Boot Camp
Course Outline/Agenda

Day One

Module 1: Introduction to Healthcare Data

Uniform Hospital Discharge Data Set (UHDDS)
Key definitions
Key elements by setting
Publically reported quality data
Types of publically reported data
Quality or performance data
Physician Value-Based Modifier Program
Utilization data
Clinical condition data


Module 2: ICD-10 Code Sets

Introduction to diagnosis coding
Overview of Official Coding Guidelines for Coding and Reporting
Introduction to hospital inpatient procedure coding


Module 3: Inpatient Prospective Payment System (IPPS) and MS-DRGs

Overview of the Medicare IPPS system
Key terminology
What is an MS-DRG?
How is an MS-DRG assigned?
Principal diagnosis
Complications/comorbidities (CC) and major CCs
Principal procedure
The impact of principal diagnosis
Medical necessity denials


Module 4: Introduction to Quality

A history of CMS quality initiatives
Quality initiatives affected by the inpatient population
Basic quality concepts
Early quality efforts
The relationship between the electronic health record and reporting quality data
National Quality Initiatives (NQI)
Different types/categories of quality metrics and their significance


Day Two

Module 5: Hierarchical Condition Categories (HCC)

Introduction to CMS-HCC payment methodology
How HCCs are used to adjust quality monitors
Case studies


Module 6: Hospital-Acquired Conditions (HAC) and Present on Admission Status

Introduction to traditional HACs
Significance of the present on admission (POA) indicator on CMS quality metrics
CMS and OIG studies on POA accuracy
Hospital-Acquired Conditions Reduction Program (HACRP)
Complication of care codes as defined by coding guidelines
The impact on provider documentation on assigning a complication of care code
Role of ICD-10-CM codes and their associated guidelines
Hospital-Acquired Conditions Reduction Program
Case studies


Module 7: Hospital Inpatient Quality Reporting (IQR) Program

History and evolution of the Hospital IQR Program
IQR as basis/foundation of other CMS quality initiatives
Potential impacts of IQR
Reimbursement
Organizational reputation
Role of principal diagnosis assignment in IQR
Role of ICD-10-CM codes
Case studies


Module 8: Hospital Value-Based Purchasing (HVBP) Program

The HVBP program
Coded data elements that impact the reporting of HVBP
Impact of the principal diagnosis on HVBP
Role of ICD-10-CM codes and their associated guidelines


Day Three

Module 9: Hospital Readmissions Reduction Program (HRRP)

About the HRRP
Coded data elements that can impact the reporting of HHRP measures
Impact of the principal diagnosis on the HRRP
Case studies


Module 10: PSI 90: The Composite Patient Safety Indicators (PSI)

An introduction to PSIs
Impact of PSI 90 on CMS quality programs
Elements of PSI 90
Pressure ulcer rate (PSI 3)
Iatrogenic pneumothorax rate (PSI 6)
Postoperative hip fracture rate (PSI 8)
Perioperative hemorrhage or hematoma rate (PSI 9)
Postoperative Acute Kidney Injury Rate (PSI 10)
Postoperative Respiratory Failure Rate (PS 11)
Postoperative pulmonary embolism (PE) or deep vein thrombosis rate (DVT) (PSI 12)
Postoperative sepsis rate (PSI 13)
Postoperative wound dehiscence rate (PSI 14)
Accidental puncture and laceration rate (PSI 15)
Case studies


Module 11: Hospital-Acquired Infections (HAI)

HAI methodology
Nosocomial infections
HAIs that may or may not be a HAC
Surveillance data vs. coded data
HAIs currently used in CMS quality metrics
CLABSI
CAUTI
SSI
VAP
Adjourn


*Course Outline/Agenda subject to change



Please contact the event manager Marilyn ([email protected] ) below for:
- Multiple participant discounts
- Price quotations or visa invitation letters
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