Q&A: CDI in home health
Editor’s Note: ACDIS Podcast guests Caryl Liptak MSHAI, RHIA, system director of CDI and coding at Baptist Health Kentucky in Louisville, Kentucky, and Regene Collier, RN-BC, BSN, COS-C, HCS-D, the home health coding/CDI specialist manager at Baptist Health Kentucky, answered these questions following the July 17, 2019, program, “CDI in Home Health.”
Q: How did you get leadership buy-in to expand your CDI reviews into home health services?
A: I think the biggest acceptance or buy-in for the CDI program in home health came from wanting to improve the quality of documentation related to the Outcome and Assessment Information Set (OASIS) and its further effect on quality ratings. Improvement in case mix index was certainly a motivator as well. We saw opportunities for improvement from a prior total outsourcing of coding to bringing it back in-house where we could not only code each encounter but also review the OASIS for quality and consistency in documentation. We were also experiencing denials related to coding that we have now been able to minimize.
Q: Will the Patient Driven Payment Model (PDPM) effective on October 1, 2019, affect home health?
A: My understanding is that PDPM is the proposed new Medicare payment rule for skilled nursing facilities. Home health agencies will be transitioning to a new payment rule, the Patient Driven Grouping Model (PDGM), which will be effective January 1, 2020. Under this model, accurate coding and CDI expertise will be even more imperative for our agency’s viability and success.
Q: What metrics do you monitor and report to leadership?
A: The metrics that we currently report are those outcome and process measures that affect our STAR ratings (timely initiation of care; management of oral medications; improvement in ambulation; improvement in transfers; improvement in bathing; improvement in pain; improvement in dyspnea; 60-day re-hospitalization rate). We also report those metrics that affect utilization of services and revenue (average visits/episode, percentage of low utilization payment adjustment, average home health resource groups, and average case mix weight).