Innovation Poster Session
HRT1215 – Innovation Awards
Sydney
11th and 12th Oct 2012
COPD: Cost of Precise
Diagnosis and
Documentation
Presenter: Liz Pardede & Kathryn Arnett
The Prince Charles Hospital
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KEY PROBLEMS
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Revenue v Cost review: $1.2 million loss on E65(COPD)
Led to coding and documentation review
Clinician anecdotal thought – patient complexity not
reflected in documentation
Previous project key focus was LOS - reduced COPD LOS
from 7.7 to 5.2 days
Large COPD patient cohort at TPCH (~680 patients) with ~
20% Bronchiectatic cohort
Comparison with HRT data showed we were not as complex
as peer facilities
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AIM OF THIS INNOVATION
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Review patients coded with E65B to ensure documentation
and coding accurately reflects care requirements
Receive adequate reimbursement in ABF environment for
complexity and use of resources
Identify inconsistencies, errors, omissions and influencing
factors
Develop strategies to address these issues and improve the
integrity, quality and capture of documentation
If successful, target other DRGs that are known to have
lower than expected complexity splits and high revenue
losses
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BASELINE DATA
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431 E65B episodes from July-March FY 2012: 95% audited
(409)
Of the 409 – 102 (25%) were found to have significant comorbidities and/or complications not documented in a
codeable form.
$1.2 million loss based on revenue v cost
Main documentation issues: respiratory failure,
hypo/hyperkalemia, hypo/hypernatremia, nicotine dependence,
renal insufficiency and malnutrition.
High Bronchiectatic cohort (20%)
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KEY CHANGES IMPLEMENTED
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Established Thoracic Data Management Taskforce
Coding DRG summary sheet
Enhanced orientation program for RMOs
Development of Clinical Coding and Audit Education Process
for implementation throughout the organization
Revision of eDS (electronic Discharge Summary) to better
reflect terminology
Improved communications – clinical engagement
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OUTCOMES SO FAR
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Coding DRG summary sheet:
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Integration into Medical Record
Use on medical ward rounds
Enhancement of medical orientation program:
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Education for Resident Medical Officers (RMOs) and Registrars – case study
Program specific orientation by HIM
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Continued improvement in documentation and coding
outcomes
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Cost retrieval of ~$550K
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LESSONS LEARNED
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Clinician interaction with HIMs is crucial
Medical nomenclature v classification terminology
Increased awareness for clinicians
Insight into model of care and impact on LOS
Accurate specificity of conditions and co-morbidities = true
complexity of the patient and resources consumed =
improved outcomes and accurate ABF reimbursement
Integrity of data for research and planning
Need for Bronchiectatic DRG
Money talks with clinicians
Many more DRGs to review
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Project Team
 Liz Pardede – Clinical Nurse – Thoracic Medicine
 Lisa McCarthy –Thoracic Clinical Nurse Consultant
 Alex Meredith – Health Information Manager - Thoracic Program
 Kathryn Arnett – Clinical and Business Analyst
 Dr Philip Masel – Respiratory Physician
 Dr Pat Aldons – Respiratory Physician
 Dr Scott Bell – Medical Director, Thoracic Program
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