American College of Cardiology - Cardiovascular Summit 2013
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As healthcare reimbursement shifts from quantity to quality, particularly in Cardiology, the importance of capturing complete and accurate quality data metrics continues to grow. Yet, significant challenges exist in the collection, abstraction and submission of Cardiology quality data. Appropriately meeting these challenges can help your organization improve patient care, increase efficiency, enhance its reputation and maximize reimbursements.
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American College of Cardiology - Cardiovascular Summit 2013
- 1. ACC Reporting: Overcoming Data Management Challenges Dr. Saji Salam MD, MBA Director of Clinical Informatics David LaMotte BCS Senior Product Manager, PVMD Cardiology
- 2. Forces of Change ■ Practice Integration ■ Reimbursement Scrutiny ■ 24% of denials related to MS-DRG 247 ■ Top reason: Documentation did not substantiate the need for admission ■ Appropriate Use Criteria Bottom Line: Quality documentation and reporting is becoming critical
- 3. 0% 10% 20% 30% 40% 50% 60% 70% 90% 100% 80% N=205 79% Maximize reimbursement: 47% 75% Improve patient satisfaction: 42% 67% Admin Reduce costs in the cath lab: 41% Cath Lab Goals 65% Report quality measures: 48% Physician 62% Achieve meaningful use: 31% 59% Prepare/prevent RAC audits: 31% Improve care coordination/ 57% communication with hospital: 29% Improve care coordination/ 56% communication with referring physicians: 27% Monitoring and improving 53% appropriate use measures: 40% Improve integration of 52% technology within cath lab: 32%
- 4. Cath Lab Goals Administration Goal Cardiologist Ranking Ranking Maximize reimbursement: 1 2 Improve patient satisfaction: 2 3 Reduce costs in the cath lab: 3 4 Report quality measures: 4 1 N=205
- 5. Drivers for data management ■ Quality is priority ■ Reimbursement ■ AUC criteria ■ Audits ■ Meaningful use ■ Patient satisfaction ■ Others…
- 6. Current State Procedure Office Report Note EMR Hemo NCDR Billing
- 7. Case Studies Case 1: Stand-alone, for-profit hospital in the North East • Using procedure documentation system for nearly all procedures • One full-time (PhD) and two part-time dedicated to reporting Case 2: Health System in the Upper Midwest • Using procedure documentation for majority of cases • Two full-time and one part-time nurse dedicated to reporting Case 3: Large health system in a major city • No procedure documentation system; use dictation • Uses two different systems for Echo and Nuke • 3 full-time nurses dedicated to reporting
- 8. Summary of Issues ■ Missing data ■ Incomplete / inaccurate data ■ Inconsistent data ■ Redundant data entry Result: Large effort, sometimes 3 hours per case . Result: Backlog of quality projects.
- 9. Challenges ■ Technical • Number of Data Sources • Integration • Source of Truth? • IT Capacity ■ Human • Conflicting Perspectives • Process Inertia • Attitudes Matter ■ Financial
- 10. Proposed point of arrival architecture
- 11. Case Study: Current State
- 12. Case Study: Interim State
- 13. Road map • Current Process • Costs / Opportunities • Prioritize • Engage leadership and stakeholders • Sell to key stakeholders and policymakers • Process changes • Technology changes • Integration changes
Editor's Notes
- Disparate systemsLimited integration among systemsManual data collection and reporting Big problems:Office NoteProcedure NoteReporting SystemSmaller problem:EMR black hole
- Multiple data sourcesInconsistentUnavailableMultiple points of transcriptionError proneResource intensiveData collection staff make conservative guesses.
- Asked them why it took so long.Needed to hunt for dataReconcile different dataCompensate for missing dataManual entry
- Different nomenclaturesWho judges between conflicting elements? Example: (maybe % stenosis or lesion length)HumanWho enters the data? From whom? Number of key stakeholders that don’t want additional work.Problem? What problem? The process works!I’m not a stenographer! I have more important things to do!Change is expensive.
- What do we want?Trustworthy data coming into the process.Doctors to use the procedure documentation system most of the time.Data as complete as we can make it.Minimize redundancy.Data to flow between departments and components.Minimize the amount of manual entry.
- Talk to the project plan, key stakeholders and actions taken to address the challengesQuality staff will get “office note” with key clinical elements and enter them into the hemodynamic systemTemplate in hemodynamic system created by internal staff (no vendor involvement)Pre-procedure nurse will validate with patientEnhancing the integration from hemodynamic system to procedure documentation to include that dataImplementing a reporting system that pre-fills data from procedure documentationMaintaining policy of the EMR as repository of most current informationChanges a majority of work from data entry to validation, thereby freeing quality staff for project backlogImproves the completeness and quality of pre-procedure data, thereby improving careMakes data needed for diagnostic appropriateness available before the procedure is performed
- Document your current process, with challenges faced by each roleIdentify the opportunities in your specific situationIdentify the value of overcoming eachGo after the highest value first – Watch out for missing requirements! (enabling technology)Identify key stakeholders and sellSet up a communication plan and follow it