Change can be a daunting endeavor. When Pam Stence, Director of CDI for Sharp HealthCare, had a hunch that her CDI program may not be performing as well as it could, she decided to dig deep to find answers. She worked with her executive team and did research into key industry players like Cedars Sinai, Johns Hopkins, and U.S. News and World Report hospital data as a place to start benchmarking and comparing her own program’s data. This led her to the conclusion that she needed to optimize her program and rethink their performance.
Pam knew that she could increase Complication/Comorbid Condition (CC) and Major Complication/Comorbid Condition (MCC) capture rates from 3M but needed to make changes to their CDI staffing plan to get the impact she needed. Over the course of two months, she worked with her internal team to establish a goal of 2.5 cases per hour and review 90% of all DRG payors. Coverage felt like a core issue. She needed the expertise and staff to get the job done. Pam was able to use her research to develop a strong case for the needed changes with her management team in order to bring her vision for her department to life.
Hiring posed an interesting problem and was not something that could be quickly scaled. New hires could take up to a year to be trained and ramp up fully into their work load. Pam recognized that they needed quality resources quickly to hit their goals and would need an external partner. She established a list of mandatories they needed:
- A partner – not a vendor
- High quality resources
- Staff with the right credentials and experience
- Training in 3M 360 and Cerner
- Responsive
- Willing to be flexible to meet needs
- Known entity with previous engagement
She turned to UASI for a solution. UASI assessed staffing needs, fully staffed up and scaled production quickly. Sharp was able review 90% of all their DRG payors within 1 year as opposed to the 60% rate the years prior. Currently, they review 98% of DRG payors and 90% of all payors at 48 hours. Sharp would hit $19M in 2023 in query impact, up from $11M the previous fiscal year. These were dollars that could have been left on the table had Pam not acted. Quality scores also improved.
We asked Pam what her advice would be to other teams who recognize that they need to make changes to their CDI programs. She came up with great tips to make digging into change easier.
- Develop a strategic partnership with your vendor
- Share data and be transparent
- Be open to a new process
- Look at the benchmark data and be objective on where you stand; reach out for help if you need it
- Improve physician engagement, involvement and query responsiveness