Real-World Case 4.1 The hospital clinical documentation improvement (CDI) specialist reports to you, the HIM manager of

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Real-World Case 4.1
The hospital clinical documentation improvement (CDI) specialist
reports to you, the HIM manager of Anywhere hospital, that the
hospital has been receiving reimbursement penalties. The physician
documentation is not appropriately identifying specific conditions
that CMS has identified as hospital-acquired conditions (HACs). In
most cases, these conditions are present in patients before they
are admitted. However, physicians are documenting these conditions
later in the patients’ stays, making it appear that the patients
have acquired these conditions from the hospital. The hospital is
being financially penalized because these conditions are considered
to be preventable if the hospital follows national treatment
standards and guidelines.
Anywhere hospital has a robust EHR. Many documentation
improvement initiatives have been leveraged by the technological
capabilities of the EHR. As the HIM manager, you wonder if
something could be done from a technology standpoint that could
assist physicians with identifying, upon admission, those
conditions that are causing the reimbursement issue, and
appropriately documenting the conditions. Physicians appropriately
capturing and documenting these conditions would demonstrate that
the hospital is following the national treatment standards and
guidelines and the patients are not acquiring these conditions in
the hospital.
You assemble a multidisciplinary team consisting of physicians,
revenue cycle representatives, HIM, and information systems
representation.
Real-World Case Discussion Questions: paragraph format
2. What is the benefit of
developing an EMR solution for this issue?
3. How does the adherence
to the treatment guidelines for the prevention of the conditions
identified as hospital-acquired relate to other pay-for-performance
initiatives?