Hospital Improves Finances Through Documentation
November 3, 2016
South Central Kansas Medical Center staff and physicians have recently started the clinical documentation improvement program, which they believe will help to increase reimbursements at their facility and ultimately improve patient care.
The program trains hospital staff to document all of a patient’s healthcare concerns currently impacting his or her treatment, clinically referred to as comorbidities.
Payment for service is a moving target in the healthcare industry, constant changes to governmental regulations and insurance provider requirements make it difficult for hospital’s to receive maximum reimbursement for the care they provide. South Central Kansas Medical Center staff and physicians have recently started a new program they believe will help to increase reimbursements at their facility and ultimately improve patient care.
“We have been leaving money on the table here at this hospital. We implemented the clinical documentation improvement program in August. It’s different, it’s new and something we aren’t totally comfortable with but it’s going to be effective moving forward,” said Virgil Watson, SCKMC’s Chief Executive Officer.
The program trains hospital staff to document all of a patient’s healthcare concerns currently impacting his or her treatment, clinically referred to as comorbidities. Holly Harper, SCKMC’s Chief Financial Officer provided an example.
“If I come in with pneumonia and I am a pretty healthy person, other than that, you are going to treat me with my pneumonia diagnosis and I will be on my way. John comes in with pneumonia, but he is also diabetic and has hypertension. Now you are going to have to treat him with different meds, you are going to have to monitor him more. So that’s what we are doing (with clinical documentation), we are putting words in a chart saying okay he has more things I have to deal with,” Harper said.
Historically only the root concern for a particular patient visit has been documented, limiting the reimbursement available to the hospital. However in the program’s first 45 days SCKMC has generated an additional $77,000 in net reimbursements.
“If you extrapolate that out you are talking $600,000 -700,000 over the course of a year. That helps. We have been doing this work all along, and we are finally getting credit in the form of dollars for what we are actually doing. The question that goes through my mind is why weren’t we doing this all along,” asked John Jones, the medical center’s Director of Patient Services.
Watson explained to the SCKMC Board of Trustees during their October meeting why the program took time to get started.
“We have been working on this for about a year. I had four things I wanted to do to get the hospital stabilized, rural health clinic, 340B, sole community hospital, and clinical documentation. CPSI brought clinical documentation to us earlier; we just didn’t have the money to do it. We had to get ourselves educated to understand what the possibilities were before we launched that program. It took me a year to get everybody on board and to get the price negotiated so we didn’t have to pay upfront. Now that we have done it we are kicking ourselves saying we should have done that in 2013,” Watson said.
Hospital administrators believe clinical documentation improvement will not only improve the hospital’s finances, but ultimately improve the care received by their patients.
“It will start to show up in very meaningful ways besides dollars in the bank. It all ties into being able to clearly represent the level of the acuity of the patients. The record more accurately reflects what we are doing for these people,” Jones said.
Jones believes a more accurate medical record allows for all healthcare providers to provide more accurate diagnoses and treatment plans.
“Everybody deserves to have a complete medical record. That’s in your best interest, it’s in the hospitals best interest, and it’s in the insurer’s best interest. That includes your comorbidities being known, a whole long list of things so that it optimizes the chance for the physician to take the best care of you. When they don’t know everything about you there is potential for error. When they have everything that they need to know about you it really provides a safer, and better care plan,” Jones said.
Based upon the initial success of the clinical documentation improvement program, Watson and the SCKMC team plan to eventually expand the program for use within the organization’s outpatient clinics.