South Central Kansas Medical Center staff and physicians recently started a new program they think will help to increase reimbursements at their facility and ultimately improve patient care.
Payment for service is a moving target in the health care industry — constant changes to government regulations and insurance provider requirements make it difficult for hospitals to receive maximum reimbursement for the care they provide.
“We have been leaving money on the table here at this hospital,” said Virgil Watson, SCKMC’s chief executive officer.
“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.”
The program trains hospital staff to document all of a patient’s health care concerns currently impacting his or her treatment, clinically referred to as co-morbidities. 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,” she said.
“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 concluded.
Historically, only the root concern for a particular patient visit has been documented, limiting the reimbursement available to the medical center.
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 to $700,000 over the course of a year. That helps,” said John Jones, SCKMC’s director of patient services. “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?”
Watson explained to the SCKMC Board of Trustees during its October meeting why the program took so much time to get started.
“We have been working on this for about a year,” he said. “I had four things I wanted to do to get the hospital stabilized — Rural Health Clinic (status), 340B (pharmacy program), Sole Community Hospital (status) and clinical documentation.” The three already have been attained.
“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 up front. Now that we have done it, we are kicking ourselves, saying ‘We should have done that in 2013,’” Watson added.
Hospital administrators think clinical documentation improvement not only will improve the hospital’s finances, but ultimately improve the care received by SCKMC 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.
He thinks a more accurate medical record allows all health care 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 hospital’s best interest and it’s in the insurer’s best interest,” Jones said.
“That includes your co-morbidities 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.”
Based upon the initial success of the clinical documentation improvement program, Watson and the SCKMC team plan eventually to expand the program for use within the organization’s outpatient clinics.
This information was provided by South Central Kansas Medical Center Director of Marketing Clayton Pappan.