2015 Trifecta 1.0

Clinical Documentation

Copy-Paste usage in the EHR

ProviderEHR Documentation

EHRPrior Visits

Current Visit

2060%Average % of note content that is copied (i.e. duplicated) text from prior notesCopy-Paste

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3M Confidential for customer's internal review only. Further use or disclosure requires prior approval from 3M.. All Rights Reserved.9 November 2015 3MPneumonia, HTN, Diabetes Type II, UTIDRG: 194 Simple Pneumonia & Pleurisy w/CC $4,069

Risks of Copy-Paste: Coding and ReimbursementPatient detailsAdmitting diagnosesDocumentation Duplicate textCoded diagnosesCoding outcomeReimbursement

76 year old malePneumoniaPhysician creating H&P copies information from prior admissions H&P...patient has HTN, diabetes type II and a UTI

High-risk issueIncorrect coding results in $1,110 over-payment UTI is not a current problem for this admission DRG should be:195 Simple Pneumonia & Pleurisy without CC/MCC $2,959

Patient OverviewDocumentation & CodingCopy-Paste Issue & Impact

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3M Confidential for customer's internal review only. Further use or disclosure requires prior approval from 3M.. All Rights Reserved.9 November 2015 3MThe Takeaway Message: Specificity queries make are impactful and can result in big changes to the final coding of a patient visit, and thus impacts reimbursement and quality/outcomes reporting.

Opening: Here is a patient case example to highlight the importance and impact of getting additional specificity. Click One: For this patient the principle diagnosis is Acute Kidney Failure, with secondary diagnoses of Urosepsis (which codes to a UTI), Heart Failure, Chronic Kidney Disease and an old Myocardial Infarction. You can then see the DRGs and Severity of Illness and Risk of Mortality based on these diagnoses.Click Two: These diagnoses are the ones that will trigger a specificity query with 360MD, as they are currently classified as un-specificied diagnoses meaning there is a more specific, detailed version of this diagnosis. Click Three: By querying a physician for more specificity on this patient, we can clarify that the patient has Sepsis, Acute Systolic Heart Failure and CKD Stage 4. This additional detail not only changes the MS-DRG by capturing an MCC, it also changes the ROM, changes the DRG weighting and the National Mortality Rate score.Transition to Next Slide: In order to capture all of the needed specificity and diagnosis information for each visit to achieve appropriate reimbursement and accurate reporting for the care provided in your hospital, this requires a full team approach

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Risks of Copy-Paste: Patient CarePatient detailsAdmitting diagnosesInitial Lab TestsDocumentation Duplicate textPatient care decision

62 year old womanAdmitted in AM due to CHFPotassium level: 5.1 (Normal range: 3.7-5.2)BNP was elevated at 2000

Patient OverviewDocumentation & Patient CareCopy-Paste Issue & ImpactHigh-risk issueHigh risk for an adverse patient care eventPotassium level is normal, copied text implies it is lowAdverse Event Risk: Administering potassium supplements to a patient with normal potassium level could have devastating impacts on the patientAvoidable Cost: Ordering recheck of the potassium level is additional cost that could have been avoided

Admitting physician creating H&P copies information from a prior admissions H&Ppatient has a potassium level of 2.9 Hospitalist covering patient on evening shift reads H&P. Based on potassium level of 2.9 orders:Potassium supplementsRecheck of potassium level next day

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3M Confidential for customer's internal review only. Further use or disclosure requires prior approval from 3M.. All Rights Reserved.9 November 2015 3MThe Takeaway Message: Specificity queries make are impactful and can result in big changes to the final coding of a patient visit, and thus impacts reimbursement and quality/outcomes reporting.

Opening: Here is a patient case example to highlight the importance and impact of getting additional specificity. Click One: For this patient the principle diagnosis is Acute Kidney Failure, with secondary diagnoses of Urosepsis (which codes to a UTI), Heart Failure, Chronic Kidney Disease and an old Myocardial Infarction. You can then see the DRGs and Severity of Illness and Risk of Mortality based on these diagnoses.Click Two: These diagnoses are the ones that will trigger a specificity query with 360MD, as they are currently classified as un-specificied diagnoses meaning there is a more specific, detailed version of this diagnosis. Click Three: By querying a physician for more specificity on this patient, we can clarify that the patient has Sepsis, Acute Systolic Heart Failure and CKD Stage 4. This additional detail not only changes the MS-DRG by capturing an MCC, it also changes the ROM, changes the DRG weighting and the National Mortality Rate score.Transition to Next Slide: In order to capture all of the needed specificity and diagnosis information for each visit to achieve appropriate reimbursement and accurate reporting for the care provided in your hospital, this requires a full team approach

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