Is your hospital in one of the 67 geographic areas defined by CMS as a metropolitan statistical area (MSA) and one that CMS has identified to participate in the Comprehensive Care for Joint Replacement (CJR) Model? If so, is your case management department ready? Does your department have the processes and procedures in place for how it will participate in this retrospective bundled payment innovative project for Medicare fee-for-service beneficiaries?
by Shannon Newell, RHIA, CCS, AHIMA-approved ICD-10-CM/PCS trainer
Approximately 800 hospitals across the country that perform inpatient total hip and knee joint replacements will be required to participate in the latest value-based payment initiative launched by CMS, the Comprehensive Care for Joint Replacement (CJR) model, which becomes effective April 1.
A recent Healthcare Financial Management Association webinar on the CJR noted it as one of the biggest Medicare changes since the implementation of diagnosis-related groups (DRG). Not surprisingly, various impacted parties continue to push for delays in implementation of the model. The CJR model holds participant hospitals financially accountable for the cost and quality of an episode of care and incentivizes increased coordination of care among hospitals, physicians, and postacute care providers.
The assignment of ICD-10 codes on both inpatient and outpatient claims impacts these outcomes by triggering which discharges are included in the program, the actual (or observed) complication rates for these patients, and?equally important but often overlooked?their risk-adjusted expected complication rates. If ever there was an opportunity for clinical documentation improvement (CDI) programs to step up to support their organizations with documentation that impacts both quality and financial outcomes, this is it!
To find the right solution for your organization, you must understand how and why employees are using messaging and email services.
"You want a solution that's easy to use, and that's within the work environment of whoever is sending the message," Apgar says. Apgar's case in point is Oregon's state-sponsored CareAccord Direct Secure Messaging email service. The service doesn't connect to all EHRs or an organization's email service. Users have to log in through the website to send a message. Busy employees, he points out, particularly clinical staff like physicians, are unlikely to use a service that requires them to go out of their way, making it a poor choice.
Text messaging solutions directed at the healthcare industry were not always common and user friendly. Until about a year ago, there were few mature products on the market for securing text messages, Apgar says. The ones that did provide good security had serious usability limitations as most could only be used to communicate with other people in your network. A specialist, Apgar says, wouldn't have been able to send a quick, secure text to his or her patient's primary care doctor if the doctor was not part of the specialist's organization. Some services, like Tiger Text and HipaaChat, offer a solution to this problem. (See the March 2015 issue of BOH for more information about Tiger Text.) If the sender uses Tiger Text, but the recipient does not, Tiger Text delivers a text message that includes a link to the now encrypted text message. When the recipient clicks the link, the browser on the mobile device opens up to the text message, which is encrypted at a National Institute of Standards and Technology standard 256-bit encryption.
Keep in mind, however, that you have to treat text messaging the same as email. Device security and storage need to be analyzed. Burton warns that some may not realize the text messages on their phones leave traces of data behind.
Apgar agrees. "They don't understand that ultimately the cell phone carrier has servers that back up your texts, and you have it [stored] on your phone," he says.
Faxing, like many other efforts to protect health information, comes down to basics. Call the recipient to ensure they are near the fax machine. Double- and triple-check fax numbers. Send a cover sheet that clearly addresses to whom the fax is intended. Follow up with a call.
"We try to call the recipient and tell them, 'Hey we're going to fax something to you. If you're at a public fax machine go stand by that machine,' " Wallach says.
Basic stuff, right? But for busy healthcare systems who can send a massive amount of faxes each day, the human error rate is high, says Frank Ruelas, MBA, who serves as principal at HIPAA College in Casa Grande, Arizona, and facility compliance professional at Dignity Health's St. Joseph's Hospital and Medical Center in Phoenix. Ruelas is also a BOH editorial advisory board member.
"Just because you're in a hurry doesn't make it right," says Ruelas. "Do we need something this sophisticated and scientific here? This is a process that should have a really low error rate. Or it should be much lower than it is."
Break down faxing policies into rudimentary steps where employees are comfortable and deploy them, he says.
Over-querying is a common concern in CDI. It can influence productivity and workflow. It can cause delays in documentation and coding processes. It can also overwhelm and frustrate physicians, who in turn may be less likely to support or engage with CDI program efforts.
