6-3 Final Project Mileston Three Implementation of Performance Initiative

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Southern New Hampshire University *

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IHP 430

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Health Science

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May 15, 2024

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Final Project Milestone Three: Implementation of Performance Initiative 1 6-3 Final Project Milestone Three: Implementation of Performance Initiative IHP 430: Healthcare Quality Management Southern New Hampshire University Professor Sharonda Ward 02/11/2024

Final Project Milestone Three: Implementation of Performance Initiative 2 Financial Implications The performance improvement plan, when executed successfully, will lead to the accurate documentation of patients’ information/records. This, in turn, will bring about significant improvements in patient care management, patient satisfaction, patient safety, and the overall efficiency of the reimbursement cycle. By ensuring proper documentation, healthcare providers can enhance their communication and contribute to the promotion of interoperability and coordinated care. Mistakes in patient records can have serious consequences, such as compromised care, patient dissatisfaction, medical errors, reduced patient intake, noncompliance penalties, legal disputes, and delayed insurance claims. The successful execution of the improvement plan will generate more revenue for the organization through enhanced and efficient processes in reimbursement cycles and patient care activities, compensating for the previous loss of revenue. A report from the Summit Healthcare Regional Medical Center revealed that the introduction of a CDI plan had remarkable outcomes. The hospitals experienced a 20% average increase in case mix index, a 37% increase in capturing major complicating conditions, and a 22.8% increase in complicating conditions. As a result, there was a significant positive financial impact of $558,187 in just a few months (Bresnick, 2015). Current Information Management Systems By effectively implementing the clinical documentation improvement plan, employees are trained and educated on the system's efficient use, the organization's information management system will undergo improvements, which will cause various benefits. These include enhanced data for patient care, improved communication between providers to ensure coordinated care, convenient access to patient data for care management, streamlined billing and coding processes, reduced instances of denied or delayed claims because of inaccurate code assignment, and

Final Project Milestone Three: Implementation of Performance Initiative 3 ultimately increased revenue for the organization (Combs, 2022). Inaccurate codes in claims processing, due to poor clinical documentation, result in increased revenue loss. In July 2020, an OIG audit found that Medicare was overbilled by more than $1 billion due to code assignment errors, resulting in overpayments to certain providers (Aapc, 2022) (Bresnick, 2015). Current Organizational Processes To guarantee the success of the CDI plan, the top priority is to adequately train and educate staff. Without knowledge and utilization of the new system, implementing the CDI plan will not yield improved results. Healthcare organizations must update records after implementing a CDI plan to ensure accuracy for patient care and reimbursement. In order to enhance the quality and coordination of patient care, another step in the organizational process will involve improving communication channels and providing providers with access to patient information (Bresnick, 2015). Communication According to Hoffman (2009), good communication is considered a crucial attribute for a successful clinical documentation improvement specialist (CDIS). Therefore, it is the responsibility of the CDIS to make sure that the staff is adequately informed about their role in the CDI plan, the potential benefits that the organization will gain from implementing the plan, and the ongoing progress of the CDI plan. By ensuring that every member of staff is on board with the plan, we can also ensure that they understand how the plan will not only simplify but also enhance their job processes. It cannot be stressed enough how crucial training and education are, as they play a vital role in equipping staff with the necessary skills to effectively utilize the

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