How to take clinical documentation from zero to one hundred

IU Health Goshen | 123-bed hospital

In 2012, when Amy Floria, chief financial officer at IU Health Goshen in Goshen, Ind., looked ahead to the changes that were coming in health care, including the ICD-10 conversion, she realized the hospital needed to ensure that physicians were keeping up with the additional documentation that would be needed in the new code set.

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It wasn't that administrators had a bad relationship with the medical staff—it was more that the relationship was non-existent. And physicians didn't realize the full impact of their documentation.

Amy Floria, CFO, IU Health Goshen

"The physicians knew they had to have a really accurate physician record from a clinical perspective," Floria said. "But I don't believe they had a total [understanding of] how it impacted our reimbursement."

Dr. Denise Murphy, a general surgeon who practices at IU Health Goshen, agrees. "As a physician, we don't really think about how the chart looks. We think about how the patient is doing."

Floria knew she had to open physicians' eyes to the financial and quality impact of their documentation. Since IU Health Goshen is a small hospital with limited resources, she turned to the Advisory Board to set the groundwork for a data-driven clinical documentation program.

Starting from zero

Over the next two years, the Advisory Board's documentation experts worked with the hospital to fine-tune its CDI program, build relationships with physicians, and use Revenue Optimization Compass technology to guide the program's priorities and provide evidence to physicians of documentation opportunities.

It wasn't easy. "We were basically starting from ground zero," Floria said.

Sally Hart, the hospital's first clinical documentation improvement specialist, remembers the challenges of the early days well. "I made friends with the physicians' office staff, because in the beginning [the physicians] wouldn't even take a meeting with me."

Eventually she made in-roads with the medical staff and won over a number of staunch advocates for her work, but it wasn't until Revenue Optimization Compass went live that Hart hit her stride.

Revenue Optimization Compass, "gave me some good insight into where things were, where there might be some opportunities, and how to actually find my targets,"she said. "It was an incredible tool to work with."

Blood, sweat, and tears pay off

All the blood, sweat and tears shed in that first year started to pay off. Physicians understood the impact of what they wrote, which translated into more accurate reimbursement.

Floria attributes $350,000 in additional revenue—and a 12% increase in case mix index—in the first year of the CDI program to the focus on documentation improvement.

IU Goshen's improve case mix index and reimbursement

"Our relationship with the physicians has grown because of CDI," Floria said. "They're starting to see how they impact financially the success of the hospital...and it's just a few words that can make a big difference."

Dr. Murphy's outlook exemplifies the stronger bond. "We have to be cognizant of what's going on for the institution," she said. "We want them to succeed, because the community needs this facility."

Today, IU Health Goshen’s CDI program has added an additional specialist, and the team continues to use Revenue Optimization Compass to guide its efforts, using its analytic capabilities to monitor ongoing performance and identify additional physician training needs.

Floria knows just how important her CDI team's work is to the hospital. "The future for IU Health Goshen is bright. We're small but mighty. We don't back down from some of the challenges we face, and we really feel that we are nimble enough to be able to respond to the needs of our community"

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There’s more to this story

In just five years, we’ve helped IU Health Goshen achieve far-reaching revenue cycle transformation, a 12% margin, and a strong foundation to continue to serve the community. Learn more about how we did it.

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