ACDIS Conference News

Observations on the 2013 ACDIS Annual Conference
By Robert S. Gold, MD

Nashville rocked for the sixth annual national convention for the Association of Clinical Documentation Improvement Specialists (ACDIS) during the week of May 20. The event continues to grow larger and attract more speakers with broader interest by the exhibitors, which now demonstrate more than the traditional coding, grouper, and CDI tracking software. The industry is being recognized as an essential part of the health care delivery continuum and deservedly so.

That’s the good news.

We have all heard of the upcoming changes in health care, the tracking system, and the reimbursement system—rewarding quality and penalizing those who apparently aren’t well-informed or who lack the foresight to prepare for the future. The classic model of documentation improvement programs traditionally has been aimed at increasing Medicare reimbursements, which certainly will not carry any hospital into the future. Yes, there are the challenges of incorporating EHRs and the upcoming perceived threat afforded by a change to ICD-10, but everyone has these same issues. The facilities whose documentation improvement programs have been mired in the models of the past are doomed when it comes to the future.

What I saw at the ACDIS convention was evidence of far too many people from far too many facilities trapped in the past and altogether too far from being prepared for the present, much less the future despite word of the changes having been out there for three to four years. And virtually all of the presentations, exhibits, and posters showed by members had to do with Medicare severity-diagnosis related groups (MS-DRGs), complication or comorbidity (CC) and major CC (MCC) capture rate, and how much money the program made for the Medicare patient population. And this is really sad.

How can I say these things? Well, the industry is looking forward to the universal acceptance of the concept of value-based purchasing and all that it entails. Universal means it’s not just Medicare. Sure, Medicare introduced the initiative in the public’s eye, but insurance companies already have latched on to the concept. Programs that encourage documentation of certain conditions, such as acute kidney injury whenever a patient’s creatinine levels increase after surgery or after IV dye studies when the clinical picture and measures do not meet acute kidney injury criteria either as an event or a codable event, will be destroyed with renal complications of hospital care. It’s not a financial event now, but it’s being tracked as a negative outcome. Specialists who encourage their hospitalists or intensivists to document acute respiratory failure for everyone on a ventilator whether or not they have acute respiratory failure are causing adverse events to pile up and will be avoided like the plague by patients, insurance companies, and Medicare. Forcing complication coding for dollars is an unwise move.

Seeking MS-DRG assignment change from this CC or MCC capture is one issue, but stopping the description of patient complexity just because you have the CC or MCC captured will not fly in the venue of severity-adjusted mortality, severity of illness, and length-of-stay data. And a hospital program that doesn’t address all patients, physicians, and payers will become a place where patients don’t want to deliver their baby or undergo coronary bypass or valve surgery (more are performed on pre–Medicare-age patients than on Medicare-age patients), so your overall data will be worse than elsewhere in the community. And not fully describing all of a patient’s coexisting conditions based on financial implications will hurt communications about a patient’s diseases that may need to be addressed prior to discharge to minimize readmissions. If that whole picture isn’t painted, something will be overlooked and you’ll have more than the average readmission rate—and the fines that go along with that.

So much of a hospital or physician practice’s future success depends on honesty, ethics, and forward thinking. You ignore any—or all—of these things, and you may as well look for a different line of work.

— Robert S. Gold, MD, is CEO of DCBA, Inc.