NEW PROGRAMS
CLINICAL DOCUMENTATION IMPROVEMENT ( CDI )
One of the goals of the ARHC resource center is to assist rural hospitals in maintaining and strengthening their financial resources . The resource center began working with Guidehouse , a revenue cycle optimization firm , to do a performance analysis , which showed that improving documentation and back-end revenue cycle processes could boost revenue collection and financial stability for these hospitals .
One of the most significant observations from this analysis was that many hospitals need a formal clinical documentation improvement program . A formal CDI program would help keep the doors open by improving accuracy in the coding used to determine reimbursement . Coding and its completeness and accuracy can have a major impact on a hospital ’ s bottom line .
To further dive into CDI , we contracted with Chirok Health , which works with health care organizations on quality improvement in patient care processes and accurate documentation , including CDI . The scope of the project would involve three parts :
1 . Inpatient coding and clinical documentation review : This would involve Chirok Health evaluating the completeness of clinical documentation and the accuracy of MS-DRG coding for inpatients .
2 . Professional fee-for-service coding and documentation review : This would determine whether hospital providers are accurately coding and diagnosing according to official guidelines . Chirok would review a sample of cases provided by the hospital , involving 100-200 charts .
3 . Informal review of the hospital : Once assessments are complete , Chirok would review the findings and opportunities and provide relevant education and recommendations .
The MS-DRG audits revealed that up to 22 % of the reviewed cases had a significant financial impact , ranging from $ 500 to $ 9,800 per case . Based on the professional fee-for-service audits , up to 15 % of the cases reviewed were considered to have additional financial opportunity . From the CDI audit of 4 hospitals , there was a total estimated financial impact of $ 170,000 in revenue opportunity .
Hospitals that participated in this process or have agreed to participate next year include Northwest Regional Health , Hill Hospital , Greene County Health System , Hale County Hospital , J . Paul Jones , and Whitfield Regional Medical Center .
ANTIBIOTIC STEWARDSHIP
UAB Medicine and its Division of Infectious Diseases developed a formal Antibiotic Stewardship Program to assist hospitals with their policies , procedures , and training . It also would provide an on-call liaison from the Division of Infectious Diseases who has experience in administering antibiotic stewardship programs .
Antibiotic stewardship programs are proven to improve patient outcomes , reduce microbial resistance , and decrease the spread of infection . They also help reduce improper administration of antibiotics , which leads to a decrease in antimicrobial costs .
The Centers for Medicare and Medicaid Services ( CMS ) finalized new regulations that require hospitals to create and implement an antibiotic stewardship program . The conditions of participation include standards that hospitals must meet if they are seeking CMS reimbursement . One of these new standards requires an infection prevention and control and stewardship program in order to receive payments from CMS . Therefore , it is important for the ARHC to assist our resource center hospitals in ensuring that they have antibiotic stewardship programs in place .
Participating hospitals include Regional Medical Center of Central Alabama , Mizell Memorial Hospital , Whitfield Regional Hospital , and Russell Medical . The ARHC would cover the cost of the program in the initial years .
4 Alabama Rural Health Collaborative Annual Report 2022