In 2017, Ascension’s Seton Medical Center based in Austin, Texas, was reviewing the quality of its clinical documentation improvement (CDI) solution that supports its coding services. As part of an ongoing effort to meet health system goals, Seton wanted to improve documentation that would lead to superior clinical care. CDI services assist in improving the accuracy of medical record documentation — documentation that impacts ICD-10 code selection, severity of illness, resources consumed, and quality indicators. Seton’s leadership team understood that — even with a quality coding solution — reliable CDI services help improve documentation accuracy at the time of discharge and support claims being dropped sooner. They also knew they were struggling to retain and attract qualified CDI specialists.
Seton leadership reached out to Guidehouse to discuss its CDI capabilities. For more than 10 years, Guidehouse had provided Seton with overflow coding services, recovery audit contractor diagnosis-related group (DRG) appeals, and had implemented a successful training program to help outpatient coders become inpatient coders.
Guidehouse performed an onsite CDI assessment for five Seton acute care facilities and provided a proactive, concurrent review and query approach to accurately capture care provided, severity of illness, and resource consumption.
"Our partnership with Guidehouse addressed the changing regulatory and documentation needs, and has been successful in providing real-time education to our physicians as well as real-time interventions with physicians and HIM coding."
— Maria Granzotti, M.D. Chief Medical Officer, Seton Healthcare
In coordination with Seton leadership, the Guidehouse team specifically focused on:
Assessing CDI staff knowledge
Building an outsource model
The assessment found that Seton did not have a dedicated CDI manager or have CDI staffing on weekends, causing inefficient processes and missed opportunities. Seton decided to outsource all its CDI functions to Guidehouse. The change provided a CDI solution for five of the system’s facilities: Seton Medical Center Williamson, Seton Northwest Hospital, Seton Medical Center Austin, Seton Medical Center Hays, and Dell Seton Medical Center at the University of Texas.
Seton and Guidehouse partnered to rebadge and transition all the CDI staff at each of the facilities and hired six additional employees to fill existing open CDI positions. A dedicated, experienced CDI manager was also hired to manage the day-to-day work of the CDI specialist and to work directly with the chief medical officers at each facility to develop consistent, structured approaches to physician education.
The CDI team provided real-time, concurrent documentation support to the physicians by attending multi-disciplinary rounds, medical staff department meetings, and providing monthly physician education sessions.
Collaboration between the CDI and coding team helped drive the solutions’ success. Bridging the gap between CDI and coding with DRG reconciliation resulted in accurately coded data that appropriately captures resource consumption which is critical to the organization’s quality and outcome measurements.
Together, Seton and Guidehouse established key performance indicator metrics to help measure and monitor the success of the outsourced CDI solution. In addition, Guidehouse helped revise the CDI review strategy and expanded the focus to include all patient refined DRGs, as well as implemented a coder/CDI reconciliation process.
About the Seton Healthcare Family
The Seton Healthcare Family is a faith-based nonprofit healthcare system founded in 1902 by the Daughters of Charity. Seton strives to expand access to high-quality, low-cost, person-centered care and services. Seton is a part of Ascension, the largest nonprofit health system in the U.S. and the world’s largest Catholic health system. Seton operates more than 100 clinical locations, including four teaching hospitals that are training sites for Dell Medical School at The University of Texas.