MS-DRG countdown: Documentation improvement

Hospitals need to understand that clinical documentation improvement is an ongoing effort and not a one-time event. This is especially true with the Oct. 1 arrival of MS-DRGs. Organizations cannot expect a one-time educational event on clinical documentation to completely change behaviors in clinicians or coders.

Current documentation improvement programs are based on the current CMS DRGs, making many elements of these programs outdated after the implementation of MS-DRGs. These programs need to be updated and hospitals should also plan for a series of physician educational events over the next few months as everyone adjusts to the new MS-DRG system.

Physician inquiries from coders are expected to substantially increase under MS-DRGs. Hospitals need to actively manage this process to minimize coder and physician productivity resulting from these increased queries. Ideas include:

1. Analyze the volume and type of physician queries from coders before Oct. 1. This establishes a benchmark for comparison purposes following the adoption of MS-DRGs.
2. After Oct. 1, any increase in physician queries should be closely monitored to determine why there is an increase (identify specific issues) and who is responsible.
3. Use this data to tailor future clinical documentation improvement efforts.
4. Analyze the physician query process to identify areas where improvements could streamline the process.
5. Get a physician champion to generate physician support and serve as a liaison between coders and physicians.
6. Stress the importance of accurately documenting present on admission (POA) indicators to physicians. (For more information about POA, read our most recent blog post on this topic by clicking here.)

Physicians need to understand that the assignment of the correct MS-DRG is directly dependent on their documentation, and each individual involved in documentation improvement needs to be aware that their actions can positively or adversely affect the organization.

Regardless of the approach to a documentation improvement program, physician buy-in is vital. Physicians must understand that any improvement in documentation practices is likely to have a positive impact on both the facility and on them personally. Physician report cards have been useful in some organizations for improving documentation practices.

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