CDI Solution Improves Documentation Integrity and Coding Accuracy at Seton

Challenge 

In 2017, Seton Healthcare Family, 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.

Solution

Seton leadership reached out to Navigant Consulting, Inc. to discuss its CDI capabilities.1 For more than 10 years, Navigant 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.

Navigant 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. In coordination with Seton leadership, the Navigant team specifically focused on:

  • Assessing CDI staff knowledge
  • Building an outsource model
  • Physician education

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 Navigant. 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 Navigant 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.

Together, Seton and Navigant established key performance indicator metrics to help measure and monitor the success of the outsourced CDI solution. In addition, Navigant 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.

Results

In the first year, Navigant helped Seton achieve the following results that met or exceeded corporate goals:

1. Business process management services described herein are provided by Navigant Consulting, Inc.'s wholly owned subsidiary, Navigant Cymetrix Corporation.

Our partnership with Navigant 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.

David W. Martin, MD, FACS
Chief Medical Officer
Seton Healthcare

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