Grace Award Recipient Emphasizes Data
Analytics in Improving Patient Care
By Daisy Franco
HEALTH information management (HIM) professionals at Hospital Sisters
Health System (HSHS), Eastern Wisconsin
Division, analyzed patient population data to
inform practices in their four healthcare
facilities, which resulted in improved patient
care. The HSHS eastern division includes four
hospitals: St. Vincent Hospital and St. Mary’s
Hospital Medical Center in Green Bay, St.
Nicholas Hospital in Sheboygan, and St. Clare
Memorial Hospital in Oconto Falls.
The Grace Award is named after AHIMA’s
founder, Grace Whiting Myers. AHIMA continues the annual recognition of the Grace
Award to honor healthcare delivery organizations for their innovative approaches.
HSHS analyzed patient demographic and
population information and diagnoses to de-
termine how to best accommodate patient
population needs. They used data to support
the decision to open a wound clinic, increase
the number of intensive care unit (ICU) rooms,
increase X-ray capacity, open an intermediate
care unit, update the ICU, and expand surgical
services to include up-to-date technology and
The division implemented an electronic query process that allows physicians to answer
questions directly, which helped reduce physician queries for procedure documentation by
90 percent for patients with transcatheter aortic valve replacements. They also developed a
mortality chart review process that reduced the
observed-to-expected mortality rate.
Additionally, the division is recognized for
decreasing denials by 20 percent in six months,
saving $50,000 in software expenses due to
identified edits, improving their case mix index
(CMI) within the last year by increasing benchmark goals by 18 percent, making bedside
iPads available for patients and family members, and leading the conversation around including LGBT information in the electronic
HIM professionals at HSHS led this work
by initiating conversations, facilitating inter-
departmental groups, serving as resources, and
“This award exemplifies the commitment our
HIM team shows day in and day out, in the
spirit of providing our patients the highest
quality of care possible as they continue to seek
new and innovative ways to use the electronic
medical record,” said Therese Pandl, president
and CEO, HSHS Eastern Wisconsin Division.
AHIMA also recognized Hennepin Healthcare with an honorable mention for accomplishments in seeking growth opportunities to
serve as transformational leaders, reporting
mortality statistics, and improving CMI. n
We Want Accurate Reimbursement,
‘No More, No Less’
By Melissa Potts, RN, BSN, CDIP, CCDS
WHEN clinical documentation improvement (CDI) first became
popular, the focus was on reimbursement and
its impact on the health record, according to
Joan Dion, RHIA, CPHQ, CDIP, CCDS,
CPC, CRC, associate director, Berkeley
In her Tuesday educational presentation,
“Building an Integrated Documentation Integrity Team,” Dion discussed how CDI has
evolved to impact multiple areas including: auditing, compliance, quality initiatives, medical
necessity, length of stay, risk of mortality, severity of illness, and CC and MCC capture.
“Unlike the old days we want accurate reimbursement—no more, no less,” Dion said.
Integral to the implementation of a successful
CDI program is identifying key stakeholders in
developing, collecting, and disseminating the
documentation. Patient documentation starts
when a patient walks through the door and pa-
tient access representatives capture demograph-
ic and insurance data. For example, payer infor-
mation, gender, and age can affect reimbursement
and risk adjustment. After the patient is admit-
ted, physicians, nurses, therapists, and other
providers all document the status of the patient
as it pertains to their area of treatment.
This information can be translated into diagnoses, which also impacts reimbursement and
risk adjustment. During the admission process,
CDI reviews the chart to clarify if the clinical
language in the chart can be turned into codes
that truly express the clinical picture of that patient. After the patient is discharged, coding
professionals review the chart and translate all
of the documented diagnoses into ICD-10-
CM/PCS or Current Procedural Terminology
(CPT) codes. Quality departments also analyze
the data in the health records to verify the accuracy of the quality of care that was reported.
Revenue cycle teams are also involved to ensure reimbursement claims and denials are
processed accurately and appropriately.
A significant factor in the success of a CDI program is identifying opportunities for improvement. Healthcare institutions need to begin by
removing silos and having inter-department
communication, according to the presentation.
Health information management (HIM) de-
partments can be a catalyst in launching this
process. HIM can help to build a collaborative
team that includes professionals from the cod-
ing, CDI, patient access, revenue cycle, and
quality departments. In addition to this collab-
orative team approach, it is vital that the execu-
tive team be involved from the beginning. The
executive team should include members of the
C-suite, physician advisors, compliance offi-
cers, and risk management. It is vital that the
executives be on board in order to get buy in
from the rest of the facility.
After the team is built and functioning it is
vital to assess and implement corrective action
plans for each member of the collaborative
team, according to Dion.
There are many barriers in each of the areas.
For example, coding managers are responsible
for achieving high productivity standards but
they also have to maintain accuracy.
It’s imperative that hospitals take a “plan, do,
check, act” (PDCA) approach to building and
sustaining their programs with success, according to Dion. The goal is to have a complete
and accurate picture of the patient for billing,
coding, quality, and patient care. The PDCA
cycle will be an ongoing process that doesn’t
end as new challenges continue to appear. n