Case Study:
Inpatient CDxI

A national health system increases CMI from 1.19 to 1.65 and increases revenue by $430 million.

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CDxI Helps Health System Increase CMI and Revenue

Many hospitals attempt to improve clinical documentation (CDI), often requiring extra resources and software implementations, and still failing to produce significant results. The key to any CDI initiative is provider and hospitalist education for more accurate charting.

Challenge

At a division of a national health system, significant resources had been added to improve documentation, case mix index and earned revenues: onsite coders, CD specialists and management consultants. Despite these multi-year initiatives, the case mix index did not reflect the true severity of illness and the revenues were far lower than they should have been with the patient population being treated.

Solution

ModusOne Health was hired to supplement the existing CDI efforts. Using the CDxI proprietary analytics, we determined which conditions were being missed most often, which posed the greatest patient risk, which presented the greatest legal risk and which cost the organization the most in lost revenue.

ModusOne then provided in-person evidence-based medicine education sessions and reference materials so providers could apply current diagnostic criteria as they saw patients. An easy-to-use mobile app reinforced the diagnostic criteria.

After the initial physician engagement, ModusOne reviewed charts on a monthly basis, scoring the accuracy of the facilities’ physician groups and individual physicians, along with the supporting information from the EMR. These “real-life” examples decreased inconsistencies and increased accuracy.

Inpatient CDxI
Case Study

A national health system increases CMI from 1.19 to 1.65 and increases revenue by $430 million.

Results
The case mix index for the hospitalists across seven hospitals rapidly rose from 1.19 to greater than 1.40 in a matter of months. As the collaboration continued into the second year, the gains continued and the CMI rose still further — above 1.65. Along with these CMI improvements, which occurred with both employed and contracted providers, came substantially higher revenues, nearly $430 million and counting. Our client was not only extremely pleased with the financial performance but also with the decrease in queries and reduction in over-documentation.
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