Modern Practice Podcast

Documenting chronic fatigue and debilities, Part 2

On this episode, Tomas continues examining an area often overlooked in documentation – chronic fatigue and debilities. Joining him is a leading expert on clinical documentation improvement. She will demonstrate how crucial this area is to reimbursement and patient care, affecting as it does mortality, length of stay and other indicators.
 
Moderator:Tomas Villanueva, DO, MBA, FACPE, SFHMSenior PrincipalClinical Operations and QualityVizient
Guests:Rachel Mack, MSN, RN, CCDS, CDIP, CCS, CRCConsulting DirectorClinical Documentation ImprovementVizient
 
Show Notes:[00:37] Additional conditions in the Vizient variable[04:57] Impact on direct costs[05:46] SDOH Coding guidelines and subsequent reluctance to document[04:50] Under-documented medical conditions and their ramifications[09:08] Barriers to capturing this Vizient variable and use of queries[11:10] How correct documentation can benefit patient care down the line
 
Resources:
To contact Modern Practice: modernpracticepodcast@vizientinc.com 
Rachel’s email: rachel.mack@vizientinc.com  
 
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Documenting chronic fatigue and debilities, Part 1

An area often overlooked in documentation can be crucial to reimbursement and efficacious care, and that is the realm of chronic fatigue and debilities. Joining Tomas is a leading expert that will explain the importance of accurate coding for these patients..
Moderator:Tomas Villanueva, DO, MBA, FACPE, SFHMSenior PrincipalClinical Operations and QualityVizient
Guests:Rachel Mack, MSN, RN, CCDS, CDIP,  CCS, CRCConsulting DirectorClinical Documentation ImprovementVizient
 
Show Notes:[01:07] Defining chronic fatigue and debilities[02:27] G, R and Z codes[03:19] Codes that capture Vizient variable for chronic fatigue and debilities[04:50] Under-documented medical conditions and their ramifications
 
Resources:
To contact Modern Practice: modernpracticepodcast@vizientinc.com
Rachel’s email: rachel.mack@vizientinc.com
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Annual coding update, Part 2

This episode of our award-winning podcast continues an examination of the recent updates to the coding guidelines released by the Centers for Medicare and Medicaid Services (CMS). Knowing these guidelines is crucial to practices and healthcare organizations for accurate reporting and reimbursement. Two leading clinical documentation experts join Tomas in this critical discussion.
 
Moderator:Tomas Villanueva, DO, MBA, FACPE, SFHMSenior PrincipalClinical Operations and QualityVizient
Guests:Sheila Bowlds, MBAAssociate PrincipalClinical Documentation ImprovementVizient
Jim Tamburini, BS, RHIT, CCS, CCS-P, CDIPSenior Consulting DirectorClinical Documentation ImprovementVizient
 
Show Notes:
[00:35] Increase to DRG relative weights and to reimbursement`
[02:54] Changes to coding guidelines
[05:37] Codes involving social determinants of health (SODH)
[07:06] Documenting SDOH
[08:48] Other changes
 
Links | Resources:
To contact Modern Practice: modernpracticepodcast@vizientinc.com
Sheila’s email: sheila.bowlds@vizientinc.com
Jim’s email: james.tamburini@vizientinc.com
ICD-10-CM Official Guidelines for Coding and Reporting: https://www.cms.gov/files/document/fy-2024-icd-10-cm-coding-guidelines.pdf
 
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Annual coding update, Part 1

Every year, the Centers for Medicare and Medicaid Services (CMS) makes revisions, additions and deletions to the coding guidelines that healthcare organizations and practices use for reporting, billing and reimbursement. The guidelines for 2024 include a number of new guidelines dealing with social determinants of health (SDOH) issues. It is crucial for practices to fully understand all the guideline updates for accurate reporting and maximized reimbursement. In the next two episodes, Tomas discusses the latest coding guidelines with two leading clinical documentation experts.
Moderator:Tomas Villanueva, DO, MBA, FACPE, SFHMSenior PrincipalClinical Operations and QualityVizient
Guests:Sheila Bowlds, MBAAssociate PrincipalClinical Documentation ImprovementVizient
Jim Tamburini, BS, RHIT, CCS, CSS-P, CDIPSenior Consulting Director Clinical Documentation ImprovementVizient
Show Notes:
[01:39] Background and explanation of CMS coding updates
[03:19] When changes go into effect
[03:37] Impact on providers and hospitals
[04:42] Number of diagnosis and procedure codes added, deleted and revised
[06:48] Specificity drives the documentation
[07:26] Changes to complications/comorbidities (CCs) and Major complications/comorbidities (MCCs)
[11:58] Changes to DRGs and MS-DRGs
 
Resources:
To contact Modern Practice: modernpracticepodcast@vizientinc.com
Sheila’s email: sheila.bowlds@vizientinc.com
Jim’s email: james.tamburini@vizientinc.com
ICD-10-CM Official Guidelines for Coding and Reporting: https://www.cms.gov/files/document/fy-2024-icd-10-cm-coding-guidelines.pdf
 
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A comprehensive approach to reducing PSIs, Part 4

On this episode of our award-winning podcast, we finish our feature on an organization that has made huge strides in reducing Patient Safety Indicators (PSIs) throughout health system. We will discuss the phenomenal results of the initiative so far and what is planned for the near future at Sanford Health.
 
Moderator:Tomas Villanueva, DO, MBA, FACPE, SFHMSenior PrincipalClinical Operations and QualityVizient
Guests:Rachel Leyk, RN, CMSRN, CPHQImprovement AdvisorQuality and Safety – FargoSanford Health
Devendranath (Dev) Mannuru, MD, CHCOMInternal Medicine HospitalistCDI and Quality Physician AdvisorSanford Hospital – Fargo
Khaled Zreik, MDDirector, Critical CareAcute Care SurgeonSanford Health
 
Show Notes:
[00:39] Use of data in managing PSI reduction
[03:14] Results of a successful program
[04:05] Lessons learned
[08:15] Expanding and standardizing throughout the enterprise
 
Links | Resources:
To contact Modern Practice: modernpracticepodcast@vizientinc.com
Rachel Leyk’s email: rachel.leyk@sanfordhealth.org
Dr. Mannuru’s email: devendranath.mannuru@sanfordhealth.org
Dr. Zreik’s email: khaled.zreik@sanfordhealth.org
PSI ACS Poster: PSI ACS Poster Final.pdf
2023 Quality and Safety Conference presentation: 2023-qsc-ppt-final presentation.pptx
 
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A comprehensive approach to reducing PSIs, Part 3

On this episode of Modern Practice, we continue highlighting an organization that has made huge strides in reducing Patient Safety Indicators (PSIs) throughout health system.
 
Moderator:Tomas Villanueva, DO, MBA, FACPE, SFHMSenior PrincipalClinical Operations and QualityVizient
Guests:Rachel Leyk, RN, CMSRN, CPHQImprovement AdvisorQuality and Safety – FargoSanford Health
Devendranath (Dev) Mannuru, MD, CHCOMInternal Medicine HospitalistCDI and Quality Physician AdvisorSanford Hospital – Fargo
Khaled Zreik, MDDirector, Critical CareAcute Care SurgeonSanford Health
 
Show Notes:
[01:06] Managing PSI notifications to staff – keeping it non-punitive
[03:46 Escalation process versus peer review – addressing practice variation
[05:12] Keys to achieving collaboration
 
Links | Resources:
To contact Modern Practice: modernpracticepodcast@vizientinc.com
Rachel Leyk’s email: rachel.leyk@sanfordhealth.org
Dr. Mannuru’s email: devendranath.mannuru@sanfordhealth.org
Dr. Zreik’s email: khaled.zreik@sanfordhealth.org
PSI ACS Poster: PSI ACS Poster Final.pdf
2023 Quality and Safety Conference presentation: 2023-qsc-ppt-final presentation.pptx
 
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A comprehensive approach to reducing PSIs, Part 2

This episode of our award-winning podcast continues the success story of how Sanford Health has reduced PSIs through a concerted, multifaceted effort throughout the organization. Tomas interviews members of the clinical team that guided the way.
 
Moderator:Tomas Villanueva, DO, MBA, FACPE, SFHMSenior PrincipalClinical Operations and QualityVizient
Guests:Rachel Leyk, RN, CMSRN, CPHQImprovement AdvisorQuality and Safety – FargoSanford Health
Devendranath (Dev) Mannuru, MD, CHCOMInternal Medicine HospitalistCDI and Quality Physician AdvisorSanford Hospital – Fargo
Khaled Zreik, MDDirector, Critical CareAcute Care SurgeonSanford Health
 
Show Notes:
[00:34] Surgeon’s perspective
[02:04 Role of nurse reviewer
[03:18] Necessities for success
[04:05] Importance of executive leadership; need to be non-punitive (the “gold nugget”)
[06:37] Reliable software and establishing the stop bill process
[08:15] Involving HIM, coding and the CDI team
[10:36] Engaging the clinical staff
 
Links | Resources:
To contact Modern Practice: modernpracticepodcast@vizientinc.com
Rachel Leyk’s email: rachel.leyk@sanfordhealth.org
Dr. Mannuru’s email: devendranath.mannuru@sanfordhealth.org
Dr. Zreik’s email: khaled.zreik@sanfordhealth.org
PSI ACS Poster: PSI ACS Poster Final.pdf
2023 Quality and Safety Conference presentation: 2023-qsc-ppt-final presentation.pptx
 
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A comprehensive approach to reducing PSIs, Part 1

Developed by the Agency for Healthcare Research and Quality (AHRQ), Patient Safety Indicators, or PSIs, represent measurements of adverse events that enable healthcare organizations to gauge how they compare to others regarding patient safety. In addition, CMS looks at PSIs in scoring and penalizing organizations. In this series, Tomas talks with members of a clinical team that has seen great results in reducing PSIs throughout the organization.
 
Moderator:
Tomas Villanueva, DO, MBA, FACPE, SFHM
Senior Principal
Clinical Operations and Quality
Vizient
 
Guests:
Rachel Leyk, RN, CMSRN, CPHQ
Improvement Advisor
Quality and Safety – Fargo
Sanford Health
 
Devendranath (Dev) Mannuru, MD, CHCOM
Internal Medicine Hospitalist
CDI and Quality Physician Advisor
Sanford Hospital – Fargo
 
Khaled Zreik, MD
Director, Critical Care
Acute Care Surgeon
Sanford Health
 
Show Notes:
[02:00] Patient Safety Indicators (PSIs) defined
[02:46] PSI-90 and individual PSIs
[03:43] Hospital Acquired Conditions Reduction Program (HACRP)
[05:06] Documentation and the “dotted line” to quality
[05:44] Benchmarking with the Vizient Clinical Data Base
[06:23] Focused objectives for the PSI reduction program
[07:34] Steps in building the program structure
[09:35] Addressing gaps in education – once clinicians know what to do, they don’t fail
 
Resources:
To contact Modern Practice: modernpracticepodcast@vizientinc.com
Rachel Leyk’s email: rachel.leyk@sanfordhealth.org
Dr. Mannuru’s email: devendranath.mannuru@sanfordhealth.org
Dr. Zreik’s email: khaled.zreik@sanfordhealth.org
 
PSI ACS Poster: PSI ACS Poster Final.pdf
2023 Quality and Safety Conference presentation: 2023-qsc-ppt-final presentation.pptx
 
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Facing hostile patients, Part 2

Physical violence in the healthcare workplace is on the rise. Healthcare workers are more in danger of violence than are police officers or prison guards. Looking at the labor force in general, healthcare workers have five times the likelihood of facing violence than workers across all other industries. And that doesn’t include the verbal abuse. Clinicians need skills to defuse conflict and hopefully settle down hostilities before they get out of hand. On this episode, Tomas and Cecilia finish their discussion with some helpful tips.
 
Moderator:Tomas Villanueva, DO, MBA, FACPE, SFHMSenior PrincipalClinical Operations and QualityVizient
Guest:Cecilia Cruz, MD, MPH, CPCC, ACCFounder and Chief Executive OfficerMarpe, LLCBoard-certified emergency medicine physicianFormer co-chair of QualityDivision of Emergency MedicineNorthShore University HealthSystem
 
Show Notes:
[00:39] Influences and attitudes from culture/media
[02:14] The pandemic factor; example from CoxHealth
[04:15] Prevalence of incivility
[05:53] Paying attention to the signs; observation skills to use; actions to take
[09:00] Give the situation the same importance that patients and families give it
[09:46] Tools clinicians can use – Marpe’s role in alleviating violence
[11:35] A symptom of the healthcare crisis
 
Links | Resources:
To contact Modern Practice: modernpracticepodcast@vizientinc.com
Dr. Cruz’s email: ceciliacruz@marpejourney.com
Dr Cruz’s Linkedin page:
Cecilia Cruz - Founder and CEO - MARPE, LLC | LinkedIn
MARPE, LLC website:
https://www.marpejourney.com/
 
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Facing hostile patients, Part 1

The hospital is increasingly becoming a hostile environment, with clinicians facing verbal abuse and physical violence from patients and their families. Clinicians need skills to defuse conflict and hopefully settle down hostilities before they get out of hand. If calming hostilities is not possible, they need to know what to do in the face of violent confrontation. On this episode, Tomas discusses patient hostility with a leading expert on the topic.
 
Moderator:Tomas Villanueva, DO, MBA, FACPE, SFHMSenior Principal, Clinical Operations and QualityVizient
Guest:Cecilia Cruz, MD, MPH, CPCC, ACCFounder and Chief Executive OfficerMarpe, LLCBoard-certified emergency medicine physicianFormer co-chair of QualityDivision of Emergency MedicineNorthShore University HealthSystem
 
Show Notes:
[01:41] Patient hostility on the rise
[02:43] Verbal violence is most prevalent, and the most unreported
[03:19] Cleveland Clinic: violence four times more prevalent in health care
[04:08] Health care workers more exposed than prison guards and police officers
[04:39] Higher risk of assaults for nurses
[05:26] Biggest risk in high-acuity settings – ambulances, EDs, ICUs, psych units
[06:10] Reasons/origins
[08:52] Patient families as source of conflict
 
Links | Resources:
To contact Modern Practice: modernpracticepodcast@vizientinc.com
Dr. Cruz’s email: ceciliacruz@marpejourney.com
Dr Cruz’s Linkedin page: Click here
MARPE, LLC website: Click here
 
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