Conference Q&A: Ericson sheds light on alternative payment models
Editor’s note: Over the coming weeks leading up to the conference, we’ll take some time to introduce members to a few of this year’s speakers. The conference takes place May 9-12, at the MGM Grand in Las Vegas, Nevada. For today’s Q&A, we caught up with Cheryl Ericson, MS, RN, CCDS, CDIP,the manager of clinical documentation services with DHG Healthcare, who will present “Leveraging CDI to Improve Performance under Alternative Payment Model Methodology.” Ericson is recognized as a CDI subject matter expert for her body of work which includes many speaking engagements and publications for a variety of industry associations. She currently serves on the advisory board for ACDIS and its credentialing committee (CCDS).
Q: Could you tell me a bit about what makes Alternative Payment Models (APM) different for CDI?
A: Participation in voluntary APMs is very complex and requires a high level of commitment from the healthcare organization. More than 800 hospitals, however, are required to participate in the Comprehensive Care for Joint Replacement Model (CJR) and an additional 1,100 or more hospitals will be required to participate in the episode payment for AMI and coronary artery bypass grafts (CABG). Because participation is based on randomly selected Metropolitan Statistical Areas (MSAs) many hospitals may be unprepared for the impact. These models are retrospective so the hospital is paid as usual under the applicable MS-DRG, but following the completion of the performance year the hospital may be required to return some of their payment to Medicare or they may receive an additional payment. This type of model, like many of the outcome measures included in the mandatory value-based methodologies, require CDI specialists to look beyond the current episode of care. The mandatory quality programs, however, only use a 30-day timeframe. In comparison, an episode of care in the APMs extends 90 days beyond hospital discharge or the date of surgery.
Q: What are three things attendees can expect from your session?
A: Attendees can expect to learn:
- The difference between the mandatory value-based programs such as HVBP, HRRP, HACRP, and mandatory APMs
- A better understanding of the mandatory bundled/episode based payment methodologies
- Strategies to incorporate into the CDI process to accurately reflect organizational performance under the mandatory bundled/episode payment methodology
Q: What is one tool CDI professionals cannot live without?
A: A grouper that supports risk-adjustment efforts.
Q: In what ways does your session challenge CDI professionals to think outside the box?
A: As the fee-for-service population decreases, which was reliant on CC and MCC capture, CDI specialists need to understand and modify their efforts to reflect modern CMS reimbursement strategies to support organizational financial health.
Q: What are you most looking forward to about this year’s conference?
A: Like most, I enjoy reconnecting with friends. I have the added bonus of reconnecting with former ACDIS Boot Camp participants. It’s great to learn how people have advanced in their career as the CDI profession continues to grow!
Q: Fun question: What is your favorite candy?
A: Dove Promises dark chocolate with almonds. Yum!