Speaker Q&A: The increasing importance of severity and risk adjustment CDI efforts

Are you looking to develop a better understanding of the APR-DRG methodology and how SOI/ROM can improve risk-adjusted metrics? Join Katy Good, RN, BSN, CCDS, who, along with Laura Saldivar, CCS, CPC, COC, will present “SOI/ROM: The Increasing Importance of Risk-Adjusted Metrics” tomorrow at 9:15 a.m. in room C111, Level 1.

Q: Tell me a little bit about how SOI/ROM can improve risk-adjusted metrics, and your experiences incorporating this into your review process?

A: Healthcare is quickly shifting into an outcomes-based system, which means that hospitals are focusing in on areas where we can improve quality data to accurately reflect care. Risk-adjusted metrics rely on the ratio between an ‘observed’ outcome and an ‘expected’ outcome. Both of these factors need to be considered when attempting to ensure that metrics are accurate. Although CDI specialists cannot typically affect an observed outcome, we can have an effect on the patient’s expected outcomes by ensuring the physician accurately describes the patients’ severity of illness. When severity of illness is accurately assessed, risk-adjusted metrics will likely improve. Incorporating this in an existing review process essentially means moving beyond a focus on CC/MCC capture and DRG maximization. By paying closer attention to APR-DRGs, rather than MS-DRGs, a program can optimize the effectiveness of existing reviews.

Q: What are three things attendees can expect from your session?

A: This session should be seen as an introduction to risk-adjusted metrics and APR-DRGs. Attendees should expect to:

• Appreciate the difference between the APR-DRG system and the MS-DRG system
• Identify the impact of APR-DRGs on risk-adjusted metrics and payment
• Understand how to use APR-DRGs in their review process to improve risk-adjusted metrics

Q: Who should attend your presentation and why?

A: This presentation is likely best for those existing programs who are interested in moving beyond MS-DRG reviews—CDI professionals who understand the basics of CDI, but are interested in leveraging this knowledge to maximize their value to the hospital.

Q: What do you think is the most important quality for a CDI professional to have?

A: CDI professionals must be internally motivated. Much of what CDI specialists do is truly self-directed and it is up to the individual to determine the how much energy they want to put into this profession. The opportunities are limitless, and I love working with people that are passionate about what they do.

Q: What are you most looking forward to about this year’s conference? What is your favorite part of the conference?

A: Networking is incredibly important in this field. I truly appreciate my relationships with other CDI professionals outside of my organization because these relationships have helped me grow. I love seeing the innovative things that programs are doing outside of the traditional CDI role. I am especially interested in how programs are interacting with other departments and how CDI can be leveraged to help facilities meet their larger goals.