How Studying the Top Ten Causes of Death Can Improve Revenue

HRG-Study-Top-10-Deaths-to-Increase-Revenue

As it does every year, the Center for Disease Control (CDC) has released the top ten causes of death in the United States.

 

The 2015 list by incidence and prevalence:

  1. Heart disease: 614,348
  2. Cancer: 591,699
  3. Chronic lower respiratory diseases: 147,101
  4. Accidents (unintentional injuries): 136,053
  5. Stroke (cerebrovascular diseases): 133,103
  6. Alzheimer's disease: 93,541
  7. Diabetes: 76,488
  8. Influenza and pneumonia: 55,227
  9. Nephritis, nephrotic syndrome, and nephrosis: 48,146
  10. Intentional self-harm (suicide): 42,773

The top ten causes of death are a window into the most prevalent diseases in the United States. Healthcare organizations should focus on these conditions to find ways to improve care delivery, streamline cost, improve coding and enhance physician documentation.

Correct coding is critical to the reimbursement process. The top ten leading causes of death are the high-volumes cases, the top DRGs. Correct code assignment leads to an accurate Case Mix Index. The CMI is a measure of the relative complexity of services provided at a particular hospital. If a facility performs high-dollar services, it will receive more money per patient. When a facility sees a drop in CMI, one of the first places they look is the coding. Are the coders doing a good job? Another key culprit is physician documentation. Are the doctors painting an accurate picture of the severity of the patient illness?

A Clinical Documentation Improvement Plan is a necessity for most hospitals today. After October 1, non-specified codes will no longer be accepted, and physicians will be required to document to the appropriate level of specificity. CDI’s are helpful in getting physicians to be more specific in their documentation, and more importantly, to know the MCC/CCs that drive DRG assignment.

Healthcare organizations can study the top ten causes of death for varying trends in reimbursement. Significant discrepancies in payment must undergo a root cause analysis. Was the code assignment representative of the physician documentation? Was the physician documentation representative of the clinical indicators? Answers to these questions can pinpoint where improvements need to be made, whether it be changes to coding staff or to a decision to implement a CDI program.

As the healthcare industry shifts from volume-based to value-based reimbursement, healthcare organizations must prove they deliver quality care, failure to do so will result in lower revenue.

An ICD-10 diagnosis code search of patient databases will identify high risk patients. Medical records review of this subset can provide detailed data analysis, which will identify patterns and trends and highlight successful treatment plans and preventative measures. The specificity of ICD-10 is a great boost to this endeavor as it provides more reliable data.

The CDC list is an important one, and healthcare organizations should study this list each year for ways to provide high-quality low-cost care, enhance coding/physician documentation and deliver quality reporting. While improvements in each area lead to increased revenue, the biggest gain is improved patient outcomes, and ultimately, omission from the CDC top ten causes of death.

Kelly-Jacobus-HIM-Facility-Coding-Specialist
 

Kelly Jacobus


Director of Facility Coding for Healthcare Resource Group, Inc. 

 

Kelly Jacobus, CCS, CDIP, CHDA, CCS-P, CPC, has just under twenty years of experience in facility and professional fee coding and AHIMA Approved ICD-10-CM/PCS Trainer. Kelly also has experience in academic medicine and shares her passion for healthcare excellence with her team of dedicated, coding professionals at HRG where she is the Director of Facility Coding.

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