Accurate documentation of major comorbid conditions (MCC) is critical for patient care and hospital reimbursement. It also directly impacts our publicly reported quality scores and value-based purchasing. In Wave 3 of the Epic Refuel, the Admission Navigator will have a new “Co-morbidities” section that suggests patient-specific diagnoses based on real-time vitals, labs, and other data points to identify potentially missed documentation.
Severity of illness levels under the Medicare Severity-Diagnosis Related Group (MS-DRG) codes are used to determine payment for hospital services. At Englewood Hospital, our clinical documentation specialists work with providers to identify documentation gaps (including MCC) and focus on deficiencies with significant revenue implications. In addition to the significant impact on reimbursement, accurate capture of co-morbidities in the medical record directly affects our predicted values for risk adjustment. The documented co-morbidities essentially determine the patient’s severity of illness, expected chance for readmission, and expected rate of major complications including death. When indicated, it is essential that any MCC is documented as present on admission. These risk-adjusted or “predicted” values, compared to our actual values, are a primary driver for many of the measurements used in our publicly reported quality scores and value-based purchasing.
As part of Wave 3, the Admission Navigator will have a new “Co-morbidities” section that suggests a diagnosis code if the specific patient meets appropriate clinical criteria for the following MCCs:
- Acute Kidney Injury
- Heart Failure
- Respiratory Failure
- Severe Protein Calorie Malnutrition
- Morbid Obesity
Please note that these embedded BPAs are not perfect tools. They are suggestions based on real-time data identified in the medical record. The physician must make a clinical determination as to whether the diagnosis is appropriate. The list of suggested diagnoses will continue to grow and the criteria for display will be refined overtime. If you find that the suggestion is inaccurate, please report it to the Epic support desk.