Pediatric Resource Group (PRG)

Can you name the administrative physician role that has the greatest impact on hospital operations? Hint: It's not the Chief Medical Officer, Chief Medical Director, Chief Quality Officer, Chief Medical Information Office or any service line medical directors. Correct answer: The Physician Advisor What is a Physician Advisor? -A physician in an administrative role who acts as a liaison between clinicians, UR/Care Management nurses, hospital admin, payers and others to facilitate efficient and high-value care. This leader ensures compliance with regulatory requirements and helps the leadership team reach overall organizational goals. What are the responsibilities of this role? -See slide 1: One Physician Advisor cannot do everything on that list. A hospital needs to decide the strategic priorities and pain points of the organization, tailor the role to meet those needs, and then staff the role appropriately. What is the return-on-investment (ROI) of the Physician Advisor? -See slide 2: It's significant. The impact of correct status determination (inpatient vs outpatient/obs), preventing/overturning denials, and following up on all CDI queries can be in the millions of dollars per year. And those are just a few responsibilities of the role. What if we already use a vendor for remote Physician Advisor reviews? -Internalizing a Physician Advisor program can save your hospital millions of dollars/year, even when factoring in the costs of paying for an internal program. In addition, an internal program creates leadership opportunities and non-clinical work that many physicians crave. You can also see greater "buy-in" from the medical staff when they interact with physician colleagues that are in this role. How can my hospital assess, optimize, train, expand, internalize, or develop a Physician Advisor program? -Contact Pediatric Resource Group (PRG) Our team of over 35 physician, nursing, admin leaders are national experts who have pioneered the role. We have pediatric and adult consultants who can provide this service for any hospital, not just pediatrics. #physicianadvisors #ACPA #revenuecycle #CMO

CDI specialists and coding auditors: Want to join the most talented and experienced pediatric consulting team in the country? Pediatric Resource Group (PRG), the only pediatric focused healthcare consulting firm, is expanding our team and also starting a new service (Pediatric Coding Assessments & Audits) If you are a pediatric CDI specialist or a pediatric coding auditor, and want remote contract/part-time work, send your resume to Ara@PediatricRG.com. Requirements: Deep knowledge of the APR-DRG or MS-DRG model Five years experience Credentials: -CDI (CCDS or CDIP) -Coding auditor (RHIA or RHIT and CCS) Make your CDI week even happier and use your expertise to help other hospitals improve their programs while earning additional income. #clinicaldocumentation #CDI #pediatrics #coding #ACDIS

We crashed the webinar platform. At the peak, we had over 6,200 CDI specialists and coders logged in to our webinar on Pediatric CDI and Pediatric Sepsis. It couldn't handle the number of people interested in pediatric/neonatal Clinical Documentation Integrity (CDI). For the folks that registered, you'll get a link to a recording of the presentation and can still get your 2 CEUs. Hospitals have woken up to the CDI opportunity on the peds floor, PICU, and NICU. Need help in assessing or developing a peds/neonatal CDI program at your hospital? Reach out to us Pediatric Resource Group (PRG) We are the only pediatric focused healthcare consulting firm in the country and CDI is our core service. #CDI #pediatrics #revenuecycle #healthcareconsulting

Sepsis is unfortunately at the top of many lists. It's the leading cause of death in U.S. hospitals. It's the most common principal diagnosis for inpatient stays in the U.S. It's also one of the most denied diagnoses by payers. Coding sepsis can often be as challenging as diagnosing it because there are a variety of definitions and changing clinical indicators that impact documentation and coding. Join Pediatric Resource Group (PRG) and Pinson&Tang on a free webinar called "SEPSIS: SIRS is Out: What's In?" on Thursday June 27th at 10a PST where we'll discuss the following: -The impact of pediatric/neonatal Clinical Documentation Integrity (CDI) programs -The evolving definition of sepsis -The new Phoenix Criteria for Pediatric Sepsis and Septic Shock Register here: https://lnkd.in/gFPHv8VP #pediatrics #cdi #sepsis #acdis

The Diagnosis Related Group (DRG) model is how the vast majority of inpatient hospital discharges are paid. The two main DRG types are: APR-DRG: All Patient Refined Diagnosis Related Group MS-DRG: Medicare-Severity Diagnosis Related Group DRGs were created by researchers at Yale in the 60's to study utilization across hospitals. Medicare started using DRGs in 1983, adopted the current MS-DRG model in 2007 and 12 state Medicaid programs pay by the MS-DRG model. APR-DRGs were created in 1990 and is currently owned by 3M and 31 state Medicaid programs use this model for payment. About 55% of pediatric discharges in the country are paid by Medicaid. Some commercial payers also pay by the APR or MS DRG model. How is the DRG created? Clinicians document, hospital coders read the entire medical record, and enter the variables seen in the attached slide into a computer software program that then creates the APR or MS DRG and severity level. Each DRG and severity level has a relative weight (RW) assigned to it. The RW is like a scale that ranks that highest resource intensity patient (based on charges) to the lowest. The higher the RW, the higher cost of care, acuity, longer expected length-of-stay and higher the payment. Hospital payment is calculated by multiplying a base rate by the relative weight. Base rate can vary by hospital and state and other multipliers or policy adjustors can be added to the formula to create higher payments for certain ages, high-medicaid hospitals, rural hospitals, etc... That payment (RW x base rate) is the entire one-time payment for the hospitalization regardless of the length-of-stay or what happened to the patient during the hospitalization in terms or studies done and treatments provided. There can be additional "outlier" payments for very high cost cases, but the majority of cases don't qualify for outlier payments. Hospital charges can play a part in DRG payment in determining outlier status but don't play any part in non-outlier cases. The biggest factor in hospital payment and severity-adjustment is the number and types of diagnoses supported by the record, documented, and coded. Clinical Documentation Integrity (CDI) programs exist to ensure the medical record and coding of the case reflects the true acuity of the patient. More diagnoses accurately documented, the higher severity-ranking and hospital payment. In the slides, you can see the DRG calculation method, an example of some APR-DRGs and their relative weights from California's Medicaid program and then hospital payment calculations for bronchiolitis, a very common admission diagnosis in pediatrics. Note the difference in payment between a hospital in CA and Texas for the exact same diagnosis and severity and the financial impact of a CDI query raising the SOI from a 2 to a 4 (highest SOI) Contact Pediatric Resource Group (PRG) to develop or optimize your CDI program #CDI #pediatrics #revenuecycle #aprdrg #msdrg

Are you using an expensive external Physician Advisor company and want to internalize your program? Or do you not have a program at all? Internalizing a Physician Advisor program will save your hospital a significant amount of money, create leadership opportunities for your own physicians, and you may even see better outcomes related to status determination, denials management, and Clinical Documentation Integrity (CDI). Pediatric Resource Group (PRG) worked with the Children's Health System of Texas (Dallas Children's & Plano Children's) and Dr. Kay Johnson to internalize and expand their Pediatric Physician Advisor program and this article in The Hospitalist describes the success of that engagement. Every hospital will eventually have a physician advisor program. PRG has physician leaders that have started and internalized adult and pediatric physician advisor programs throughout the country. #physicianadvisors #statusdetermination #denials https://lnkd.in/g_Sq3xsz

Payments for pediatric hospitalizations oftentimes don't cover the cost of care. Over 50% of pediatric discharges in the country are paid by state Medicaid programs. For some children's hospitals, it could be 75% or more. For the same diagnosis, Medicaid pays 20%-50% less than Medicare rates and orders of magnitude less than commercial (PPO) payers. The map below shows your state's Medicaid payment model. If you have any percentage of peds/NICU discharges that are paid by the DRG method (some commercial payers pay by DRG as well), you need to ensure your Clinical Documentation Integrity (CDI) team is reviewing those cases. Given the chronic underpayment for pediatrics, hospitals should be using their CDI teams to optimize severity-adjustment, CMI, and hospital reimbursement for this patient population. Pediatric Resource Group (PRG) is the only pediatric focused CDI consulting firm in the country. Our team has assessed, developed, optimized, or leads dozens of CDI programs at academic medical centers and community hospitals. Let us help you improve the financial health of your peds/NICU cases so you can expand the care provided to the neonates and children in your community.

We are receiving a lot of great feedback on the new "Pediatrics by PRG" module in the Pinson & Tang CDI Pocket Guide, which is the preeminent resource in the CDI space. If you haven't checked it out yet, take a look at the detailed review of over 40 topics that provide guidance to CDI specialists, coders, & clinicians on pediatric and neonatal conditions. This partnership is a key element of how Pediatric Resource Group (PRG) can help hospitals understand the CDI opportunity in the peds/neonatal space and tackle it confidently. If there are other topics you'd like to see, let us know, we can develop and publish those quickly. #CDI #pediatrics #Clinicaldocumentation