Articles:  January-February 2007

Monica Hardy-Johnson, EdD, RHIA

Campaign: Save the Region
Monica Hardy-Johnson, EdD, RHIA
FHIMA Director

One afternoon after leaving a poorly-attended regional meeting, I was in my car driving to meet my best friend for lunch. I was thinking about how I could energize HIM professionals and increase participation in our region. Then it hit me - have a drive or campaign to save the region. If attendance and participation at regional meetings are low, why not go to the leaders/decisions-makers to find out why staff is not attending the meetings?

The brainstorm described above became reality in the Northeast Region in six steps; I called it Campaign: Save the Region. With the assistance of the former FHIMA Director (Dwan Thomas-Flowers, MBA, RHIA, CCS) and the current NEFHIMA President (Carnell Hansley, MBA, RHIA), a campaign to save our region was launched September, 2006.

Step 1: Roster of HIM Leaders

It is always a good idea to develop a plan to provide direction. My plan started with an excel spreadsheet that listed every facility, and HIM director in the region. Of course, this was not a quick task because for those I did not know, I had to either call my fellow HIM colleagues for assistance or call each facility and ask for the HIM department to find out who the director was. At first, I thought this would be easy; just call the regional secretary and get that information, but be advised; every HIM director may not be a member of the regional association. In addition to the director’s name, I wanted the names of the managers or supervisors just in case the director was not available. I also included directors/educators in our local colleges because it is imperative that we bridge the gap between theory and practice. My spreadsheet consisted of 5 columns: name, title, facility, phone number and e-mail address. Once all this information was compiled, I created an e-mail distribution list so I could e-mail everyone at once.

Step 2: Meeting Preparation

The next step in my plan was to figure out the best time, day of the week and location to have a meeting. The first challenge was time. I automatically selected the lunch hour, but given the fact that most directors are so busy, many do not get to eat lunch. So, an incentive was required. The next challenge of choosing a day of the week came down to the question, “what days are the busiest?” There were numerous concerns with this one; so, I chose Friday simply because it was the end of the week. I figured I could charm the directors to get an early start on their weekend. One thing is for sure; the best day of the week was definitely a topic of discussion because determining high volume days was critical if we wanted more involvement in the regional association. Finally, the challenge with location was finding a central place, since everyone was so spread out. I called a few colleagues to get input because I am directionally challenged. Unfortunately, everyone was going to have to drive because nothing was really central. Restaurants, libraries, and hotels were all considered, but I had to factor in money, time, technical equipment, and most importantly, making this an informative meeting (avoiding noise and distractions). I ended up choosing a conference room in one of the local facilities because it met the criteria of being large, comfortable, decent travel, no cost, and fully-equipped for technology and food.

Step 3: Meeting Incentives (Food & CE Certificate)

Since I am so passionate about this profession, I thought saving the region was incentive enough for the leaders to meet. However, the reality of the matter is although people care, involvement in the regional association is voluntary and does not pay. So, I had to find a way to make it worth the leaders’ time to leave their offices. Although this was for the region, I did not want to heavily involve the regional officers because they had enough on their plates with regular meetings. I also knew that given the poor attendance, the budget was low. Therefore, I prepared to pay for lunch even if I could not be reimbursed. I called a local restaurant, and they had a “lunch meeting” item on the menu, which included food, drink and complete set-up.  I then thought about the purpose of the meeting and topics to be discussed. I referenced the AHIMA website, realized that I could offer a CE and had a CE certificate designed especially for this meeting.

Step 4: Meeting Set-Up (Agenda, Presentation & Sign-In Sheet)

Once I begin thinking about the topics to be discussed for the CE credit, I thought it best to draft an agenda. I wanted the meeting to run smoothly and for everyone to fully understand the purpose of the meeting up front. The agenda items consisted of welcome, introductions, purpose, national and state level updates, how these updates impact the region, the importance of maintaining the region, the challenges the region is currently facing and how we can improve the regional association. A PowerPoint presentation was developed to mirror the agenda. The slides were in bullet format because the meeting was to be very interactive. I served more as a facilitator than a presenter. Finally, I created a sign-in sheet. Although simple, this is very important as it serves as documentation for attendance and distribution of the CE certificates.

Step 5: Survey

After every regional meeting, in addition to the evaluation, a survey is distributed to the membership to find out if the meeting dates, location, time, topics, etc. are meeting their needs. I took that survey and reformatted it by expanding the questions and adding more questions to see if we could identify the root cause of the poor attendance and participation. The survey was instrumental and prompted in-depth discussion. I was surprised to find that may HIM professionals do not see the value in attending the meetings because CE credits can be acquired through other venues. However, this meeting allowed us to remind the leaders that meetings are about more than just CE credits; they are also a way to network, gather resources, encourage, and to stay abreast of industry changes (which should be apart of each employees performance appraisal). It also forced everyone to think outside of the box--possibly conducting more non-traditional meetings than the traditional face-to-face meetings.

Step 6: Flyer

Last but certainly not least, I wanted to extend an invitation to the leaders in a colorful, concise manner. The flyer had to be a little different from the norm; so, I used business

meeting clipart and in big letters stated “ATTENTION, ATTENTION - CALLING ALL HIM LEADERS”. The flyer answered the basic questions who, what, when and where. It also let the leaders know that lunch would be served and a CE credit would be provided. Prior to attaching the flyer, I prepared an invitation style e-mail. I wanted to add a personal touch by letting the HIM leaders know that as a state director this year, it is my goal to not only be a cheerleader for the profession but also a cheerleader for our region as we are the “NOBLE, NOTABLE, NORTHEAST REGION”.

It is my hope that all HIM professionals, especially those that are board members, committee chairs and regional officers will read this article and reach out to the HIM leaders in your areas and motivate/encourage them to join forces to not only save their regions, but to advocate for our profession!  If you have any questions, need ideas or copies of materials already developed, please feel free to contact me via e-mail at: monica.hardyjohnson@jax.ufl.edu

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The Present On Admission Reporting Requirement:  Are You Ready?
Carla Gaines, MPH, RHIA, CCS
FHIMA Director

The AHCA inpatient data reporting rule (Chapter 59E-7) was modified in 2005 to incorporate the national guidelines for reporting present on admission (POA).  The POA indicator applies to diagnosis codes for claims involving inpatient admissions to licensed general acute care hospitals and takes effect for all inpatient discharges on or after January 1, 2007.  The POA requirement basically states that for each diagnosis and external cause of injury code reported, a POA Indicator must be assigned.  It is based on conditions known at the time of admission and those conditions that were clearly present, but not diagnosed, until after the admission took place. 

The National Uniform Billing Committee (NUBC) defines POA as present at the time of the order for inpatient admission occurs.  Conditions that develop during an outpatient encounter, including emergency department, observation, or outpatient surgery, are considered as present on admission. The reporting options for POA are as follows:

     Y-Yes (present at the time of inpatient admission)

     N- No (not present at the time of inpatient admission)

     U- Unknown (documentation is insufficient)

     W- Clinically undetermined (provider is unable to clinically determine whether
          condition was present on admission or not must be documented as such by
          the provider)   

     Unreported/Not Used  (Exempt from POA reporting)   This option is the only
     circumstance in which the POA field is left blank.  For a complete listing of
     these diagnoses; refer to Appendix I of the Official Coding Guidelines
     October 1, 2006 available on the National Center for Health Statistics website.

The following dates are important to remember:

• January 1, 2007, POA Indicator required by AHCA

• March 1, 2007 UB-04 Implementation  required for Receivers (ie health plans, clearinghouses

• March 1, 2007 – May 22, 2007 Submitters (health care providers, (e.g., hospitals, skilled nursing facilities, hospitals) can use either UB-92 or UB-04

• May 23, 2007 All institutional paper claims must use UB-04 (to date POA has not been approved for use on electronic claims

In order to promote data integrity, coders, health care providers and all staff responsible for or involved in collecting or reporting POA Indicators must work together to ensure that documentation is consistent and complete. Medical record documentation from the provider (a physician or any qualified healthcare practitioner who is legally accountable for establishing the patient’s diagnosis) must clearly delineate those conditions that were present on admission but diagnosed within the hospital stay. Organizations who have not begun educating and informing their medical staffs must start now and act quickly to ensure that each provider understands their role and the additional documentation requirements. Coders should rarely have to query the provider as to whether or not a condition was present on admission nor should the reporting option U be over reported to compensate for lacking documentation.  It is also important that individuals responsible for billing claims and submitting quarterly AHCA data stay tuned for updated information on the UB-04 and other state reporting guidelines.

For additional information on the State and Federal POA reporting requirements, please visit the Centers for Medicare Services, American Hospital Association, Florida Hospital Association, National Center for Health Statistics websites.

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An Update on the Activities of the GHIIAB – Steps Taken and Future Path
Carolyn Glavan, MS, RHIA

Background

In May 2004, Governor Jeb Bush called for the creation of a plan for development and implementation of a Florida health information infrastructure.  He established a Board, called the Governor’s Health Information Infrastructure Advisory Board (GHIIAB), to develop the implementation plan and advise AHCA along the way.  One requirement for the plan was that it protects privacy and security of health information.  The GHIIAB set up a group called the Privacy and Security Project to meet this requirement.

The First Step

The members of the Privacy and Security Project met and decided to set up a step by step plan.  The first step was to set up a sub-group called the Variations Work Group.  This group was formed to identify various practices regarding the exchange of information by health care providers in Florida.  They wanted to see how information was released by providers, what policies providers followed when exchanging information.  The group analyzed both hospital and physician methods for releasing information.  They also identified barriers providers encountered when releasing information. Some of these barriers include:  inconsistent state laws, lack of knowledge about these laws and HIPAA.  The Variations Work Group wrote down their findings, submitted the information back to the Privacy and Security Project group and was disbanded.

The Second Step

The next group to take over in the implementation plan was the Legal Work Group.  This group was given the task of identifying legal aspects behind the practices of releasing information that were uncovered by the Variations Work Group.  The Legal Work Group conducted a legal review of applicable laws relating to health information exchange, including laws relating to the release of information, authorizations, HIPAA, etc.  The group then developed a listing of legal barriers to exchanging health information in various types of settings and situations.  This group found that most of the barriers fell into 3 main categories:  Inconsistent state laws, Inconsistent Federal Laws and health care provider knowledge of laws and regulations regarding exchanging health information.  They passed their findings off to the Solutions Work Group, the next work group in the process.

The Third Step

The third step in the process was the formation of the next work group, called the Solutions Work Group.  This group was given the materials generated by the Legal Work Group and their job was to identify solutions to the barriers identified by the Variations Work Group while keeping in mind the legalities researched by the Legal Work Group.  The Solutions Work Group came up with 38 solutions and fitted these into one of five categories: legislative action, regulatory action, technological solutions, administrative/organizational action and public education. Some of the solutions proposed include:  consolidating state statutes related to the exchange of health information to resolve any conflicts between Florida Law and HIPAA, introduce legislation to create the Florida Health Information Network (FHIN), recommend ways to reconcile differences between state and federal laws, establish procedures for health information exchange between stats in the event of a national disaster, establish a standardize patient consent form and educate the public on how to access and manage their health information.  These recommendations were then passed on to the next work group.

The Fourth Step

The next step was the recent convening of the Implementation Plan Work Group. This group is charged with going through each solution recommended by the Solutions Work Group and developing a workable implementation plan for each solution.  The Implementation Plan Work Group is still in progress.  At this time they are determining if each solution should be eliminated, consolidated or amended.  They are also working on working on developing an outline implementation plans that are actionable at national, state, or local or individual community or organizational levels. They will also be determining which solutions may be better suited for implementation at which level and the key stakeholder groups or organizations that should be responsible for implementation of the proposed solution.

The Future Path

The legislature has called for the development an electronic health information network for the sharing of electronic health records. Furthermore, the Legislature provided $2 million in funding for the Florida Health Information Network Grants Program in FY 2006-2007. Funding this program has spurred local communities to develop local health information exchanges and groups of stakeholders interested in developing health information exchange have formed organizations called Regional Health Information Organizations (RHIOs).  Although still in the initial phases of development, three RHIOs (Big Bend RHIO, Palm Beach Community Health Care Alliance, and Tampa Bay RHIO) are currently operating networks that can be accessed by hospitals and physicians participating in the RHIO. An additional four organizations have received FHIN grants and these RHIOs will begin to exchange data in 2007.

The development of the Florida Health Information Network (FHIN) is an undertaking driven by the GHIIAB and AHCA and supported by the health care stakeholders of Florida.  The initiative proposes an Internet-based, statewide network that will integrate communications and data transfer among local health information networks (HINs) and RHIOs, establish standards for health information exchange and promote health information exchange among authorized healthcare providers. The FHIN will maintain a state-level server that functions as the highest level server in a statewide client/server hierarchy. The FHIN will make data communications among Regional Health Information Organizations RHIOs and HINs more efficient and timely, reduce bandwidth usage across the network and increase the effectiveness of health information exchange on a statewide basis.

All of the work done by the various Work Groups under the direction of the GHIIAB will help provide a foundation for Florida’s participation in the creation of a Nationwide Health Information Network.  The Privacy and Security Project will conclude in March 2007, and the end product will be presented to a state and national audience. 

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