2022 Stronger - P154 - Avoiding PSI and HACRP Penalties is a Team Sport - On Demand
In the federal fiscal year (FFY) 2019 Centers for Medicare & Medicaid Services Hospital-Acquired Condition Reduction Program (HACRP), three of six Sanford prospective payment system hospitals incurred a penalty. A system quality staff member reviewed patient safety indicators (PSIs) and identified opportunities to improve documentation and coding. Plan-Do-Study-Act cycles led to a standardized process involving hospital quality teams, clinical documentation improvement (CDI), coding and health information management staff. At least 70 erroneous PSIs were avoided in 27 months. Two hospitals made enough significant improvements in the PSI-90 composite to avoid penalties in two or three of the FFY 2020, 2021 and 2022 program years, saving at least $1 million.
- Healthcare Quality Professionals
- Other Healthcare Professionals
Develop a system-level PSI review process using an interprofessional team for accurate documentation and coding of inclusion/exclusion criteria.
Identify exclusion criteria specific to individual PSI.
Describe strategies to improve PSI measures and mitigate penalties.
Jeremy Morgan, MS, Senior Quality Strategist, Sanford Health, Sioux Falls, SD
Rachel Leyk, BSN, RN, CMSRN, Quality Improvement Advisor, Sanford Health, Fargo, ND
Vizient, Inc. designates this enduring material for a maximum of 0.50 ANCC contacts hours.
Healthcare Quality Professionals (CPHQ)
This activity is approved by NAHQ® for 0.50 CPHQ CE credits.
Other Healthcare Professionals (General CE Credit)
Vizient, Inc. will award a maximum of 0.50 contact hours to all other healthcare professionals who successfully complete the activity. These individuals will receive a Certificate of Participation indicating the maximum credits available.
Many state licensing boards and credentialing bodies accept certificates of participation from accredited CE activities to meet CE requirements for license renewals and re-certification. It is the responsibility of the participant to contact their state licensing board and/or certifying body for verification on credit eligibility reciprocity.
- 0.50 ANCC
- 0.50 CPHQ – Certified Professional Healthcare Quality
- 0.50 General CE – Attendance