P73. Clinical review of spine surgery patient safety indicators avoids CMS payment reductions

Abstract

BACKGROUND CONTEXT The Hospital Acquired Conditions Reduction Program provides a financial incentive to reduce Patient Safety Indicators (PSI), defined as potentially preventable hospital-related events associated with harmful outcomes for patients. PSI are identified by ICD coding. However, ICD coding does not always reflect the true medical course of the patient. PURPOSE To determine if addition of a clinician to the review process results in a reduction of incorrectly generated PSI. STUDY DESIGN/SETTING Retrospective chart review. PATIENT SAMPLE Patients who had spine surgery at a single institution from 2015 to 2019. OUTCOME MEASURES N/A METHODS All PSI generated at our institution were collected over a 57-month period. The number and type of spine-related PSI were compared before and after the implementation a clinical reviewer to identify incorrectly generated PSI. The financial impact of this intervention was also calculated. RESULTS From 2015 to 2019, a total of 1,290 PSI were reported with 140 (11%) attributable to spine surgery. Prior to implementation of a clinical reviewer, 112 PSI were reported over 40 months (2.8 PSI/month). Following implementation, 28 PSI were reported over 17 months, a statistically significant decrease by 1.2 PSI/month (p<0.000). In addition, 10 different PSI types were reported prior to, compared to six after implementation. This resulted in our organization avoiding a 1% CMS cost reduction, ranging from $3 to 4 million. CONCLUSIONS Implementation of a review process with clinician collaboration to ensure ICD-10 coding accurately reflects the medical course for a patient may lead to more precise PSI reporting, with substantial cost-savings for hospitals. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs. The Hospital Acquired Conditions Reduction Program provides a financial incentive to reduce Patient Safety Indicators (PSI), defined as potentially preventable hospital-related events associated with harmful outcomes for patients. PSI are identified by ICD coding. However, ICD coding does not always reflect the true medical course of the patient. To determine if addition of a clinician to the review process results in a reduction of incorrectly generated PSI. Retrospective chart review. Patients who had spine surgery at a single institution from 2015 to 2019. N/A All PSI generated at our institution were collected over a 57-month period. The number and type of spine-related PSI were compared before and after the implementation a clinical reviewer to identify incorrectly generated PSI. The financial impact of this intervention was also calculated. From 2015 to 2019, a total of 1,290 PSI were reported with 140 (11%) attributable to spine surgery. Prior to implementation of a clinical reviewer, 112 PSI were reported over 40 months (2.8 PSI/month). Following implementation, 28 PSI were reported over 17 months, a statistically significant decrease by 1.2 PSI/month (p<0.000). In addition, 10 different PSI types were reported prior to, compared to six after implementation. This resulted in our organization avoiding a 1% CMS cost reduction, ranging from $3 to 4 million. Implementation of a review process with clinician collaboration to ensure ICD-10 coding accurately reflects the medical course for a patient may lead to more precise PSI reporting, with substantial cost-savings for hospitals.