Differing HIM Processes in Military and Civilian Health Care FacilitiesHCMT 2030Michele SutherlandFall 2015

Section I

Introduction: General History and Overview of Navy Hospital Pensacola, Pensacola, FL.Cincinnati Children’s Hospital Medical Center, Cincinnati, OH.

The following pages will display information obtained through PPE, or Professional Practicum Experience through activities at The Naval Hospital Pensacola, FL., and Cincinnati Children’s Hospital Medical Center. Experiences were obtained in Credentialing, Case Management, Coding, Record Analysis, and Use of Statistical Data.

The Naval Hospital Pensacola is one of the oldest medical facilities in the United States of America with over 175 years of continuous history. I t is a general medical surgical facility with 28 beds. I t previously held a trauma center, but, this has been replaced in recent years with a single bed urgent care center that can admit as well. The primary mission of Naval Hospital Pensacola is to support the nearby settlement Pensacola Air Station. There are approximately 2,000 medical specialists employed on site, and houses a residency program, although this is being phased out currently.

Cincinnati Children's Hospital Medical Center

(CCHMC) is a 598-bed pediatric hospital located in Cincinnati, Ohio. I t is ranked third among all Honor Roll hospitals in the 2013 U.S. News & World Report survey of best children's hospitals. I t is home to the country's busiest pediatric emergency department, performs the second largest number of surgical procedures at a children's hospital in the nation, and is Southwest Ohio's only Level I pediatric trauma center. Cincinnati Children's receives the third-most NIH funds of any pediatric institution in the United States. The pediatric residency training program at Cincinnati Children's is among the largest in the world, training approximately 130 graduate physicians each year. Cincinnati Children's is home to a large neonatology department that oversees newborn nurseries at local hospitals and the medical center's own 59-bed Level IV Newborn Intensive Care Unit.

Section II

Differing Focuses of Reimbursement Between Military Health Care Facilities and Civilian Facilities

Although the focus of healthcare delivery in both settings is to have the best outcome possible, there are pronounced differences in the area of reimbursement

Military The most significant difference in

reimbursement is that in the military, there are no DRGs, and there are no RACs. In this case, it is one area of the government funding another area. Therefore, the pressure of fixed dollar amounts and concern of government funding audits is removed.

Providers are referred to as MC, or Medical Corpsman, and Nursing Corpsman

Civilian Particularly in cases of the elderly

utilizing Medicare, and the uninsured utilizing Medicaid, fixed payment amounts are common place. Additionally, there is the added pressure that with an audit, a RAC may attempt to re-coup funds that had been previously paid for a case.

Providers are referred to as MD, or Medical Doctor, and RN, or Registered Nurse

Section III

Comparisons in Coding

Coding: Vast differences between the two for utilization

Military D.O.D. policy takes precedence

over CPT/ICD guidelines Utilized primarily for statistical

purposes Impacts value unit based system There is a specific code for

convalescence (as opposed to observation) utilized specifically by military; and a new record must be created exclusively for this

Civilian Utilized primarily for reimbursement Impacts direct payment to facility Admittance for observation is

included into patient encounter and billed along with other procedures during encounter

CCHMC allows for remote coding (as do many civilian facilities), and utilizes Sharepoint for this. NHP is significantly smaller, and only houses office based coding positions

Additional Coding Specifications Exclusive to Military Extenders are utilized based on type of physical examination and the

occurrence thereof Additionally physicals may be repeated several times depending on

nature of post/job title Diagnostic coding must be critically observed with assignment

(especially when coding depression as this can negatively impact and enlisted’s post/job assignment)

Section IV: Case Management

Differences and Similarities Between Military and Civilian Health Care Facilities

Case Management SimilaritiesThere are indeed similarities between military and civilian health care facilities. A major one is that of being under the watchful eye of the J oint Commission and its standards of care and documentation. Another similarity is how Case Management is handled.

Both utilize telemedicine for the best outcome and quality of care

HIPAA plays a heavy role in privacy and record utilization for both

Discharge planning begins with day of admission

Differences in Case Management for Military vs. Civilian Health Care FacilitiesWhere the differences begin is the nature of the

diagnosis. If the diagnosis is stress/mental health, again, it is imperative that a case manger handle the case in question with sensitivity as it can detrimentally impact the post/job assignment. Additionally, the case manager must take into consideration special impacts if the enlisted is living in barracks as they may not have an adequate support group to care for them post discharge; the case manager would need to accommodate for this. Just as in the civilian world, case management is handled by nursing.

Section V: Quality

Parallels of Quality Directives

Although most areas of quality initiatives hold similarities, there are some that differ between the two

Military H+P required for documentation

with in 24 hrs. of admission *If military corpsman is non-

compliant usually penalties/discipline will not follow

Dictated documentation may take up to 30 days to be appended to a record

Military administration decisions come from BUMED (Bureau of Medicine and Surgery)

Civilian H+P required for documentation

with in 24 hrs. of admission *If physician is non-compliant

financial penalties could follow Documentation is generally

expected the day following a procedure for dictated information

Civilian facility administration decision comes from individual boards exclusive to the facility

Additional comparisons: Again, with military, the looming RAC is non-

existent, however, there are monthly and annual internal audits

Per Joint Commission; Accreditation Participation Requirements (APR) covers the following areas of both mil. and civ.

*Coding*Record Review*History and Physical*Surgical Master Notes*Clinical Records*Legally Documented Notations*Physician Progress Notes

Section VI: Record Analysis

Similarities in Processes between Military and Civilian Processes

Parallel processes in record analysis

Military Records are reviewed by specific

individuals as outpatient (APVs), and inpatient

APVs can included same day surgeries and colonoscopies

Deficiency sheet is filled out if part of record is found missing

Military systems are Essentris, CHCS and ALTA

Civilian Records are reviewed by records

analyst; CCHMC has 3 individuals working simultaneously as inpatient review, outpatient review and deficiency review

Civilian record systems are often EPIC and /or Chartmaxx

Section VII: Risks of Project

Unavoidable Risks of PPE

Risks of PPE in a Military Health Care Facility Various individuals that I was able to shadow had a knowledge base of

their job functions exclusive to the military Per military security, I was never able to gain access to areas such as

birth/death certificates, and was never able to gain system access Statistical data was not utilized in traditional fashion as benchmarking

between military facilities is non-existent

References

Project Resources and References

Project Resources and References

Naval Hospital Pensacola Navy Base in Pensacola, FL | MilitaryBases.com. (n.d.). Retrieved November 22, 2015, from http://militarybases.com/naval-hospital-pensacola-navy-base-in-pensacola-fl/(2015). Retrieved November 22, 2015, from http://health.usnews.com/best-hospitals/area/fl/naval-hospital-pensacola-6390840Naval Hospital Pensacola | Pensacola News Journal. (2015). Retrieved November 22, 2015, from http://archive.pnj.com/videonetwork/3822400314001/Naval-Hospital-PensacolaNavy Hospital Pensacola, FL. Logo. (2015). Retrieved November 22, 2015, from https://sp.yimg.com/ib/th?id=OIP.Me7a3763c7b2167c37cac204e6662e398o0&pid=15Cincinnati Children's Hospital Medical Center. (2014, June 11). Retrieved November 22, 2015, from https://en.wikipedia.org/wiki/Cincinnati_Children's_Hospital_Medical_CenterResearch Leads to Auditory Discovery. (2012, September 30). Retrieved November 22, 2015, from http://www.newsrecord.org/news/campus/article_231355d8-0b48-11e2-813e- 0019bb30f31a.html?mode=image&photo=0

 

Project Resources and References

Kolwyck, CPC, CPMA, S. (2015, September 1). Shadowing in Compliance Auditing [Personal interview].Swab, RHIA, A. (2015, October 1). Processes in HIM [Personal interview].Salchi, RHIA, K. (2015, October 1). CCHMC observation [Personal interview].

Robbins, RHIA, R. (2015, October 1). CCHMC observation [Personal interview].Leasure, RN, J. (2015, October 1). Case management [Personal interview].Bestor, RN, C. (2015, October 1). Case management [Personal interview].