Addressing a Decrease in Mammography Volume

SCENE ONE: The Vice President of Clinical Services reviewed a report from radiology and noticed a decrease in the volume of mammography studies performed over the past 9 months. She wants to learn what may be contributing to the decrease, so she arranges to meet with the Radiology Performance Improvement Team (R-PIT) which monitors the performance of the radiology department and works on improving services.

1. As the lead on R-PIT, you begin by completing the R-PIT Plan of Action which will be presented to the VP of Clinical Services for approval. Copy the R-PIT table below into a Word Document and complete it for submission.

R-PIT Plan of Action Complete the four boxes in the right column for presentation to the VP. VP will review for approval and roll-out.

A. Identify the issue – record it for reference.

B. Identify a quality measure to determine cause of the issue.

C. Identify the category of data on the measure identified in (b) above. (Tangible vs. intangible, structure, outcome, process measures).

D. Explain the rationale for using the quality measure identified in (b) above.

Approval given by VP: __________________________________ on date ___________________________.

SCENE TWO: Six months later (after the R-PIT was approved, quality measure researched and radiology quality improvement action has been completed) you request a new data report to validate mammography improvements. The new data report demonstrates a new problem, unfortunately, and this problem is outside of the radiology department. You find that of the 1800 mammograms completed in radiology over the last 3 months, only 27% of them have been coded and therefore have not been billed. This leaves a little over 1300 mammograms unbilled which is likely why multiple patients have called recently asking why they have not been billed.

You went to high school with the coding manager, Charmaine, and head over to her office to share this information. Charmaine asks you about the Process Improvement Team and you offer to assist with the newly discovered Coding Delay Issue. Charmaine is committed to HIM best practices for her entire coding team, including the outpatient clinic coding group.

2. Complete the HIM Plan of Action which will be presented to the VP of Financial Services for approval. Copy the table below into a Word Document and complete it for submission.

HIM Plan of Action Complete the four boxes in the right column for presentation to the VP. VP will review for approval and roll-out.

A. Identify the issue – record it for reference.

B. Identify a quality measure to determine cause of the issue.

C. Identify the category of data on the measure identified in (b) above. (Tangible vs. intangible, structure, outcome, process measures).

D. Explain the rationale for using the quality measure identified in (b) above.

Approval given by VP: __________________________________ on date ___________________________.

3. Consider Charmaine's intention of functioning with Best Practices. Create a Best Practices Coding Statement for Charmaine to use for her own Performance Improvement Team in HIM. Best Practice considerations should include at a minimum – patient satisfaction, financial well-being of the facility and chart completion requirements by regulating agencies such as CMS (Centers for Medicaid and Medicare Services).

Your submission will have 1) a completed R-PIT table, 2) a completed HIM Plan of Action table and 3) a Coding Best Practices Statement.