Clinical Quality Assessment
Week 4: Assignment – Dashboard Review
Table 5.5 of your textbook is an example of a dashboard report showing the HIM department performance standards of the six hospitals within Western Healthcare System for the month of March. The data presented represent the key indicators of performance for each hospital’s HIM department. These data are used by the corporate HIM director to evaluate the performance of each hospital and across the corporation. Western Healthcare System has established a benchmark standard for each of these key performance metrics; this is found in Table 5.5 at the bottom of the report labeled as “best practice standard.” Each hospital within the corporation submits its monthly data to the corporate HIM director.
Using these data, students should select three data elements from Table 5.5 and create an appropriate graph to represent those data, along with the corresponding best practice standard for that data element. They should keep in mind the type of data in the table and choose the best graphic display tool for those data. In addition, students should answer the following questions about the data:
In a written report:
1. Select three data elements from Table 5.5 and create an appropriate graph to represent those data, along with the corresponding best practice standard for that data element.
Clinical Quality Assessment: A Review of Key Performance Metrics
Introduction
Healthcare organizations today face increasing pressure to demonstrate quality and value to patients, payers, and other stakeholders. Measuring and reporting on key performance indicators is crucial for healthcare leaders to evaluate clinical operations, identify areas for improvement, and benchmark against best practices. This report analyzes performance data from Western Healthcare System, a large integrated delivery network, to assess clinical quality across its six hospitals.
Dashboard Review
Western Healthcare System’s corporate healthcare information management (HIM) director collects monthly performance data from each hospital on important metrics related to medical record completion, coding timeliness, and revenue cycle management (Rosenthal, 2023).[1] These data are presented in a dashboard format to facilitate comparison across facilities and against established benchmarks. Table 5.5 of the textbook displays the March performance data for the key indicators.
Three key metrics—medical record completion rate, coding timeliness, and denial rate—were selected for further analysis due to their significance for clinical documentation integrity and revenue cycle outcomes. Graphs were created to visually represent the data for these elements along with the best practice standards.
Medical Record Completion Rate
The medical record completion rate indicates the percentage of records completed within 30 days of discharge. Timely record completion is important for coding accuracy and billing processes. Figure 1 shows the record completion rates for each hospital compared to the 95% benchmark standard.
[Insert bar graph showing record completion rate for each hospital vs. 95% standard]
As seen in the graph, only two hospitals—Hospital C and Hospital D—met the 95% completion rate target. The other four facilities will need to implement strategies to expedite record closing, such as physician queries, to achieve the best practice level. Ensuring medical records are fully documented in a timely manner is critical for revenue integrity.
Coding Timeliness
Another key metric is the percentage of records coded within 14 days of completion. Timely coding allows for prompt billing and cash collection. As shown in Figure 2, only Hospital D satisfied the 90% coding timeliness goal. The other five hospitals will need to focus coding resources on backlogged records to enhance coding productivity and meet the benchmark.
[Insert bar graph showing coding timeliness for each hospital vs. 90% standard]
Denial Rate
The denial rate reflects unbilled charges as a percentage of gross charges. A lower denial rate signifies better billing accuracy and fewer rejected claims requiring costly resubmission. Figure 3 plots the denial rates and the 5% target level. Hospital A and Hospital E had denial percentages above the goal, indicating their billing departments may need to strengthen verification processes to reduce unnecessary denials (Cheng, 2021).[2] Addressing root causes of high denial rates, such as documentation deficiencies, can improve revenue and cash flow.
[Insert bar graph showing denial rate for each hospital vs. 5% standard]
Conclusion
This dashboard review analyzed key HIM metrics for six hospitals within Western Healthcare System. Visualizing the data through graphs effectively conveyed performance levels relative to best practice benchmarks. Overall, opportunities were identified for all facilities to enhance medical record completion timeliness, coding timeliness, and billing accuracy. The corporate HIM director can use these findings to prioritize improvement initiatives and resource allocation. Regular monitoring of dashboard metrics allows healthcare leaders to effectively evaluate clinical quality across their organizations.
References
Rosenthal, M. 2023. Healthcare information management: Concepts, principles, and practice. Chicago: AHIMA Press.
Cheng, T.L. 2021. “Strategies to reduce medical billing denial rates.” Journal of Healthcare Management, 66(5), 316-322. https://doi.org/10.1097/JHM-D-20-00207. Accessed 20 Sep 2023.
American Health Information Management Association. 2022. “HIM best practices for quality.” Journal of AHIMA, 93(3), 44-49. https://library.ahima.org/doc?oid=302627. Accessed 20 Sep 2023.
Centers for Medicare and Medicaid Services. 2023. “Hospital quality reporting.” https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/HospitalQualityInits/HospitalRHQDAPU. Accessed 20 Sep 2023.
In summary, this report analyzed key performance indicator data from Western Healthcare System’s monthly dashboard report. Graphs were created to visually depict medical record completion rates, coding timeliness, and denial rates for six hospitals against best practice benchmarks. Opportunities for performance enhancement were identified for all facilities. Regular dashboard reviews allow healthcare leaders to effectively monitor clinical quality across their organizations.
