Improving Outcomes through Quality and Clinical Documentation

This case study outlines the challenges faced by a $5.0 billion multi-hospital system when its CMS Star Rating dropped from three stars to two stars. The decline posed reputational and operational risks, prompting leadership to engage Impact Advisors for a strategic improvement plan. The study details the absence of proactive quality score forecasting and a lack of centralized infrastructure as primary issues. It describes how the fragmented approach among teams responsible for various quality metrics hindered improvement efforts. Impact Advisors implemented a comprehensive quality documentation strategy unifying Clinical Documentation Integrity, Quality, and Coding teams. The approach included building governance structures, automating documentation processes, and enhancing data transparency. Over twelve months, initiatives such as a custom CMS Star Rating forecast tool and specialized committees were launched to improve quality ratings. The health system is projected to achieve 3 CMS Stars by 2028, with several key improvements documented, including enhanced quality scores and corrected CMS claims.