May 14, 2012

Why—and How—Should Hospitals Implement a CDI Program?

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We could not count on one hand the times that reports from Recovery Audit Contractors (RACs) have a guideline such as the following: Medical documentation for patients needs to be complete and support all services provided in the setting billed.

 

Clearly, better documentation is essential to overpayment reductions, compliance, better reimbursement, and a host of other essentials. Enter clinical documentation improvement (CDI) programs.

Although CDI programs have been around for several years, they have become a must-have for hospitals trying to juggle the multiple requirements of the healthcare system, including the Medicare severity DRGs and quality initiatives.

 

"Not only are hospitals that don't have CDI programs behind the eight ball, they will start to recognize a significant loss of revenue," says Maria Alizondo, MA, RHIT, director of consulting services for Caban Resources, a Lawndale, California-based health information management (HIM) consulting firm ("Clinical Documentation Improvement: Gauging the Need, Starting Off Right," Journal of AHIMA 80, no.9, September 2009, pp 24-29). Alizondo goes on to say that "detailed documentation is tied to coding and reimbursement under the MS-DRG system."

 

Although it's true that CDI often links coding and reimbursement, there is another equally important dimension and that is the need to collect quality data and use it to improve hospital practices and processes.

 

Questions to Ask, Steps to Take

 

There is more than one approach to incorporating a CDI program into your daily operations. Before you start, you'll need to answer some questions, such as the following.

 

How do you want to develop the program? Do you want to build it through outsourcing, modify an existing program, or launch a comprehensive new program? Do you need outside assistance to start this program?

 

What staff members must participate? What must you do to get physicians and physician extenders on board? Who will take the lead in promoting and organizing these efforts? How will you communicate information about the project and the changes it will bring?

 

Which quality programs will you incorporate, and how will you do it?

 

Hospital HIM leaders who are in the trenches of CDI program development have answered questions like the above and done the following. These steps provide the uninitiated with an idea of what's ahead.

 

  • Define your program methodology and plan based on your facility's goals and objectives.
  • Select "invested" task force and steering committee members.
  • Develop a work plan with reasonable time frames.
  • Analyze the severity of your facility's case mix index (CMI) and risk-of-mortality index to determine your true patient population.
  • Set reasonable CMI, capture-rate and productivity targets.
  • Implement the best possible communication and feedback techniques for educating your physicians, clinical documentation specialists (CDSs) and coders.
  • Incorporate CDI into your facility's quality initiatives.

 

Success Depends on Cooperation

 

Even the best-laid plans may falter without buy-in from many angles, particularly physicians and the executive suite. It is vitally important that all of these individuals, in addition to health information management staff, understand the philosophy of the program and why it exists.

 

Getting physicians on board early is particularly essential, so be sure to talk with the facility's chief of staff and hospital medical director.  Because physicians may not appreciate receiving directions on how they can improve their documentation, be sure to come prepared with facts and statistics-the more details the better-related to how CDI positively affects quality data and appropriate reimbursement. Getting a physician to champion the project is a deal breaker.

 

Be prepared with the answer when physicians ask, "What's in this for me?" Among others, be sure to mention improved:

 

  • Documentation for peer-to-peer patient care communications
  • Patient care
  • Quality scores
  • Patient population based on publicly available quality data

 

Last but not least, those involved must be committed to the plan to improve documentation and keep the momentum going with care providers. Incorporating ongoing analyses that are shared with key players after the program gets off the ground can be helpful in re-focusing efforts and tracking success.

 

About the Author

 

Janis Oppelt is editorial director for MedLearn Publishing, Panacea Healthcare Solutions, St. Paul, MN.

 

Contact the Author

 

joppelt@medlearn.com

 

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