Embracing Change

Jocelyn E. Murray

Summer is finally here! It’s been a long-time coming for New Englanders! I contrast the abundance of this wonderful, although too brief, season with all the enhanced CDI insight and transition to current practice.

Our ACDIS 10-year anniversary conference this year in Vegas was terrific! Education tracks embracing current CDI transition in risk-adjustment and outpatient practices were insightful. I also attended an event by the NYHIMA which also delivered insights into CDI areas of expansion. I’m excited about the CDI practice progression at our national association levels and love that I am surrounded by healthcare professionals who embrace a desire to evolve our scope of practice and support today’s healthcare system.

A common theme of these events was the recommendation for CDI programs to eliminate the old one-payer DRG review mindset and primary MCC/CC revenue impact focus. I’m fortunate to work with a group of HIM subject matter experts who hear the message, (it surely isn’t a new one), and embrace an environment of true learning for excellence needed to remain forefront in HIM knowledge.

CDI programs have transitioned into outpatient settings taking with them the insight gained from inpatient practice. Rather than focus on separate processes, the program has evolved to become more enhanced. CDI reviews include: quality, safety, and risk adjustment elements in the patient record. Integrity is the true key to CDI performance.

Experienced CDI leadership realizes that financial impact and return on investment (ROI) fall into place as key performance indicators (KPIs) focus toward integrity. CDI insight is in a paradigm shift; medical necessity capture and identifying documentation practice that will trigger denial are current performance measures. I believe our CDI clinical trial is over as the ROI evidence in reporting will continue to sustain CDI efforts and program expansion.

Once we release expectations of quantity versus quality from our CDI practitioners’ performance measures, CDI staff can focus on enhanced education productivity, a critical performance of any CDI program success. CDI software products continue to revise tracking and reporting tools to meet the changing documentation requirements. Some are capable of abstracting key diagnostic terms to identify records for CDI further review. CDI staff work cohesively with IT staff, providing recommendations for CDI capture to assist in program progression.

CDI programs focusing exclusively on financial capture often trigger denials and reimbursement downgrades. The practice has also been identified to negatively affect provider and practice value-based purchasing quality measures. Proactive integrity reviews, removing the old thinking of one payer DRG mindset, and performing prebilled final audits help to ensure positive gain from CDI productivity efforts. All it takes is embracing change and a ZDoggMD-type of mindset to help move us all towards a “CDI 3.0 vision.”