In the wake of the pandemic, the need for CDI specialists has never been more necessary. Accurate clinical documentation is crucial to enhancing any healthcare organization’s success, and CDI specialists are essential to capturing the complexity of care. These experts are evolving to do more than just supporting healthcare organizations’ efforts to maximize reimbursements; they are also enhancing documentation habits and providing more physician billing education while improving quality standards.
Rich data provides CDI experts with “meaningful insights to win the next battle and ultimately the war” against COVID. With a more data-driven and strategic approach, healthcare leaders have a more sustainable approach to ensuring financial security as well as maximizing quality clinical outcomes.
Let’s look at how to assess the success of CDI departments, the value of CDI experts’ work when it comes to providing patients with exceptional care and optimizing reimbursements, and the importance of protecting themselves from burnout.
Assessing CDI department success
Part of advancing in CDI includes improving the return on investment. This often means determining the impact of a CDI department by evaluating the amount of inpatient or outpatient care an organization provides. Once a solid base volume has been determined and the type of services provided, the billing process can then be analyzed to determine any weak points in the documentation and reimbursement process.
Next, healthcare organizations analyze a breakdown of what specific patient services should be included in the CDI department. The goal here is to determine where a department will have its most impact. This requires facilities to decide whether they are going to assess all outpatient or inpatient services simultaneously or if they will prioritize and assess each service individually.
Some facilities may choose to analyze this data by the line of service. In contrast, others will find it useful to cross-reference patient data to avoid missing reimbursement opportunities. For example, when establishing criteria for selection of outpatient visit types, organizations may consider:
- highest revenue
- highest number of unbilled rates
- highest volume
- highest rejection rates
Organizations should then ensure CDI professionals have the space to discuss documentation practices and identify potential challenges and areas of improvement with providers.
But should ROI for CDI departments be measured by one-size-fits-all metrics? Cheryl Ericson, RN, MS, CCDS, CDIP, a recognized CDI subject matter expert says not so fast:
“The same set of circumstances that led to the success of ‘CDI programs,’ the ability to adapt and evolve, must translate into how we measure the success of ‘CDI departments.’ Let’s move away from a focus on ROI, because today’s CDI departments do so much more than just capture CCs and MCCs. As an industry, let’s be really honest about the case for CDI, which may be revenue enhancement and may or may not be quality assurance. Whatever route your department takes, be sure to “measure what matters” and develop key performance indicators that reflect the day-to-day role of the staff.
As it should be, the CDI department is educating providers and changing documentation habits. Today’s reality isn’t growing CMI through capturing more CCs and MCCs; it is maintaining a hospital’s operating margin (profitability). Furthermore, as we expand our focus into areas of quality, shouldn’t we consider incorporating some of their metrics? When a CDI department has a focus on quality, shouldn’t it be measuring the impact on expected outcomes, while quality focuses on actual outcomes, since most quality metrics use a formula of expected over actual?”
Choosing the right resources to avoid burnout
Having the right tools and resources for CDI experts can help substantially in avoiding burnout. These can include:
- query templates: a query can be a powerful communication tool that can clarify pertinent information in the health record to achieve accurate code assignments
- natural language processing: this leverages artificial intelligence to identify key information from the unstructured spoken or written word
- integrated computer-assisted coding and prioritization: this can help develop worklists that identify CDI tasks in order of importance
- employee training programs: by providing clinical staff with reasoning and timelines behind the CDI initiative, CDI experts can share the load and reduce the stress on all team members
It’s also vital for organizations to analyze current areas for improvement. Reviewing team strengths and weaknesses and taking collaborative action to improve those weaknesses can help CDI experts work more efficiently, which can reduce errors and interdepartmental stress.
Maintaining a healthy work-life balance
CDI departments are made up of some of modern healthcare’s unsung heroes. The work of these specialists “helps to paint an accurate picture of the severity of a patient’s illness and the extent of the care required.”
That work is essential to population health and certainly comes with its share of stress, underscoring the need for a positive work-life balance. Healthcare organizations can help support that balance by:
- offering alternative working environments such as remote and travel CDI
- developing career ladders and incentive programs
- fostering a culture that allows experts to learn at their own pace with a strong and diverse support system
- ensuring department leaders model healthy work-life balance
- considering employee needs when making decisions for the team
- consistently checking in with team members, especially while facing an emotional toll
At Harmony Healthcare, we celebrate the value CDI experts bring to the healthcare community. From optimizing documentation and coding tools to simplifying workflow and maximizing quality clinical outcomes, these professionals ensure the incredible work doctors do is reflected in the long-term picture of patient care.
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