Thanks to technological advances and minimally invasive surgical procedures, the majority of medical procedures are moving into outpatient facilities. Financial incentives, patient preferences, government support and other policies have also supported outpatient services in lower cost settings. But value-based care incentives have been the main driving force behind this trend. Value-based payment models are encouraging more patients to avoid hospitals and shift to outpatient settings. According to a study by Deloitte, aggregate hospital revenue from outpatient services increased from 30% in 1995 to 47% in 2016. Most of this growth is driven by patient preferences and clinical advances that minimize complications and help patients to get back home sooner. A robust outpatient CDI system is essential to manage the growth of outpatient services.
Significance of Outpatient CDI
Outpatient clinical documentation (CDI) programs have found their way into hospitals and healthcare systems as they continue to embrace outpatient services. The main benefits of outpatient CDI are:
- Diagnosis specificity is as vital in the outpatient world as in the inpatient world. Each diagnosis must be documented to the optimal level of specificity as it will impact the hierarchical condition category (HCC) assignment.
- Accurate CPT code assignment is obtained through detailed procedure notes to capture procedure specificity.
- Accurate Ambulatory Payment Classification (APC) reflects the prospective outpatient payment system. Documentation support for appropriate APC assignment in outpatient settings is as important as that for DRG assignment in inpatient settings.
- CDI offers high quality clinical documentation for reimbursement which is very important to get the accurate reimbursement for outpatient services.
- CDI ensures that the documentation of outpatient services is of the same excellence as inpatient services to capture accurate quality scores.
- Accurate and updated outpatient CDI reduces the scope of payment denials due to missing documentation of the medical necessity.
- Accuracy of HCCs and risk scores for the patient population can be maintained.
- Improved documentation of infusions, procedures, and support for observation services.
- Outpatient CDI facilitated better co-ordination between the provider documentation and coded data.
- Comprehensive health record for enhanced patient safety and satisfaction.
Measures to prioritize CDI for Ambulatory CDI
Once a solid outpatient CDI is in place, it can be extended to the ambulatory setting. To achieve this, the following issues must be addressed:
- Identify areas where ambulatory CDI will be helpful. The Focus must be shifted from acute medical conditions to chronic conditions.
- Recognize many issues that may not be directly related to CDI, such as physician evaluation, coverage determination, management coding and so on.
- Identify a strict definition of what exactly you wish to accomplish and what obstacles you are looking to overcome through Ambulatory CDI. Determine what clinics ambulatory CDI will be implemented and what will be the sequence of implementation.
- Define metrics that need to be used in the process of ambulatory CDI. Appropriate KPIs must be established since they demonstrate the effectiveness of an organization in achieving business objectives. The Risk Adjustment Factor (RAF) is an ideal metric to measure the impact of Ambulatory CDI.
- Identify staffing considerations required for Ambulatory CDI as some programs can be quite labor-intensive, as they evolve along with progression of software and technology.
- Coordination between various programs is mandatory for a successful ambulatory CDI program. Healthcare systems need to look beyond their four walls to understand the requirement for outpatient CDI. The ideas must be floated from the top levels and CDI managers must address issues regarding administration, ROI, staffing, quality of patient care, physician engagement and so on.
- Accurately identify the patient population in the ambulatory clinical setting. Outpatient CDI satisfies different needs for different people. Apart from determining patient population, there must be clarity on the intended goals before the organization can progress with its CDI program.
- Compliance checks must be performed before any program is undertaken and relevant documentation must be submitted to the ACDIS. Finding resources for outpatient CDI can be a challenge, hence it is key to network with peers outside the organization.
- For an ambulatory CDI program to be successful, team effort is essential. First, the operational staff will check the impact of the CDI process on patient care. The CDI team must be well-informed of all the staff members’ processes. Physicians must interact with the IT department and CDI staff to effectively manage the EHR records.
- Hire and train CDI specialists. Since the main goal for CDI is accurate documentation and coding, the ambulatory and the inpatient teams report to the same leader. Weekly staff meetings must be scheduled to promote idea sharing and collaboration.
Understanding organizational goals and developing an ambulatory program that aligns with them is imperative. A strong leadership combined with flexibility to adapt to change is crucial to the success of any ambulatory CDI program.