Summary: The fact that CDI programs can improve documentation practices leading to better patient care, compliance and reimbursements is well known in every hospital. Yet, there remains a significant scope for improvement in effectiveness of such programs. CDI departments need to stay abreast of the latest regulations, which makes their jobs tougher. Changing requirements can turn the older methods of working obsolete and create newer needs to address. In this paper we discuss how technology can be an assistant in bridging the gaps in CDI. There are multiple factors involved in successfully implementing a CDI program and technology is a necessary component. We discuss the areas where a CDI software should ideally impact and follow that with a discussion of corresponding features. We conclude that CDI programs require a technology partnership to get the full benefits of a CDI department.
As the healthcare industry plays catch-up with the latest Governmental regulations, CDI programs are gaining strategic importance.
The current shift towards Value Based Care is testament to the fact that healthcare industry is experiencing a paradigm shift – from a fee-for-service to value-for-money approach. In hindsight, this has been a long time in coming. U.S has the highest per capita spending on healthcare among all other countries, but the results, if not worst, are only as good as the rest of the developed nations. Clearly, there is a need to justify the amount being spent on healthcare.
Almost all hospitals are aware of the importance of CDI. Only 0.86% hospitals do not have a full time CDI employed (Association of Clinical Documentation Improvement Specialists, 2017). At its heart, the CDI’s duty is to ensure data accuracy. However, CDI programs are yet to reach their full potential as there remains lot of scope for growth in hospital outpatient services. The types of patient coverage also has room for improvement as only 45.77% of the hospitals responded that they have expanded their coverage of CDI to all patient categories other than Medicare.
One of the main goals for a CDI program is to improve collaboration throughout the hospital. It is important to recognize the fact that care providing is a concentrated effort of various departments. Much of the documentation effort is spent on chasing paperwork all over the hospital. In this respect, the physician is of paramount importance as he/she is the primary director for the care provided to a patient. Unsurprisingly, one of the key parameters to track for a CDI program is the query rates.
In a recent study ( Association of Clinical Documentation Improvement Specialists, 2017), it was observed that the number of people reviewing for financial impact went up, while the number of people reviewing for any document clarification went down. This change of focus is troubling. In the healthcare industry, where medical errors are 3rd in line for leading causes of death in U.S., financial goals can take away focus from providing the best possible care for the patient. As a CDI, who is in a position to audit the quality of care, financial priorities might come at expense of quality. In the longer run, this trend might bite hospitals in the back. With the focus on value based care, quality focused metrics will quickly put these kinds of CDIs at a disadvantage.
Review expectations have also changed over time. A lot of variables affect the chart review process, which makes it difficult to benchmark performance. However, it would stand to reason that as time passes, the general processes and skill improvement would push the numbers higher. The numbers state otherwise. It has been speculated that EHR is one of the main factors that can hinder progress. Having to navigate multiple applications for a single task is likely to bring down effectiveness for any CDI.
The nature of the process is such that hospitals have to spend considerable amount of time and effort behind these kinds of programs. Given the current trajectory, it would be prudent to expect new upheavals in the near future as well. Hence, even after investing large sums, there is little guarantee that the outcome of the process will be satisfactory for the stakeholders.
What do hospitals need?
The issues with the current documentation programs can be traced back to the following factors:
- FLEXIBILITY – All CDI programs come with their set of assumptions as to what is important. The process and practices are built around these assumptions. This works as long as the industry you are working in is stable. However, the current healthcare trends point to the contrary. Newer regulations will keep most practitioners on their toes.
- EFFICIENCY – As a side effect of evolving landscape, the CDI specialist is having to juggle multiple concerns. Financial impact, clinical validity, re-reviews are making the average CDI specialists workflow more and more complicated. Achieving potentially conflicting goals leads to a suboptimal performance in most cases.
- COORDINATION – Any big organization will find challenges in making all its departments work together. A hospital is no different. Even the best CDI programs can work only as well as the participants. More the number of moving parts, the messier it gets. To achieve a quality documentation, the entire administration needs to work together.
- COMPLIANCE & QUALITY – Introduction of quality measures mean that not only do the hospitals have to ensure details are present, they also need to abstract the necessary information for reporting their quality, for reimbursement purposes. Care is not just provided, it has to be captured.
How can technology help?
Some tasks are built for people, others are better automated. Technology can easily bridge these gaps and take a CDI program to the next level. The main areas where technology is expected to contribute are:
- DOCUMENT COLLECTION – Having all the documentation in one place makes life easier. Using a CDI software, hospitals can consolidate their CDI effort into a single application. Any decent CDI software will collect all the records and make them visible to the specialist for review.
PROTIP: Some of them actually go a step further and notify whenever a document is missing.
- WORKFLOW MANAGEMENT – Depending on the workflow that the hospital follows, CDI specialists will need to juggle multiple cases at a time. Reviews and re-reviews are part of their daily activities. The CDI software is capable of managing all this, so that the specialist can concentrate on the case. As a prerequisite, CDI software must be in close agreement to the workflow that the hospital is following.
PROTIP: CDI software can have built in flexibility, so that it can accommodate whatever program the hospital is following.
- QUERY TEMPLATES – Similarity across cases manifest in similarity across queries. You can save valuable time by providing standard templates to CDIs.
PROTIP: The more advanced CDIs take it a step further by actually make suggestions about what is a potential query on the case.
- IT INTEGRATION – EHRs stand at the center of Hospital IT process as it carries all the records of the patients and the care that they receive. Integrating with the EHR is the basic requirement for any CDI software. PROTIP: CDI can combine with the CAC software to provide a holistic view of the reimbursement procedure.
CDI METRICS – Monitoring the CDI department for effectiveness is a prerequisite for any CDI program. Software that provides reports on queries, cases and their financial impact are vital.
PROTIP: The modern CDI software will also track quality metrics such as CC/MCC, LOS etc.
- SUPPORT – Technology is best left to experts. Therefore, whenever choosing a CDI software, it is necessary to view them not as a simple vendor, but as a partner in implementing your CDI. Newer regulations will mean upgrading your CDI program and by extension, your software. In a supplier – buyer relationship, you are likely to be charged for any service, be it training, support or upgrades. A partner who is invested in the success of the hospital is likely to provide a better deal, going above and beyond ensure your success.
PROTIP: Avoid the giants. Their size and structure automatically prevents them from collaborating effectively.
To keep pace with changing healthcare landscape, it is important to have a technology piece that possesses all the above qualities. CDI needs to take a holistic view of hospital processes and impact the correct metrics. For this choosing the right software is of paramount importance.
- Association of Clinical Documentation Improvement Specialists. (2017, May 23). https://acdis.org/resource-type/surveys. Retrieved from acdis.org: https://acdis.org/system/files/resources/37796_PhysicianQuerySurvey_final.pdf
- Association of Clinical Documentation Improvement Specialists. (2017, September 17). 2017 CDI Week Industry Overview Survey. Retrieved from acdis.org: https://acdis.org/cdi-week-type/industry-survey
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Bodhisattya Roy is double Masters in Management from IIM Ahmedabad and ESCP Europe. He is also a trained engineer from IIT Kharagpur. As a strategist at ezDI, he is responsible for sales and planning. He is engaged in helping hospitals and physicians deal with compliance and revenue challenges so that they can go back to focusing on patient care. Bodhisattya strongly believes that data and AI is key to addressing these obstacles.