ACDIS update: Quarterly Call covers how CDI efforts affect CMI

Measuring a CDI department’s impact is imperative to tracking and proving its success, and one key performance indicator that CDI programs are consistently measured by is the case-mix index (CMI). While CMI is essential to track, more education is needed to put its relationship with CDI efforts in context. Hospital administrators often don’t understand how CDI programs affect CMI, the other factors that come into play with CMI outside of CDI efforts, or which metrics besides CMI can more accurately capture the impact of a CDI department.

Along with the white paper they are writing, four ACDIS Advisory board members spoke on this topic in the most recent ACDIS Quarterly Call: Chinedum Mogbo, MBBS, MBA, RHIA, CDIP, CCDS, CCS, a CDI manager at Tenet Healthcare in Dallas, Texas; Lena N. Wilson, MHI, RHIA, CCS, CCDS, RCS specialized manager at Indiana University Health in Indianapolis, Indiana; Emily Emmons, MSN, RN, CCDS, regional director of CDI at Kaiser Permanente Northern California Region in Oakland, California; and Sheri Blanchard, RN, MSN, FNP-BC, CCDS, CCS, corporate director of CDI at Orlando Health in Orlando, Florida.

In their discussion of how CDI efforts affect CMI, they noted that the relationship isn’t perfectly linear. Sometimes sending queries will have a negative impact on CMI, for instance, and eventually CMI will have to stop increasing and should level off. Looking at CMI metrics over time provides a much better picture of CDI impact, but even then, there can be outliers. To see CDI impact more accurately, they recommended that higher-weighted DRGs be removed when measuring, as they can greatly skew metrics. The DRG relative impact can also be measured by looking at pre- and post-CDI DRGs to more accurately calculate DRG weight.

In measuring impact for the facility, the group suggested comparing specific service lines of different organizations, while making sure the two facilities have the same patient volume, payer types, and types of surgeries to ensure a useful comparison. Comparing physicians can also be helpful if they have a similar number of patients, types of patients, and number and types of procedures. Otherwise, the data found will be less than useful.

“Make sure you’re not comparing an apple to an orange,” advised Emmons, “but apples to apples.”

Plenty of factors influence a facility’s CMI outside of CDI efforts, but most finance administrators don’t understand all the variables, including:

• Physician absences
• Changes in patient flow
• The CDI program’s focus on certain conditions
• The quality department’s focus on certain conditions
• Service lines gained or lost
• Higher-weighted DRGs
• Changes in MS-DRG coding

To help administrators understand CDI impact, the group recommended a CDI department start with educating on CDI efforts in general. They also recommended showing the leaders other metrics that CDI work affects aside from CMI, specifically those that can measure and impact the care and safety of a patient. “You dilute the benefits of what a CDI program can give if you only focus on the financial metrics,” Wilson said. “If the quality of the documentation is there, everything else will follow.”

Editor’s Note: Members can listen to the full recording of this Quarterly Call by clicking here. Fluegel is an editor for ACDIS. Contact her at jfluegel@acdis.org.