CDI Programs Drive Up Case Mix Index, Revenue

As hospital and health system finance leaders look for ways to enhance revenue in an era of shrinking margins, many turn their attention to their organization's case mix index (CMI). A higher CMI means more reimbursement dollars for providing care because it indicates that a hospital is treating a sicker patient population. The CMI, and many other metrics within a facility, hinges on having clinical documentation that accurately reflects the severity level of patients' conditions. Without thorough records, hospitals can miss out on substantial revenue.

So Heritage Valley Health System, a two-hospital, $450 million integrated delivery network based in Beaver, Pennsylvania, set out about two years ago to improve its CMI, and quickly zeroed in on the idea of rolling out a CDI program built, says Joann Hatton, director of the utilization management/clinical documentation program.

"The CDI specialists are actually out on the patient care units reviewing physician documentation and working closely with the medical staff to enhance the documentation in real time, doing a concurrent review," Hatton says. "They can have a face-to-face interaction, as well as get clarification on paper, to ask physicians for more clarification and specificity, then it helps the coders to code more accurately."

HVHS hired and trained 11 CDI specialists—four at Heritage Valley Sewickley hospital and seven at Heritage Valley Beaver hospital—and one supervisor to staff the program. They hired from within their pool of existing employees who were well-respected by physicians gave the initiative immediate credibility, Hatton says.

"We were very fortunate to hire nurses in high-level nursing positions within our organization. [Our staff have been] faculty in the school of nursing, supervisors in critical care units, nurses in the cardiovascular labs and had already established good relationships with the physicians."

As a result, the system's CMI has increased at both hospital campuses. In the program's first year, which spanned from October 2013 to October 2014, the system saw a 13.79% increase at Heritage Valley Sewickley and a 6.4% increase at Heritage Valley Beaver.

The results surpassed HVHS's expectations, Hatton says. "We were hoping to get a 5% increase in our case mix index based upon some of our preliminary assessment findings. We are really trying to capture a lot of comorbidities and anything at all that we can use to more accurately reflect the severity of how sick our patients are."

Editor's Note: This article originally published in HealthLeaders Media.