CDI Week Q&A: CDI and Quality

September 21, 2017

CDI Blog - Volume 10, Issue 133

As part of the seventh annual Clinical Documentation Improvement Week, ACDIS has conducted a series of interviews with CDI professionals on a variety of emerging industry topics. Nancy Ignatowicz, RN, MBA, CCDS, a remote/traveling CHI nurse with MedPartners, based in Bourbonnais, Illinois, and a member of the 2017 CDI Week Committee, answered these questions on CDI and quality. Contact her at nrmignatowicz@comcast.net.

Q: Can you describe the relationship of CDI to quality initiatives, and how CDI can make a difference?

A: CDI and quality can have a variety of relationships. For instance, CDI can offer concurrent notification of actual or potential issues to the quality department. CDI can assist with concurrent data collection and quality interventions. CDI queries can also address present on admission status, cause-and-effect relationships, surgical puncture/laceration specificity, risk of mortality, and severity of illness. For example, CDI can help capture pressure ulcers, catheter-associated urinary tract infections, pathological fractures (which may have been diagnosed intra/postoperatively), surgical lacerations integral to the procedure, and diagnoses that were present on admission but not previously identified in the documentation.

Q: Has reviewing for quality measures hindered your department’s “traditional” CDI chart reviews or overall productivity?

A: It has not hindered actual CDI chart reviews, but productivity has decreased with the addition of quality reviews.

Q: When did CDI start getting involved in looking at quality-related documentation concerns, and what was the impetus for the evolution? What were the initial focus items, and how have they grown or changed?

A: I’ve been fortunate to always have had a relationship with and focus on quality from the beginning of my time in CDI.

Q: Have ongoing changes in CMS and other payer reimbursement models pushed CDI program involvement with quality forward?

A: Yes. Facilities/providers who want to become centers of excellence, and those wishing to maintain that distinction, need to clearly show that they take care of high-acuity patients. Plus, they need to prove that they do not cause harm while the patient is in their care. POA queries aim to show that a condition was present and did not develop after admission. Querying for active secondary conditions shows how sick the patient is.

When negotiating with payers for reimbursement rates, it’s also important to show that a facility’s or a provider’s actual mortality rate is less than the expected rate, in addition to other financial markers, including actual length of stay versus expected length of stay.

Q: How do you see quality in the greater healthcare industry evolving, and what can CDI do to prepare?

A: In the future, I really see quality driving reimbursement. Historically, we have seen the healthcare industry look at costs of care such as staffing, supplies, and information technologies. But now, in addition to cost of care or rather patient charges, we are seeing more marketing for quality such as: