Mission CDI: Guiding goals, values, and principles

The heart of any CDI department should be its mission. What does the program stand for? What is its purpose? What does the program hope to achieve? If you can’t answer these questions, it may be time for your team to chart a course of action.

Specifically, we’re talking about drafting an official mission statement for your CDI department. The importance of a mission statement cannot be underestimated. A single sentence could help your program:

• Establish value within a larger facility or department
• Define your purpose for providers and executives
• Promote continuity and improvement for CDI team members

At the six-hospital Legacy Health Systems in Portland, Oregon, a CDI mission statement has been in place for several years. It was last updated in 2013, when CDI program managers felt the department needed to play a larger role, says Marjie Aranda, RN, CCDS, interim CDI manager at Legacy.

“We thought that, in order to make the rest of the health system aware of who we were and what we did, we needed to know what our goal and plan was,” Aranda says.

So the CDI team—comprised of both clinical and coding professionals— delved into potential mission statements. Bringing expertise and knowledge from their various backgrounds, the group first established its values. Using the ACDIS Code of Ethics and facility guidelines, they identified five key points:

1. Excellence
2. Integrity
3. Dedication
4. Innovation
5. Confidentiality

The values should describe the qualities your team keeps in mind while conducting daily duties, says Jane Hoyt, BA, BSN, RN, CCDS, CDIP, owner of CDI Nurses, Inc., and a CDI specialist at University of Colorado Health in Denver. These can include the terms listed above, but can also incorporate values such as respect, stewardship, kindness, and honesty. Hoyt also suggests the concepts of humor, to remind staff to enjoy their work and not take themselves too seriously, and growth, to encourage the team to learn from mistakes rather than being afraid of making them.

Next, the team at Legacy identified a series of goals for the department. For example, team goals included reviewing 25 charts a day (new and re-reviews), updating clarification policy and query forms to meet new national standards, and helping reduce Recovery Auditor denials. Previously, the goal list included ICD- 10 education for both CDI specialists and providers. “Goals help us identify what we aspire to,” says Aranda. “As we accomplish them, we can remove them and establish new ones. This keeps our program moving forward with what’s happening in the industry.”

Finally, the mission statement was born:

Collaborate with healthcare providers to ensure complete documentation of the findings, diagnosis, and treatment in the patient health record to reflect the severity of illness and capture accurate codes and statistical data for research, reimbursement, and clinical measures.

That’s it: a simple one-sentence description of what the department accomplishes for the facility through its daily efforts. The statement doesn’t have to be poetic— but it should be comprehensive and specific. It should also include input from all department members, says Aranda, and be reviewed and updated on a regular basis.

A good mission statement can also be accompanied by a vision statement, which details where the CDI department hopes to be in the long term, says Hoyt. This helps explain to providers and other executives why the CDI department performs the work it does, as in this example Hoyt provides:

By securing a thorough, complete, and accurate patient health record, we will achieve the correct reimbursement for resource utilization, the highest quality measures and outcomes, superior communication between providers, and ultimately high patient satisfaction.

At Yampa Valley Medical Center in Steamboat Springs, Colorado, Cari Merlina, RN, BSN, and Jessica Stevenson, RN, BA, both CDI specialists, started to discuss developing a mission statement in March of this year. For their department—which is only six months old—forming a mission statement, policies, and procedures is part of the educational process to help those unfamiliar with CDI (including hospital administration, providers, and new CDI staff) understand the importance of the role. Merlina and Stevenson are currently working with HIM, quality, and revenue cycle personnel to review existing policies and to discuss what a mission statement should look like. The final statement will likely include a combination of reimbursement and quality improvement initiatives, Merlina says.

“We don’t want to hide the fact that we’re working to improve reimbursement, but CDI is not only for monetary gain,” she notes. “We definitely want a quality piece in there.”

A list of goals accompanies their mission statement. These goals put forth that CDI efforts help to do all of the following:

• Ensure continuity of care
• Improve physician and hospital profiles
• Increase case-mix index
• Ensure appropriate reimbursement related to the resources used

Merlina and Stevenson’s efforts illustrate how even newer CDI departments understand that having a mission statement allows a program to truly take off.

“We can speak to physicians and say ‘these are our goals’ in one simple sentence,” Merlina says. “Our hospital places a lot of value on its mission statement. As an organization, CDI having its own mission statement helps establish us as official and is a point of professionalism.”

Alternatively, for those CDI departments that are still growing, Aranda says it’s okay not to rush to create a mission statement. It can be difficult to establish one if the program isn’t initially sure of its focus or how it fits into the larger health system.

If that’s the case, “give it a year and see where you’re going, and then address this,” Merlina recommends.

Having an official mission statement allows a program to achieve accountability and integrity, says Erin Holthusen, RN, CCDS, CDI manager at Allina Health in Minneapolis. However, it’s also important for CDI teams to actively follow the tenets included in the statement.

“We use our mission statement quite frequently, especially when talking to providers,” says Holthusen. “This helps with buy-in and explaining the overall goal.”

For example, when a CDI specialist got pushback from a physician, they referenced the mission statement and were able to clearly define why CDI was necessary for an accurate medical record, opening up an opportunity for further education and building trust with a provider who was new to CDI, Holthusen says. Further, when working through the denial process, CDI specialists can reference the mission statement to determine if they will appeal or accept a denial.

Keeping manageable goals, values, and principles at the forefront of the CDI department is the primary purpose of having a mission statement. “We should be able to readily discuss what our goals are and what CDI is doing,” Holthusen says. “You don’t need a big document to describe what your program is going for.”