Note from the ACDIS Director: Risky business, second in a series of risk-based CDI papers published

by Brian Murphy

In case you missed it (and if you did, you’ve got double the reading to do!), last month we published part one of a series of papers on risk-based CDI. “Risk-based CDI: A holistic approach to record review,” covered what risk-based CDI is and why it’s important, reviewed some of the major risk models operating in the market, and offered strategies for getting your CDI program started with a focus on diagnoses and documentation that impact a wide number of these models.

This month we’re pleased to debut part two, “Aligning CDI with organizational mission: What matters”? While part one laid the groundwork, part two is an in-depth look at how to reorganize your CDI work around risk-adjusted models. This includes the critical first step of creating a mission statement that aligns with your CDI work, and your hospital’s objectives.

It’s not easy to change focus, as there are many internal and external factors that can impede progress. These can include insufficient staffing, a lack of analytics or support tools, or objectives that are misaligned with your quality department.

Overcoming these obstacles takes a mindset shift. As the Roman emperor Marcus Aurelius famously said, “the impediment to action advances action. What stands in the way becomes the way.” If you can shift your mindset and view these roadblocks not as insurmountable obstacles to avoid, or pitfalls to traverse, but as the catalyst for finally getting your CDI program and work where it needs to be, you’ve taken the first and most important step. This paper includes a positive, affirmative message for getting the right mindset in place before you begin your journey:

When something goes awry with the organization’s quality rating, reimbursement, or lengths of stay, the CDI team may inherit the responsibility to correct the problem. Subsequently, the team may feel like it is saddled with “making the documentation right.” However, instead of viewing this scenario as an unfair task, CDI professionals should instead view it as an opportunity. While CDI leaders acknowledge the above-listed obstacles, none of them should ultimately inhibit the department from furthering the organizational mission. CDI leadership must be able to strongly and positively communicate to organizational leadership that CDI is part of the same team and is working toward the same mission.

The principal authors of the paper series are members of the ACDIS advisory board, and these amazing individuals have done the hard work of implementing risk-based CDI in their own hospitals, or for their clients, and have set down their hard-earned lessons on paper. They are here to support you, in this series. In part two you’ll find a sample dashboard, strategies for engaging reluctant or overburdened physicians, and auditing and benchmarking for success—both pre- and post-implementation. Finally, the paper provides some key performance indicators you may wish to consider benchmarking to ensure that you remain on track.

Risk adjustment is the future of hospital reimbursement, and therefore CDI work. We hope that this series provides you with the fuel—insight, tools, and encouragement—to align your work and get started.

As a postscript, part three will be out in early 2022 and include how risk adjustment is impacted in the outpatient setting. The Congressional Budget Office projects that the share of Medicare beneficiaries enrolled in Medicare Advantage plans will rise to about 51% by 2030. Medicare Advantage insurance plans rely on risk adjustment when determining the costs associated with providing healthcare services, and much of this is predicated on capturing patient’s chronic disease burden in the outpatient setting.

We’ll conclude the series with a helpful appendix of bonus resources.

You can download part two of the series under the “Thought Leadership” tab of the ACDIS website in the “Position Papers” section or by clicking here. ACDIS position papers are free and open for both members and non-members to download and read.

Overcome those obstacles, and happy reading!

Editor’s Note: Murphy is the director of ACDIS. Contact him at bmurphy@acdis.org.