Note from the Associate Editorial Director: A glass half full of financial return

by Melissa Varnavas

In 2017, nearly 38% of CDI professionals said they review medical records primarily for financial outcomes, according to an ACDIS benchmarking survey. ACDIS sources sounded alarm bells saying:

• “On the one hand, those numbers were really very surprising and, quite frankly, alarming. On the other hand, though, maybe it’s not so surprising. We’re under so much pressure to prove a return on investment.”
• “The fact that we’re reviewing for primarily reimbursement is really going to put the industry behind the curve of value-based purchasing. We’re supposed to be looking at the bigger picture.”

In some respects, however, those results could be seen through a glass half full point of view. We all know that CDI programs came about as a response to the implementation of MS-DRGs. At the time, CMS frankly said in the IPPS Final Rule that there was “nothing inappropriate” in healthcare organizations optimizing the documentation in medical record in order to ensure accurate code assignment and appropriate reimbursement. MS-DRGs introduced a type of severity-level categorization system which enables providers to capture the depth of care and get paid more based on that level of care.

Moving the needle over a 10-year span (2007-2017) from CDI being nearly 100% focused on a strictly fiscal return on investment to one where only 38% of respondents indicated they focus solely on financial outcomes, actually represents a significant shift.

It’s a shift brought about by our changing societal focus, by the needs of an aging population, by a healthcare system seemingly gone awry in terms of outrageous costs, and by government regulatory initiatives aimed at reining in those costs while nevertheless continuing to provide the care needed by those it serves.

But make no mistake, it’s also a shift brought about, in no small part, by CDI programs’ growth and maturity, by the expansion, innovation, ingenuity, curiosity, and passion of those who perform the role. In short, by you. By continuously staying informed about how your organization’s medical record documentation is being analyzed for a myriad of reasons by a kaleidoscope of organizations you advance your practice, your profession, and the outcomes and focus for us as an industry.

So where are we now in terms of CDI query efforts, two years later? Help us find out by taking about five minutes to respond to our 16-question survey today. We’ll share the results in the March/April edition of the CDI Journal and offer highlights here in CDI Strategies as results roll in.

“CDI must change with the times while continuing to focus on areas that impact organizational outcomes,” as the May 2019 ACDIS White Paper “CDI yesterday, today, and tomorrow: Staying relevant in changing times,” stated.

We’re looking forward to learning how your query practices have changed, grown, and adapted to the changing needs of our times.

Editor’s note: Varnavas is the associate editorial director of ACDIS. Contact her at mvarnavas@acdis.org.