Q&A: Inpatient CDI expansion
Q: Does anyone have any proposal examples of inpatient CDI team expansion they'd be willing to share? I am working on putting one together, but it would be very helpful to see other leaders’ successful proposals. To further clarify, what we are trying to do is basically justify the increase in the CDI team for the inpatient side, since we are currently only covering about 35%-40% of inpatient admissions. We are under the revenue cycle umbrella, so showing the potential financial return on investment (ROI) would be necessary.
Response #1: From a general perspective, leverage your existing performance to predict the increase in the total financial return (as well as other impacts). Be conservative (i.e., predict but then discount by approximately 25% so what you are sharing with executives is a prediction that is 50%-75% of what your calculations suggest as an additional return). Understating the predicted impact supports outstanding success. This approach was successful for me some years ago and has been successful for at least two others.
Response #2: When I present a business plan for additional resources, I use a calculation of lift per case versus the impact per CDI specialist. We track this in our monthly dashboard and use it to support ROI and missed opportunity on the cases we don’t cover. This number gives a level of confidence that is based on proven performance over time and accounts for the varied levels of experience we have across our teams.
- Current lift per case year-to-date (YTD): $419
- Missed cases YTD: 3,450
- 3,450 X $419 = $1,445,550 missed revenue
Then we calculate the needed FTEs to cover the missed cases and the cost to come up with an ROI business case.
Response #3: We all understand the need to show an ROI with our teams and planned expansion. However, I made some changes last year regarding how the CDI team operates and have done so with fewer FTEs than we have ever had. We also created an auditor/educator position that has allowed one person to do the reconciliation process and then provide education or feedback when it is needed. This person also assists with real-time case audits, which has been very helpful for our team.
We started this process as we had issues with our utilization review team getting each patient assigned to the correct status. At least 100 cases every month converted into observation after we had already opened them and perhaps even shifted the DRG. We had to work differently, and this process has been very helpful. I track our dollars each month and graph them against the year prior. It has really helped us move the needle from the way our program ran historically. With that said, I am looking to fill a position with CMS telling Medicare Advantage payers that they are expected to follow the two-midnight rule as we expect a higher inpatient volume in 2024.
Editor’s note: This question was answered by members of the ACDIS CDI Leadership Council and originally appeared in the CDI Leadership Insider, the monthly newsletter for members of the Leadership Council. For the purposes of this article, all Council member answers have been deidentified.