Q&A: Making the case for higher paid CDI professionals

Q: Our hospital system recently restructured our department and downgraded the staff level compensation (we were previously equal to a case manager level). How can I make a case for increasing our staff’s compensation again? I’ve already reviewed the CDI Week Industry Survey and the 2017 CDI Salary Survey.

A: “We need to continually help our leaders understand and see the value the CDI department brings to the organization as well as the high-level skills the staff are required to possess,” says Karen DiMeglio, RN, MS, CPC, CCDS, director of CDI at Lifespan Corporate Services in Providence, Rhode Island. “You’ll need good data on your impact and an accurate job description that details the expected high-level skills.”

It’s also helpful to build your case by differentiating what the CDI specialists do from what other departments do.

“I have found that the education the case managers provide is primarily regarding medical necessity, which is a much narrower topic than those covered by CDI,” says Patti Fountain, BS, RN, MBA, CCDS, market director CDI, New England and South Carolina, at Tenet Healthcare Corporation. “I’d agree that educating the executive teams regarding the role of CDI is important, but more importantly, you have to have the data to demonstrate impact.”  

Gathering the needed information, data, and job duties, however, can take some time and it relies on the answers to a few questions, according to Charrington “Charlie” Morell, RN, CCDS, director of CDI at HCA West Florida Division Office in Tampa, Florida:

• What degrees do your CDI specialists hold? (e.g., RN vs. BSN vs. MSN, or RHIT vs. RHIA)
• Does your organization have a grid to determine compensation?
• Is there a productivity expectation for your CDI team? How does it compare to other departments and what are your actual review numbers?
• Are the CDI staff members hourly or salaried?
• What are other hospitals in the area paying their CDI specialists? (This is where data from ACDIS salary surveys, productivity white papers, a polling data can help.)

“Whether our staff member is from a coding or nursing background, they must have at least a two-year degree,” says Morell. “A higher degree level would likely have higher compensation. You also have to factor in relevant job experience, such as case management, quality, revenue integrity, or other CDI experience.”

Though credentials can tell you about a staff member’s educational level and therefore help you determine adequate compensation, their experience is also crucial to determining their pay grade, Jeff Morris, RN, BSN, CCDS, supervisor of CDI at University of Southern Alabama Health System in Mobile, agrees.

“If you’re going to hire someone in a CDI role, then the pay should be equal regardless of credentials,” he says. “Having a ladder or level system is a great idea, but it should still be equal and have certain criteria to achieve the next level, not just a separation between a coder CDI and a RN or clinical CDI.”

Presenting a system by which more experienced CDI professionals receive higher salary rates may help ease the tension amongst the CDI staff, says Analyn Dolopo, RN, BSN, CCDS, ACM, CDI program director at University of California San Diego—HSHR. She proposes the following two levels after entry level:

• Advanced CDI specialist
  
  • Has work experience in CDI, but is not certified
  • Has a bachelor’s degree or is in the process of a bachelor’s degree program
• Expert CDI specialist
  
  • Has work experience in CDI greater than three years
  • Has earned the CCDS or CDIP credential
  • Has a master’s degree in a healthcare related field
  • Has one-to-two years of formal leadership experience

Ultimately, regardless of which model you present—levels based on experience or a flat, higher salary based on job complexity—Morell says you have to make the benefit of CDI known by the human resource department and the healthcare system administration. Otherwise, the CDI staff look like an extension of whichever department it reports under and compensation could be allotted accordingly.

“I always call CDI the Rosetta Stone between clinical (physicians, quality, etc.) and coding,” she says.

Editor’s note: Members of the ACDIS Leadership Exchange group answered this question. If you have questions you’d like to pose to one of ACDIS volunteer boards, committees, or networking groups, contact Associate Editorial Director Melissa Varnavas (mvarnavas@acdis.org). To read the 2017 Salary Survey report, click here. The 2018 Salary Survey is forthcoming and will be published in January 2019. To read the CDI Week Industry Survey, click here. To download a sample letter regarding credentials required for CDI and pay scales, click here. To read about CDI reporting structures, click here.