Q&A: Outsourced CDI staffing

Q: Our organization is considering outsourcing some of our CDI staffing to help us out when we have full-time employees off on extended leave or paid time off. Additionally, the outsourced staff would be helping with some specific review areas. Before we pursue this, I had some questions:

• What are the benefits?
• Have you encountered any issues?
• How did you use the outsourced staff?

A: One of the biggest benefits to adding outsourced CDI staff members to your team is that it allows the department to pilot reviews in other settings and figure out the next best step for expansion without stretching full-time staff too thin or paying for full-time employee salaries right of the bat.

“We have 15 CDI specialists and have used between 15-20 [additional adjunct staff] for the past four years,” says Tonia Catapano, RN, BSN, CCDS, CCS, RHIA, director of coding and CDI at Yale New Haven Health. “It’s given us flexibility to try new strategies for coverage of various patient types and quality projects. We used two for almost two years on a children’s hospital CDI program before making the decision to expand to that setting.”

Of course, some outsourced staff will work out better than others, Catapano says. She recommends that CDI leaders work with the vendor/outsourcing company to develop checks and balances to ensure outsourced staff are performing at an acceptable level.

“We’ve had great success with [our outsourced staff] but because of the volume of staff we use, we do require the vendor to provide an auditor to perform quality assurance checks on their staff and provide us with those results,” she says.

In addition to allowing the CDI program to expand without overburdening full-time staff, outsourced CDI specialists can help fill staffing shortages, says Kerin Draak, MSN, WHNP-BC, CPC, CEMC, COBGC, system director of clinical and financial integration at Hospital Sisters Health System.

“We’re short a CDI specialist and are using the outsourced staff to backfill, but we’re planning to continue to use them for summer [vacations], etc.,” says Draak.

Though there are real benefits of bringing in outside help, make the case to organizational leadership by providing a return on investment, Draak says. Luckily, it’s not a difficult task.

“We have two outsourced CDI specialists and we’ve kept one on permanently due to her extraordinary performance. She’s covered the cost of her salary, so it’s a win for us,” says Draak. “CDI specialists can usually cover their costs. We can show that by tracking productivity and the financial outcomes of queries.”

Plus, if the outsourced staff member meshes with department’s and organization’s needs, the program may be able to hire him or her and fill staffing vacancies permanently without going through the interview and recruitment process, Catapano says.

 “We’ve had some candidates with less than stellar work habits so you can go through a few before finding your solid candidates,” she says. “On the other hand, though, we’ve found some exceptional staff and have hired them on permanently. You get a chance to try them out.”

Editor’s note: Members of the ACDIS Leadership Council answered this question. If you have questions you’d like to pose to one of ACDIS volunteer boards, committees, or networking groups, contact ACDIS Editor Linnea Archibald (larchibald@acdis.org), or post it to the ACDIS Forum.