Radio Recap: Advancing a CDI program

Most CDI programs start the same way: looking for CCs and MCCs to maximize the DRG for reimbursement purposes. But, as programs matured over the last decade or so, that mission has necessarily changed. Due to the wide variety of program expansion areas, however, one program’s definition of “advanced” may differ from their neighbor’s.

For the CDI team at West Virginia University (WVU) Hospital in Morgantown, advancing their program means increasing their focus on quality measures and ensuring physicians portray an accurate picture of a patient’s clinical condition in their record.

“From WVU’s perspective, the definition of an advanced program is one that has moved beyond reimbursement and incorporated quality initiatives, looked at all payers,” said Dawn Diven, BSN, RN, CCDS, CDIP, a CDI specialist at WVU and MedPartners on the March 14 episode of ACDIS Radio. “The CDI staff become respected members of the patient care team and we work with the providers to paint the most accurate view of their patient as possible.”

Of course, those goals can be easier said than done—as any CDI professional working in a growing program can attest. “The success of advancing our CDI program was contingent on changing our focus,” said Shari Nay, CCDS, a CDI specialist at WVU. “Our goal was accuracy and the key to accuracy was physician education.”

Rather than simply increasing the quantity of queries for a whole slew of new conditions and purposes, the CDI team at WVU, according to Nay, focused on limiting the burden and irritation for providers.

“We recognized what the provider was not saying, identified patterns, and then we educated,” she said. “We are engaged with our providers. They rely on the CDI specialists to know their educational needs and their weaknesses.”

The CDI team also tailored the education to the individual provider, offering group sessions as well as one-on-one meetings, depending on the needs and educational styles of each physician. “We logged over 100 education sessions in one year,” said Nay.

Knowing what will work educationally for each provider comes down to knowing the providers personally, added Diven. The CDI specialists on the WVU team are assigned to their own service lines and work with the same group of providers consistently, said Diven. 

“Each CDI is not only responsible for the cases for specific services, but also for providing customized education to the residents, the staff, and the APPs [advanced practice providers,]” she said. To that end, the CDI specialist attends mortality meeting and rounds with their service line as well.

The assignments weren’t arbitrary either, said Diven. Each CDI specialist was able to specify what areas they were most knowledgeable in and their backgrounds were taken into consideration when making the assignments.

“That strength of knowledge absolutely has led to more sophisticated queries and it has contributed to a more professional relationship with the providers,” Diven said.

While WVU was able to get this advanced program and structure off the ground with support from their leadership, other programs may face more struggles. “It’s difficult to sell this to administration,” said Diven. “It takes a strong team to walk up to leadership and say the industry is changing and we need to do the same.”

Editor’s note: To listen to the complete show from March 14, click here. ACDIS Radio is a free biweekly show. To learn how to register and listen live, click here. To subscribe to the show on Apple Podcasts, click here.