Serenity CDI: Meeting the needs of changing CDI dimensions

By E.S. Damalie, MD, FACHE, FHFMA, RHIA, CCDS, CDIP, CCS

For some organizations, CDI may be something new; an innovative dream touted as beneficial to the organization. To others, CDI exists in its rudimentary form. Yet there are others who may have CDI programs operating at that full scope with a continuous push in addressing areas that not only broaden the CDI focus but bring sanity and serenity to the organization’s clinical operations.

Whichever level you find yourself at, there is a horizon line of hope—a hope that someday your program can get to that level where it is recognized as a driver of the organization’s clinical operations. CDI has become increasingly clinical in nature and professionals in this field who want to be on top of their game need to keep up with their clinical knowledge and skill set.

Gone are the days where all the focus of the CDI program was about ensuring correct and accurate coding and generating knee-jerk queries based on just a condition listed, even if it is in the past medical history. For example, documentation of congestive heart failure (CHF) in any part of the patient’s record may automatically elicit queries for acuity and type of CHF without a thorough review and understanding of the clinical indicators that may already point to the acuity and type of CHF.

While this may be a sound tactic in some instances, asking for acuity and or type without having the necessary clinical indicators to drive it may defeat the purpose of documentation improvement. CDI in today’s healthcare terrain has to be holistic enough to address coding related issues and proper DRG assignment, severity and risk concerns, medical necessity of care issue, pay for performance issues, quality of care and related care coordination issues, denials management/clinical appeals.

Obviously, not all organizations can roll this out immediately, but as health systems/organizations continue to grow their CDI program, such efforts should be looked at in the context of clinical operations more than anything else. Truth be told, today’s healthcare environment is driven significantly by clinical operation. The effectiveness of an organization’s clinical operations can make a difference in its fiscal survival, patient satisfaction, and public perception.

CDI staff need to be well informed and educated to effectively champion the organization’s clinical operation initiatives. This evolution of CDI as an integral piece of an organization’s clinical operations could be likened to the hitherto unheard-of CDI programs been stand-alone departments in their own rights which is increasingly becoming the trend now.                   

The reality is that those who can see the light and take steps toward it can have the serenity of mind and withstand the turbulence of today’s healthcare environment with its many audits, challenges, and changes.

Editor’s note: Damalie, a physician and CDI specialist, is currently affiliated with Serenity CDI+ Solutions, which offers CDI, appeals and denials management, coding and auditing, and other revenue cycle services. Currently a fellow of both the America College of Healthcare Executives and Healthcare Financial Management Association, he also serves on the ACDIS CDI Practice Guidelines Committee, and as chairman of the Certification Committee for the Southern California Chapter of HFMA. He. The opinions expressed do not necessarily reflect those of ACDIS or its advisory board. Contact Damalie at serenityCDIplus@gmail.com.