Tip: Readmissions an emerging CDI focus area

As more facilities face the specter of reimbursement losses related to the Readmission Reduction Program, CDI programs may be asked to take a second look at records to help ensure documentation is adequate to fully support the patient’s diagnoses, says Susan Wallace, MEd, RHIA, CCS, CCDS, CDIP, director of compliance and inpatient consultant at Administrative Consultant Service, LLC, in Shawnee, Okla.

While it may seem like “just one more thing” added to the CDI review plate, Wallace says it needn’t be an onerous project.

First, make sure CDI focuses on more than CC/MCC capture and problem-focused reviews.  The readmission reduction targets currently include acute myocardial infarction, congestive heart failure, pneumonia, COPD (also COPD secondary to respiratory failure), stroke and elective hip/knee replacements.  Beyond the current readmission reduction program, inpatient quality reporting measures also target hospital-wide readmissions, so appropriate risk-adjustment is important for all admissions.

Second, reach out to other departments such as case management and quality to discuss how they are evaluating readmissions and brainstorm ways CDI can help.

Thirdly, says Wallace, stay informed. Review your facility’s Quality Net data and be familiar with the codes, diagnoses, and documentation requirements for those conditions.

“The Quality Net report to hospitals includes an appendix with factors used for risk adjustment; facilities can look at that data to compare their own facilities to other state and national statistics,” says Wallace. “That’s information that isn’t typically shared or reviewed, so CDI can look for opportunities there. Simply asking for the report can be a way to open the door and begin communications with the quality department.

Editor’s Note: If your CDI program is reviewing records with readmission reduction in mind, ACDIS would like to hear from and share your lessons learned in an upcoming CDI Journal article. Send your program description to Associate Director Melissa Varnavas at mvarnavas@cdiassociation.com.