2021 CDI Week Industry Overview Survey

ACDIS celebrates CDI specialists annually with a full week of recognition for the profession through activities, education, and fun. This year’s CDI Week theme is CDI Kitchen: Recipes for a Successful Program, aiming to go back to the basics of what it takes to make a CDI program great.

Each year leading up to CDI Week, ACDIS releases a survey to gain insight into the state of the industry. This year’s survey included questions about the basics of CDI, physician engagement, outpatient CDI, productivity, and staffing/ professional development. It marks the 11th annual CDI Week Industry Survey, continuing more than a decade of industry evaluation.

“Surveys such as this are important to gain perspective on industry trends, growth, and areas for improvement,” says Kelly Sutton, RN, BNS, MHL, CCDS, who was the CDI educator of the West Florida division of AdventHealth in Tampa when this article was written. “The data in this type of survey can be leveraged to support the expansion of CDI programs— for example, increasing the number of frontline staff, creating new positions for second-level reviews, incorporating denials management, or expanding the scope of a program to include emergency room or outpatient reviews.”

This year, 944 respondents took part in the survey, nearly 100 more than last year’s 849 and the highest number of respondents to date. Although this report will not discuss every survey question in detail, readers can examine all the responses in graph format beginning on p. 13.

Survey respondents were asked their title and role to get a picture of different positions within the field. Similar to last year’s results, CDI specialists made up the largest group, with 44.39% of respondents fitting into this role. This number, however, is down slightly from last year’s 49.32%. The change is likely due to more 2021 respondents who are CDI managers (17.37% versus 14.72% in 2020), directors (11.44% versus 10.6% in 2020), and team leads (4.13% versus 3.3% in 2020). The shift from respondents in CDI specialist roles to those in higher positions likely demonstrates individuals growing within their career. (See Figure 1.)

“As the potential for program growth is realized, the opportunity for promotion to a leadership role allows a pathway for continued professional growth,” Sutton says. “I have watched many nurses throughout my career leave positions due to the lack of opportunity for professional advancement. The data in this survey suggests a career in CDI has both longevity and the potential for upward mobility.”

Only 48.09% of respondents noted working in an acute care hospital, down drastically from 85.28% of respondents who selected this answer last year. This large drop is likely because the 2021 survey added survey answer options aimed at greater specificity. These options included academic medical center/teaching hospital (16.53% of respondents) and healthcare system with multiple sites (26.27% of respondents), which were not available choices on the 2020 CDI Week Industry Survey. (See Figure 2.)

According to survey results, most respondents (33.47%) said that they have been in their current profession for over 20 years. Additionally, 18.54% have been in the profession for six to eight years, and 17.69% selected 11 to 15 years. Most respondents (56.36%) have been in their current role between zero and five years. An additional 21.4% have been in their role for six to eight years, and 1.38% of respondents have been in their current role for more than 20 years. (See Figure 3.)

“I am not surprised to see so many people in the CDI field for so long,” says Sutton. “CDI demands use of critical thinking skills, clinical knowledge, and collaboration with other disciplines to ensure success. What other career away from the bedside allows professionals to utilize all these skills and still learn something new every day?”

When respondents were asked how long they intend to stay in CDI, their answers were spread fairly evenly across the board. Most respondents said they intend to stay for more than 20 years (20.44%), and an additional 17.69% said they intend to stay for three to five years, while 15.04% of respondents picked the middle road and answered nine to 10 years. (See Figure 4.)

Most respondents (34.22%) indicated their facility has between 101 and 400 beds, and 25.53% said the total number of beds in their health system is 3,000 or more. (See Figures 5 and 6.) While these numbers are comparable to those on the 2020 CDI Week Industry Survey, it should be noted that those with more than 2,000 beds in their healthcare system increased by over six percentage points (from 30.97% in 2020 to 37.29% in 2021), and those who answered they were not part of a healthcare system decreased by more than seven percentage points (from 22.14% in 2020 to 14.62% in 2021) year-over-year. The increase in overall hospital beds in a system and decrease in respondents who are not part of a larger hospital system could be due to the trend of larger organizations acquiring smaller hospitals. (See Figure 7.)

Folks in the CDI field come from different educational and professional backgrounds, including nursing, coding, and health information management (HIM). Because of this, it is not uncommon for CDI professionals to hold a vast array of credentials. Most respondents (74.58%) noted that they hold an RN credential, and 63.03% of respondents hold ACDIS’ Certified Clinical Documentation Specialist (CCDS) credential. All other credential options offered on the survey had lower response rates. For example, 15.36% of respondents noted holding the CCS, 10.49% hold the CDIP, and 6.25% hold an RHIA credential. (See Figure 8.)

“As CDI programs expand into realms other than traditional inpatient CDI, and the programs become more robust, the list of credentials will continue to grow and become more diverse,” Sutton says.

For this year’s CDI Week Industry Survey, ACDIS increased the amount of answer choices for the question about CDI reporting structure, allowing for a more detailed look at whom CDI departments ultimately report to. Just over 27% of respondents said their CDI department reports to revenue integrity/cycle (a new option on the 2021 survey), and closely behind, 23.31% of respondents report to HIM/coding. Another new answer option, finance, garnered 14.19% of responses, and only 6.89% of respondents indicated they have a stand-alone CDI department, down from 11.43% in 2020. While the decrease in respondents from a stand-alone CDI department could have resulted from additional answer options redistributing that number, it is also possible that the past year has seen a shift away from stand-alone CDI departments. (See Figure 9.)

“As more CDI programs expand and diversify, the financial impacts will be realized. It makes sense that more programs are reporting to finance and rev cycle,” Sutton says. “As the focus in healthcare is trending toward preventative medicine and managing chronic conditions so patients do not require inpatient hospitalization, revenue cycle and finance are perfectly positioned to forecast, track, and adapt to the changing landscape in healthcare.”