CDI Week Q&A: CDI Expansion
As part of the seventh annual Clinical Documentation Improvement Week, ACDIS has conducted a series of interviews with CDI professionals on a variety of emerging industry topics. Rhonda Peppers, RN, BS, CCDS, a CDI specialist at Care Coordinators, MedPartners, in Tampa, Florida, and a member of the 2017 CDI Week Committee, answered these questions on CDI expansion. Contact her at rhondapeppers@benefis.org.
Q: When did you first get involved in CDI, and what was your CDI program’s focus?
A: I started working in CDI in 2011, and our program’s focus was on earning money. We were given monthly monetary totals on the queries we wrote. We were very competitive. Our goal was to see who could make the most money. As a matter of fact, I was told when I first started that we were not to write the query if it was for severity of illness (SOI) or risk of mortality (ROM), just write the ones for MCCs and CCs.
Q: How has the focus of your CDI program changed over the years?
A: I have seen many changes in many different aspects of the program. Over the years, CDI has gradually become more of a quality tool for physicians and hospitals than about the money. Its importance has shifted to a complete, precise documentation program that is placing more importance on the SOI/ROM than the monetary reimbursement. One statement I hear a lot lately is, “If you have complete and accurate documentation, then all the monetary benefits will fall into place.”
Q: How has your CDI program kept up with changes in the larger industry?
A: We’ve been placed in a different department with a manager who’s enthusiastic about CDI, encourages personal education for the staff, and sends as many staff CDI team members to the annual ACDIS Conference as she can. We are responsible for educating the physicians, interacting with the physicians, and providing education for other departments. We all must have our CCDS. Our program also engaged a physician advisor who is involved in all aspects of the program.
Q: What do you think is the most important thing for a CDI specialist/manager to do to stay informed about industry trends?
A: Any CDI specialist or manager should keep up with national trends in the CDI arena by attending the ACDIS Conference and keeping abreast of the current literature provided by ACDIS, HCPro, and AHIMA. They are many free webinars, ACDIS Radio shows, and written literature provided by those organizations to keep current with the latest trends and the future of CDI. Attending local chapter meetings will also provide an opportunity to network with other people and programs.
Keeping current with CMS rules and changes should be another priority for your department. Lately, it could just mean watching the news or reading the paper to see where healthcare is heading.
Q: What do you think CDI programs/staff should track in terms of data to show program effectiveness and opportunities for expansion?
A: I think it’s important to know data about physician involvement, mortality index, and SOI/ROM. Quality is a key component of this, in my opinion, and quality reviews can provide areas for growth in CDI. Now we need to ask ourselves whether we should be tracking denials and whether they’ve decreased due to improved validation queries. Any areas in the Value-Based Purchasing Program would be good indicators of areas that need improvement or are already doing great.
Q: Where do you think the greatest opportunities for CDI program growth lie in 2017/2018?
A: What I’ve been seeing and hearing a lot about is expanding to the outpatient and clinic areas of operation for the hospitals. We would be great assets for long-term acute care facilities and skilled nursing facilities, too. The ACDIS site also states that validation queries are a big trend in the industry. This provides many opportunities for individual CDI specialists and programs as a whole. Another opportunity could be to expand to patients in the observation setting. This could aid in medical necessity and proper status assignment.
Q: When CDI programs identify target areas, what are some of the typical obstacles they face in obtaining administrative support for the program expansion?
A: I think the main issue is that they’ll have a hard time proving the benefit of the program against the cost of the program. They will also have limited personnel who are knowledgeable in the introduced program. These leaders will have a large group to educate about the program before it can even be initiated.
We also need to consider how to get the current CDI personnel to buy into the proposed program/expansion. Will this increase their already heavy workload? Another area will probably be physician buy-in—why should they do this? What benefit will they see? The results of the program will probably not be seen immediately. So, no “immediate gratification” can be offered.
All in all, I see a great future for CDI and continued growth nationally. Our importance to hospitals and physicians has grown, and will continue to grow, exponentially with the advancement of ACDIS and its members.