Note from the ACDIS Director: The concept of continual improvement is true in all walks of life, CDI included

By Brian Murphy

You’ve probably heard the mantra that, in order to grow personally and professionally, you need to “continually improve.” This is often accompanied by the advice, “get comfortable with being uncomfortable.” These pat aphorisms are often presented as memes on LinkedIn or other social media sites, and generate several “likes” and comments of encouragement.

I often read these, and nod my head in agreement. But are they actually true?

The answer is yes. The world is changing rapidly, with healthcare in a constant state of disruption. Our small corner is no exception. CDI focused solely on capturing CCs and MCCs will fail. There are too many pressures in the industry working against this model: auditors looking for one CC and MCC on a chart and issuing denials; natural language processing algorithms and computer assisted coding programs automating basic review and coding functions. And inpatient volumes are declining. Noted healthcare observer and pundit Paul Keckley stated in his weekly column of January 29 that the core business for hospitals, inpatient care, is shrinking, with admissions dropping 12% over the last decade.

CDI must adapt, or it too will shrink.

In what concrete ways can the CDI professionals adapt as individuals, and improve and expand the reach and the value of the profession? Buy into the “continual improvement” mantra and be ready to “get uncomfortable.”

One answer is continual education, taking the time to learn the regulations and payment initiatives coming down from CMS, and then creatively modifying your program to adapt. The thought struck me as I was listening to Tuesday’s CMS Bundled Payments for Care Improvement (BPCI) Advanced Open Forum Q&A session. (Tip of the cap to former ACDIS advisory board member James Kennedy, MD, CCS, CDIP, CCDS, for reminding me about this event.)

The BPCI Advanced program is a new initiative which CDI can affect. While several quality programs are in flux due to deregulation efforts by the Trump administration, bundled payments is not one of them. CMS Administrator Seema Verma recently stated in an interview with the American Hospital Association that the new administration will continue to push the development of payment models that tie payment to quality outcomes.

Its worth paying attention. CMS received more than 600 questions from registrants of the BPCI Advanced Open Forum Q&A session, looked at trends in those questions, and answered those of greatest appeal. CMS plans to put these into a new Frequently Asked Questions document in two weeks.

The BPCI Advanced program is voluntary and open to hospitals and accountable care organizations, physician groups, and small unaffiliated physician practices. It includes 32 clinical episodes—29 inpatient and three outpatient—including major joint replacement of the lower extremities, congestive heart failure, chronic obstructive pulmonary disease, and many others.

BPCI Advanced participants qualify for incentive payments if the entire bundled episode of care comes in under expected costs (“target price”) set by CMS. CDI can make a real impact by clarifying diagnoses that fall into the inclusion/exclusion criteria used in these risk-adjusted models. CMS on Tuesday’s call stated that it is expanding the inclusions list to include additional MS-DRGs.

CDI professionals must understand how these bundles are built and the impact the bundles have on physicians and hospitals. Doing so is the best way to get physician buy-in to CDI, according to Kennedy.

Remember that the “I” in CDI stands for improvement. We need to keep improving to help our providers, our hospitals—and ourselves. So make the commitment to be a lifelong learner. Get involved with ACDIS, or if you can’t join, hook up with your fellow CDI specialists online or at a local chapter meeting. Put to use the creativity you had to develop when nursing at the bedside with limited resources, or when you took the leap from HIM/coding to CDI. Improve your knowledge base of programs like BPCI Advanced, and you’ll improve yourself—and your value to your hospital.

BPCI Advanced begins in October 2018. The deadline for submission of applications for the initial enrollment period is March 12, 2018, at 11:59 p.m. eastern. Make the effort to get your hospital involved. CDI specialists can play a huge role in this effort by raising awareness and offering to lead the charge.

Staying relevant in our fast-changing world requires bravery and initiative. Who better to take the plunge than a Clinical Documentation Improvement Specialist?

CMS will host its next BPCI Advanced Open Forum on Thursday, February 15, noon to 1 p.m., eastern. You can find a recording of the January 30 program on the CMS website.

If you are interested in learning more about ways in which CDI specialists can improve quality outcomes, check out the ACDIS CDI and Quality Care Measures Boot Camp. To learn more about risk adjusted payment and the ways in which CDI can make a difference, consider the ACDIS Risk Adjustment Documentation and Coding Boot Camp.

Editor’s note: Murphy is the director of ACDIS. contact him at bmurphy@acdis.org.