Guest post: Justifying the value of CDI as ABC

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

More often than not CDI professionals are confronted with the task of justifying the value of CDI for the organization. Hospital administrators want to know why they should approve the hiring of a CDI staff or the purchase of educational program or a tool for the CDI department. It becomes our role to clearly articulate/justify such needs without leaving any doubts in their mind.

In this article we will spell out an approach to help you get the needed staff, educational material, or tool you very much need for your day to day operations. A note of caution, some programs will not obtain approval for some expenditures no matter how much trouble you go through in justifying and articulating your needs.

Another note of caution, just because everyone you know is going for one fancy tool or another, doesn’t mean you should. Know thyself and make the case for common sense, financially prudent items.

Justify the value of a CDI program by recognizing your audience. If it is someone who deals with numbers, put your numbers together. If the individual deals with quality data, put your quality hat on and justify your value in such terms. If it is the big picture person, limit your justification to as little detail as possible while articulating the value of CDI in broad strokes.

In justifying the value of CDI, always remember to break it down under two broad categories--the tangible and intangible. Traditional metrics such as case load per staff versus your facility volume, review rate, query response rate, agreement rate, etc. are always relevant. Also throw in the CDI case-mix change which you can convert into a dollar amount, pay for performance impact (if the program addresses this), before- and after- data of any audit finding following program implementation, denials rate change post implementation of the CDI program, appeals turnover rate (if the program is involved in addressing this component).

Make sure to include any other areas the program may be involved in which, while difficult to measure, contributes to the safety of the facility, patient satisfaction, and positive public perception.

Make sure you first document all the various departments you interface with and your role in helping them achieve overarching organizational goals. Quantify that if you can. For instance, a nascent CDI program for a 100-bed hospital with about 50 average daily census (ADC) and only 1 CDI specialist can make the case for additional staffing by pointing out potential lost revenues or missed opportunities by indicating the review rate, the CDI case-mix change, and the potential opportunities should additional CDI staff be added.

Then extrapolate to identify missed opportunities related to a pay-for-performance angle. Explain how limited staff equates to limited review time and scope. The same analysis can be made for denials rate and other areas the CDI roles have been expanding into. Put a dollar amount to each goal by month and annualizing it. That should be enough for any senior executive to approve the investment.

If we as professionals do our justification well, there should be minimal challenges in us getting the support we need to play that critical role in the organization’s clinical operations. I have seen organizations in their desperate quest to stay financially viable cut off their CDI program without really realizing the value the program brings when run properly. Too late, they learn (relearn) the value of those CDI efforts to their organization’s survival.

As the good book says, my people perish for lack of knowledge. We need to champion the relevance of the CDI program to our organization or get champions that can promote the CDI value to our organizations.

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. The opinions expressed do not necessarily reflect those of ACDIS or its advisory board. Contact Damalie at serenityCDIplus@gmail.com.