Blog by David Reece, BSN, RN, CCDS, Consulting Director, Outpatient CDI Solutions, MedPartners University
Starting an Outpatient Clinical Documentation Improvement (CDI) program can be an overwhelming task and you may find yourself asking, where do I start? Defining outpatient CDI in of itself is a topic many people have been talking about for awhile now. For the purpose of this blog, I’m going to focus on the steps to starting an outpatient program that’s applicable to any setting. In order for a program to be successful, there are certain key elements you should start with.
Developing a steering committee is an important first step to ensure coordination between departments that will be impacted by the OP CDI program. It is also extremely important to gain support from leadership and key stake holders at this stage to minimize any roadblocks in the development of your program. Your steering committee members should include a representative from any department with a vested interest in program outcomes as well as those impacted by any workflow changes. This includes executive leadership, Health Information Management, physician leaders, Information Technology and the inpatient Clinical Documentation Improvement team. Determining the program focus, scope and objectives requires help from the steering committee to keep your initiative on track. Include physician input when developing objectives to ensure buy-in and engagement at the earliest stages.
In order to know where your opportunities and pain points are, the first step is to gather data for a baseline assessment. A great place to start is a review of payer and denial reports. A review payer reports can provide critical information of risk adjustment opportunities for healthcare systems participating in shared savings, risk-based contracts, Accountable Care Organizations, Medicare Advantage, Quality Measures, and Medicare incentive programs. A review of payer denials will provide insight as to the types of denials you are receiving such as medical necessity, documentation issues, or coding errors. A review of your practice or facility evaluation and management levels against national benchmarks will show areas of opportunities related to under or over coding.
Compare data metrics to other like outpatient facilities and physician practices may provide a view of potential outliers or concerns that need additional focus.
An objective review of sample charts along with trending the findings will help pinpoint the root cause of the trends found. Prioritize the trends based on the financial impact of their resolution to your facility or practice.
If you participate in any shared savings programs or are part of an Accountable Care Organization, coordination with Population Health is vital. This will help your program maximize efforts without duplication as well as garner support and buy-in. Clear baseline data is essential in order to show a return on investment and show the fruits of your efforts.
Once the steering committee has been established and you’ve determined the area of focus for the program; the next step is to develop the staffing infrastructure with a well-designed workflow process.
Outline your medical staffs’ responsibilities and their accountability with regard to the success of your program. Identify providers that could provide oversight and outline a physician education process that will be amenable to the providers patient care processes. Develop policies and procedures with measurable metrics for all staff involved in the success of the program. Development of program documents such as workflow outlines and query templates will also be beneficial.
An additional component of this step may also include researching available software for your OP CDI team and coordinating with IT for electronic query options. While the technology market has been slow to develop a working outpatient CDI software platform, there are possible integrations within many EMRs that can be explored.
Now that you are almost ready to roll out your program, the final step may be one of the most critical to ensure success and provider buy-in. It’s time to educate the providers and staff on the purpose and expectations of the outpatient CDI program. Topics should cover why the initiative is important to the providers, the healthcare system and most importantly, the patient. Additionally education should be offered to the providers to familiarize them with the query process and details on why the queries are necessary in this setting.As in any new venture, there will be learning curves along the way. Looking at outside resources for assistance in developing your program is a great way to minimize the curve and implement a great program in a much shorter time period. As a leader in CDI staffing, training, auditing, workflow assessments and program implementation, MedPartners has the experience and solutions to ensure a successful journey into outpatient CDI.