outpatient cdi program, cdi and coding

Starting a CDI Program

When first starting an Outpatient Clinical Documentation Improvement (CDI) program, it’s important to identify which departments you will need to interact with and who will be impacted through the CDI process. Interaction and transparency with these departments early on will assist in gathering much needed support for the program as you introduce a new process to providers who may not be as receptive as you might wish.

A key figure to work with from the very start is the HIM department. Establishing efficient workflows and effective communication with HIM leadership and coding staff is important to both departments to achieve positive outcomes. Sharing information related to denials, evaluation and management levels, the billing process, or any common issues will be of great benefit in decreasing associated risk and revenue cycle delays. It is important to understand how the CDI process may impact workflows in the revenue cycle as the goal is to not create additional challenges on top of any you may already be facing. Regularly scheduled meetings and updates between HIM and CDI leadership is essential to the process.

 When it comes to data gathering, defining return on investment (ROI) metrics, and identifying opportunities, there are several departments along with HIM that can be valuable to collaborate with. The CDC views Population Health as “interdisciplinary, customizable approach that allows health departments to connect practice to policy for change to happen locally.” In a hospital or healthcare system, Population Health departments coordinate many of the quality measures mandated by payers with other departments to achieve positive outcomes and are often the source of data reports from payers identifying opportunities associated with risk-based contracts. In addition to Population Health, Clinical Improvement or Quality departments are also a valuable partner as they are actively involved with process improvement activities within the hospital or healthcare system that often go hand in hand with Outpatient CDI initiatives.

Another important collaboration effort in the outpatient setting will be with the Medical Group leadership team. Because you may be interacting with providers from various specialties, service lines, and locations, communication that comes from the leadership team about any potential impact to provider workflows or a new process is highly recommended. Any provider metrics you track for program performance, such as query response rates or Risk Adjustment Factor (RAF) scores, should be shared with the leadership team on a regular and consistent basis. Very often, the Medical Group will incorporate CDI performance metrics into the bonus structure of their providers in an effort to maximize engagement with CDI efforts. In addition, collaboration with the leadership team will keep you informed of additional responsibilities that may have been placed on providers that could impact their available time to interact with CDI staff.

While this is only a sample who you should coordinate efforts with, the primary goals of collaboration with various departments within the hospital or healthcare system are to maximize the ROI of your Outpatient CDI program efforts, prevent the duplication of services by other departments and negate potential conflict with their goals, minimize the impact to workflows, and support the overall initiatives of the facility or practice setting.

Whether you are in the beginning stages of exploring potential opportunities in the outpatient setting or already have an Outpatient CDI program in place, MedPartners has the experience, knowledge, leadership, and staff to assist you at any point in your journey. 

 

Blog by David Reece, BSN, RN, CCDS, Consulting Director, Outpatient CDI Solutions, MedPartners University

Collaboration between various departments and service lines in the healthcare setting is often a challenging venture due to competing focuses, priorities, software systems, operating in a silo mentality, hospital culture, and people not wanting to share “ownership or control” of a process. But without collaboration, it is very difficult for a department to grow, be successful, and work toward the common goals of the institution.

 

 

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