The Next Big Thing in Clinical Documentation Improvement (CDI)
From the beginning, the hospital inpatient was the focus of a CDI program. As its importance was realized, CDI expanded from a single setting reimbursement focus to a quality based, multiple setting focus with the expansion into other inpatient settings such as rehabilitation, pediatric, and long term acute care settings, and now CDI has expanded into the outpatient environment. Since the healthcare environment focus has shifted to the patient by providing value and quality over fee-for-service, the CDI profession has shifted accordingly.
The past several years has brought about a healthcare focus on population health as the lines differentiating the settings have blurred. But what is population health? The Healthcare Information and Management Systems Society (HIMSS) points out that “Population health addresses the health status and health issues of the aggregate population. It brings significant health concerns into focus and addresses ways in which communities, healthcare providers, and public health organizations can allocate resources to overcome the problems that drive poor health conditions in the population, e.g. diabetes, obesity, autism, heart disease, etc.”
The Centers for Disease Control and Prevention (CDC) views population health as an opportunity to connect practice to policy with a customizable approach utilizing partnerships among public health, industry, academia, health care and local government sectors to achieve positive health outcomes.
Mentioning population health often brings about an association with public health. The CDC points out the differences between public health and population health as it explains that “public health works to protect and improve the health of communities through policy recommendations, health education and outreach, and research for disease detection and injury prevention. It can be defined as what ‘we as a society do collectively to assure the conditions in which people can be healthy’ (IOM, 1988). On the other hand, population health provides ‘an opportunity for health care systems, agencies and organizations to work together in order to improve the health outcomes of the communities they serve.”
One of the programs the CDC has implemented to support population health is HI-5, or Health Impact in 5 Years. The CDC points out that “achieving lasting impact on health outcomes requires a focus not just on patient care, but on community wide-approaches aimed at improving population health. Interventions that address the conditions in the places where we live, learn, work, and play have the greatest potential impact on our health. By focusing on these ‘social determinants of health’ (SDOH) and on ‘changing the context to make healthy choices easier’, we can help improve the health of everyone living in a community. The Health Impact in 5 Years (HI-5) initiative highlights non-clinical, community wide approaches that have evidence reporting 1) positive health impacts, 2) results within five years, and 3) cost effectiveness and/or cost savings over the lifetime of the population or earlier.”
For those working in the mid-revenue cycle, it does not go unnoticed that the information surrounding social determinants of health, like the data surrounding all conditions and diseases, is collected from billed records, which is driven from codes that are assigned using provider and non-provider documentation in the medical record.
What are social determinants of health? There are close to one hundred ICD-10-CM codes that designate SDOH into general categories of
- problems related to education and literacy
- problems related to employment and unemployment
- problems related to housing and economic circumstances
- problems related to social environment
- problems related to upbringing, primary support group and family circumstances
- problems related to psychosocial circumstances
Because CDI professionals carefully review the medical record with the purpose of documentation integrity that precisely reflects the individual’s health status, they can be viewed as the “gatekeepers” of the medical record. Due to the CDI professional’s clinical and coding expertise and their gatekeeper experience, they are in the unique position of being integral to successful partnerships among the key community sectors to attain positive health outcomes for the individual within the population. With the CDC stating that social determinants of health are one focus that can improve the health of everyone living in a community, and CDI moving beyond the hospital walls with the focus on continuity of care for the individual, it holds promise that the next big thing for CDI is population health.
Are you ready for the next big thing in CDI? MedPartners has the Mid-Revenue Cycle experts ready to help you with your population health initiative.
Karen Newhouser, RN, BSN, CCM, CCDS, CCS, CDIP, CCDS-O
CDI Education & Compliance Manager
CDC. What is Population Health? Retrieved from https://www.cdc.gov/pophealthtraining/whatis.html
CDC. HI-5. Retrieved from https://www.cdc.gov/policy/hst/hi5/
HIMSS. Population Health. Retrieved from https://www.himss.org/population-health