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CDI: Just Tell Me What to Say

ICD-10 and CDI: Improving the Improvement Program

Published April 6, 2012 1:55 PM by Alice Zentner

Many providers have clinical documentation improvement programs. The belief is that more accurate, detailed clinical documentation is better for the patient, the institution, the government, researchers, and all aspects of quality of care. So why not have an improvement program for the improvement program?

Too many CDI programs focus on the short-term goals of reduced denials and fewer queries only for those DRGs and types of cases payers are reviewing today. But a truly visionary CDI program takes a much longer-term view of both the areas for documentation improvement and the ability for programs to achieve a return on investment.

Certainly, CDI programs should focus on current areas of weakness that are impacting cash flow, but with a focus on the longer-term goals, such as successfully implementing ICD-10 and building the framework for strong documentation practices that will support future upgrades to coding systems. Quality initiatives and pay for performance seem to be gaining traction as healthcare initiatives, which also would benefit from better, more accurate documentation. Looking forward to incorporate these programs into today's CDI initiatives gives providers time for a methodical transition to any new reimbursement model - not to mention solid quality data and business intelligence to make better, long-term decisions.

Trying to jam change into the last minute is a formula for mediocrity. You get done the absolute minimum needed to meet a program's needs, but you never reap the upside benefits that these programs present.

Your CDI initiative is a living process that should be proactive to future needs, not reactive. Preventative medicine is always preferred to illness intervention. Make sure your CDI program has an oversight group charged with improving the improvement program. While ICD-10 and the many other initiatives in healthcare seem to be overwhelming, a successful CDI program can greatly smooth the road to change.

3 comments

The first step in implementation of a successful CDI program that will have sustainable results is to complete an Organizational readiness assessment. This assessment is a comprehensive review of the organization's capability to evolve with the necessary changes a CDI will initiate throughout a facility whether it be acute inpatient, long term acute rehabilitation, skilled nursing, physician private practice, hospice, and/or home health. The impetus of CDI is based on federal, and state regulations that ensures compliance and mitigates potential revenue losses. To achieve compliance and optimize potential reimbursement opportunities requires an engaged Executive Leadership team, an active board current on regulatory issues impacting healthcare, and a Physician Advisor with intricate knowledge and experience of the role excellence in providing care, clinical documentation, and the revenue cycle have on the fiscal stability of the organization.

Alice Zentner, HIM - Director of Auditing and Education, Consultant May 11, 2012 10:55 AM
Springfield MO

Alice, how would one go about implementing a CDi program in their facility?

Rosalee Mancuyas April 29, 2012 11:57 PM

I agree with Alice's comments about a CDI program. We as coders need to widen our skill-set beyond coding to the entire revenue cycle. This will give us insight to how information is interrelated and allow for targeted improvements.

Gina Homminga, HIM - President, Consulting April 9, 2012 11:46 AM
Detroit Metro MI

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