In this continuation of our series about the financial well-being of rural and critical access hospitals, we explore the importance of clinical documentation improvement (CDI) programs and how to establish one at your facility.
This post was previously posted on Healthcare IT News on February 12, 2019. Republished with permission.
“I wear a lot of hats around here.”
It’s a phrase that we all hear, and
repeat, regularly, but it may be no truer than at rural and critical access
hospitals. In these environments, the health information management (HIM)
person may do triple-duty as they focus on compliance and documentation
initiatives. The COO may work on
quality, and nurses are dedicated to patient care and leadership roles. The IT
staff which is often quite small may cover several roles. There may not even be
a chief medical officer.
In other words, because personnel and
resources are in short supply, everyone must pick up the slack and do more with
less. And this becomes even more evident as we recognize the financial
vulnerability of too many rural hospitals across the U.S., in which case leave
communities strapped with a lack of facilities. In fact, at least 30 rural
hospitals entered bankruptcy in 2019, leaving many people with zero local
access to medical care.
The value of CDI
programs
Clinical documentation improvement
(CDI) programs combine clinical documentation expertise with processes and
technology to improve the quality, accuracy and completeness of patient
records. In organizations of varying size, CDI initiatives have been associated
with a wide range of benefits. Among the improvements, enhanced patient care processes, more
accurately coded data, and enhanced financial outcomes, and better-quality
metrics. When CDI programs are driven by clinical strategies and evidence-based
guidance through technology-based software solutions, documentation accurately
and comprehensively captures diagnoses, procedures, and comorbid conditions in
ways that lead to appropriate reimbursement and fewer denials, and productivity
improvements and stronger revenue cycle management. Many organizations can also realize
improvements to a variety of publicly reportable peer to peer program
comparisons and satisfaction scores.
CDI programs can have a positive
impact on physician efficiency, patient care, and outcomes. Documentation that
accurately, completely, and specifically conveys critical patient information
to all members of the healthcare team, in other words continuity of clinical
care communications, reduces error and builds a strong platform to support
better care.
Elevating CDI in
rural healthcare organizations: advice to get started
Despite their good track record,
however, many rural healthcare organizations have extremely limited or no CDI program in place because resources are
already spread too thin.
In reality, establishing even a
small-scale CDI program can support the organization’s clinical programs and
financial strength. Creating your own program involves generating and filling a
job position for the role of a CDI specialist. Education is a crucial step for
this role and the medical staff—it begins with an understanding of documentation
best practices and its effect on coding. This critical healthcare colleague
must gain knowledge in coding and chart review as well as on-the-ground
engagement tactics with the key members of the medical staff. Start small with
clearly identified medical leadership, even one busy surgeon, a hospitalist, or
an intensivist for example. Find what works for your organization. Communicate
the necessity and benefits of such an endeavor often.
At the same time, your new CDI
specialist or small team will need to work closely with the hospital CFO and
clinical leaders to establish targets and key performance indicators (KPIs).
Whether you’re measuring improvements to severity of illness, risk of
mortality, geometric length of stay, and other quality measures, tracking and
robust analytics are essential and ideally included with your choice of
technology. Otherwise, there’s no way to know how you’re doing and whether
you’re getting a return on your investment. If you can’t measure it, you can’t improve it.
I’ve had the privilege of working with
numerous organizations demonstrating success establishing nascent CDI programs.
Stay tuned in the coming weeks for a continued discussion on CDI, and how one
such hospital reaped the rewards of ROI and elevated quality from a technology
supported CDI program.
This blog post is the second in a three-part series. To view the first blog post, click here.
