May 03, 2012 | | Comments 1
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Crossing CDI program boundaries

What will it take to push your program beyond its artificial boundaries?

What new boundaries are CDI professionals exploring? CDI specialists discussed several areas of expansion during the 2011 CDI Week celebrations last September. You can read about them in the special CDI Week Q&As and in the CDI Week Industry Survey, which are still available on the ACDIS website. CDI professionals also frequently explore the boundaries of the CDI profession on the ACDIS Blog and on CDI Talk discussion strings.

And I know that those fortunate enough to attend the ACDIS conference in San Diego next week will certainly learn about new documentation improvement opportunities. Come to think of it, the conference has such good ideas every year—and a good idea doesn’t truly get stale—you should take a look back at conference materials from previous events to see what tips you may find and consider implementing.

Conversations regarding CDI expansion really should be considered aspects of program and organizational strategic planning. CDI managers need to consider where CDI specialists will focus their primary efforts over the next year, two years, even five years.

Yes, the regulatory environment governing healthcare is always changing and most CDI program directors can guess about how those regulatory changes will affect CDI, patient care, and the healthcare revenue cycle. But well-informed professionals can make some practical suggestions to position their CDI team appropriately for the future.

Warning, what follows is somewhat like throwing pasta against a wall—some ideas may simply fall and other ideas, like a good al dente macaroni will stick. Regardless, here are my thoughts about possible avenues for CDI program expansion.

CDI specialists should consider conducting record reviews for:

  • Mortality/quality/length of stay/severity of illness profiling
  • Surgical complications
  • Hospital acquired and present on admission conditions
  • Medical necessity support (both initial and ongoing stay)
  • Evaluation and management documentation

Additionally, CDI programs may gain ground by exploring:

  • Medicaid, third-party, private payer initiatives
  • Outpatient CDI (e.g., emergency department, ambulatory, denials management)
  • Documentation improvement opportunities in alternative settings such as long-term care, rehabilitation, psych, pediatric, and obstetrics units (ACDIS recently launched a new networking group dubbed APDIS-the Association for Pediatric Documentation Improvement Specialists)
  • New government initiatives such as Value-Based Purchasing, Accountable Care Organizations, and payment bundling
  • Proactive Recovery Auditor and external auditor defense
  • Collaboration in development of clinical best practice, documentation, protocols, etc.
  • Data mining and reporting (internal drivers and external reports)
  • ‘Hardwire’ documentation improvement elements in EMR and IT systems
  • Quality data versus coded data
    • Why and where does a difference exist?
    • What can be done to ensure both data sets are parallel and completely accurate?
    • How can CDI contribute to clinical care and quality data measurements?

Of course, a number of previous posts directly or indirectly address exploring new CDI areas. As you investigate new ideas, try new things out, consider sharing with your professional colleagues—comment on CDI Talk, write a blog post, contribute a CDI Strategies quick note, or partner with other staff to write a CDI Journal article.

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Filed Under: Growing your program

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Donald A. Butler About the Author: Donald A. Butler entered the nursing profession in 1993, and served 11 years with the US Navy Nurse Corps in a wide variety of settings and experiences. Since CDI program implementation in 2006, he has served as the Clinical Documentation Improvement Manager at Vidant Medical Center (an 860 bed tertiary medical center serving the 29 counties of Eastern North Carolina). Searching for better answers or at least questions, Butler says he has the privilege to support an outstanding team of CDI professionals, enjoys interacting with his CDI peers and is blessed with a wonderful family.

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  1. Nicely stated, Don. It’s so easy to get caught up in CC/MCCs and reimbursement impact routines, but after you get the hang of that–and the physicians get it, too–your program can stagnate if you don’t take it in new directions.

    Long term care is an interesting place for documentation improvement, because it’s one area where nursing and therapy documentation–much more than physician documentation–is absolutely critical in setting the RUGS levels that get the SNF paid for their Medicare population.

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