Just as clinical coders transitioned to home-based offices in the early 2000s, many CDI specialists are now seeking greater flexibility in the workplace. During the 2016 Annual ACDIS Conference in Atlanta, TrustHCS sponsored a focus group with 15 CDI directors, managers, and supervisors who shared their thoughts on the evolution of the CDI industry. Here are five items I took away as areas to watch in the coming year.
- CDI programs are expanding:
New venues for CDI programs include: all payers, outpatient, rehabilitation, observation, second and third Medicare reviews, value based purchasing and core measures, mortality reviews, PSI/complications, and pediatrics. The barrier to these expansion plans is the ongoing shortage of trained, qualified staff, and funding for implementation, which leads to the second discussion topic—CDI outsourcing.
- CDI outsourcing ahead:
While most participants preferred to hire and train their own CDI specialists, the group concurred that CDI outsourcing is becoming increasingly necessary to fill staffing gaps. Needs included weekend and vacation coverage, and growing demand for more CDI reviews as part of their program expansions.
The pros and cons of outsourcing through staffing agencies versus a full-service outsourcing company were discussed and four must-haves were identified:
- Only qualified CDI specialists need apply: The agency or outsourcing company must fully vet, audit, and test CDI specialists. Performance results should be made available for review and substantiated through CDI staff auditing and testing prior to the engagement.
- Onboarding support required: Along with the quality of the candidate, the onboarding of CDI support staff should also be provided by the agency or outsourcing company with an overall plan of how the onsite leadership team will collaborate with remote staff. Specific attention must be paid to documentation, coding, and physician nuances of each individual facility.
- Staff audits necessary: The agency or outsourcing company should also audit their own staff, rather than ask the facility to review CDI staff performance. CDI outsourcing must save management time—not increase the CDI director’s workload.
- Technology enablement essential: The focus group voiced that any outsourced CDI specialist—through an agency or full-service firm—must have ready access to technology. The outsourced CDI specialist depends on technology to assign a DRG, review cases remotely, and communicate queries electronically. Outsourced CDI programs need to be able to efficiently operate the facility specific software or have technology available to them to seamlessly join the workflow occurring in-house. CDI directors are encouraged to ask about technological capabilities or familiarity with systems before entering into any type of outsourced CDI arrangement.
- More CDI reporting needed: While most of the CDI programs began with a focus on reimbursement, they are quickly shifting to a focus on quality outcomes. Providing good reporting and analytic support is a major need for most, if not all, participants in the focus group. Current systems were noted as missing key capabilities for data reporting and analytics for CDI performance.
- Understanding the reporting structure:Most of the CDI programs represented during the focus group are housed in the HIM department—or at a minimum, report to the HIM director. The participants agreed the HIM department was the best fit for their CDI efforts because of the availability and access to patient records and HIM’s mutual goals. However, other organizations are finding success with CDI reporting through quality or case management. Outsourced CDI firms need to understand the differences that accompany various reporting structures.
- Remote CDI workforce emerges: We know the coding industry works well in a remote setting. Would remote CDI be a viable option for healthcare facilities thriving in a remote environment today? Here is what the focus group said:
- Remote CDI specialists require a fully implemented EHR system.
- Only certain functions are recommended for remote CDI—including case ID, case reviews and queries. A blended approach is best practice.
- Remote staff could rotate—with at least one day a week spent onsite at the hospital/health system/care location.
- There must always be at least one onsite CDI lead or liaison to communicate with physicians, coders and other departmental teams.
- High-quality standards must be maintained throughout the program—including for remote staff.
- CDI programs must be well established before attempting a remote program.
Editor’s note: Amber Sterling, RN, BSN, CCDS, director of CDI services at TrustHCS, wrote this article about a focus group hosted during our 2015 event. ACDIS is currently looking for speakers to apply to present at our 10th Annual ACDIS Conference in Las Vegas. Click here to learn more about the application process, and to apply.