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Cornerstone for CDI success is clear goals, objectives

Association of Clinical Documentation Improvement Specialists, January 1, 2015

by Wendy Clesi, RN, CCDS

Editor’s note: The following is an excerpt from the forthcoming white paper “Getting CDI started: Set a strong foundation to ensure future success.” 

Development of an effective CDI program can only be achieved by tailoring the program to the unique needs of each organization. This discussion focuses on some factors that CDI managers may need to reassess or establish, regardless of whether they are brand-new to the organization or have been in place for several years.

The mission statement

The CDI program mission statement outlines the program’s overall goals and focus. The statement serves not only as a touch point for CDI staff, but also as a measuring stick to assess achievement, future decision-making, and program expansion. The following is one example my company uses of a basic CDI mission statement:

Our goal is to provide education and process development to enhance communication and understanding among all individuals involved in the documentation and coding of the medical record to ensure the clinical reliability and integrity of healthcare data.

Other factors to assess

Once the mission statement is developed and a clear vision for the program established, further development can occur. New programs need to work on the following items from scratch, but experienced programs should annually reassess these factors:

Data analysis and goal setting: Review baseline data, such as your facility’s case-mix index, CC/ MCC capture rates, DRG volumes (either Medicare Severity or All-Payer Review), DRG pairings, query response rates, quality outcomes, etc. to determine opportunities for improvement. Set these focus areas and establish incremental goals based on current data. Remember that these goals should be adjusted accordingly based on program development, growth, maturity, and success.

Ongoing data dashboard: A CDI dashboard to track metrics can be another useful tool. A well-developed performance dashboard provides relevant and timely information for measuring staff performance and managing the program. Effective CDI programs generate an extensive amount of information affecting various areas of the organization. Each entity needs to know how the information will be collected, analyzed, and reported. Tracking of key metrics against program targets can help identify new opportunities for improvement. In addition, program outcomes should be reported to designated departments on a regular basis.

Staffing: Determine and reassess staffing needs based on program focus and opportunities for expansion. Staffing considerations also need to take facility size and organizational structure into consideration. At the same time, be sure to develop role-specific job descriptions that align with the program’s stated goals.

Initial training and ongoing education: All CDI team members require formal training on the principles of high-quality documentation, DRG management and coding concepts, the query process, and query compliance. Consider a combined training approach that includes classroom lessons followed by shadowing tutorials to ensure appropriate application of the information. Once the initial training process is complete, initiate a process to evaluate individual CDI specialists’ knowledge, performance, and effectiveness, and be sure to include ways to identify opportunities for ongoing education.

Physician advisors: Many CDI programs operate without an official physician advisor, but such a position can be greatly beneficial in supporting the CDI mission and advancing the program. Such duties include:

  • Serving as a resource to CDI and coding staff, especially on clinically complex cases
  • Performing select chart reviews
  • Querying and educating providers
  • Addressing challenging or non-engaged medical staff

The physician advisor role requires expertise and experience with clinical documentation and coding practices, but formal training can (and should) be provided to physicians new to the role. To be effective, the physician advisor should be respected by the medical community and have the interest and capacity to serve in this role.

Physician education: This is an essential part of every CDI program and should be tailored to the individual audience. Each session should be conducted by a peer (either a physician advisor or champion related to the specific specialty, or CDI/coding staff with expertise in that genre). Every physician education session should include information relevant to the individual audience and be delivered with brevity. CDI programs should work with physician leadership (and medical staff services) to determine the best approach and forum to ensure physician attendance. Additionally, participation by executive management and physician leaders is imperative in communicating the value of the program to the medical staff.

Process development: Every CDI program should be guided by standards, policies, procedures, and key metrics. These guidelines set clear expectations regarding CDI staff member productivity, provider engagement, program compliance, and program goals.

CDI productivity standards: The primary responsibility of the CDI specialist is to perform record reviews, query providers, and provide ongoing physician education. You should base the average number of daily reviews expected of each CDI specialist on overall program focus and CDI responsibilities. (Read the related article on productivity on p. 10 in the full issue`.)

Policies and procedures: Policies can be formulated in a generalized fashion outlining:

  • The goals and purpose of the program, including program focus, and specific program roles and functions
  • Credential requirements for CDI professionals
  • CDI orientation, training, and ongoing education requirements
  • Query process
  • Quality assurance Procedures should be designed to include specific methods employed on a day-to-day basis to promote consistency in CDI performance. Policies and procedures should be designed to influence and determine all major CDI decisions and actions, set program boundaries, and ensure program compliance. Types of procedures include, but are not limited to:
  • Concurrent review processes (includes initiation and frequency of reviews)
  • Chart review processes
  • Chart review prioritization processes
  • Concurrent query processes (formulating compliant and effective queries, including facility-specific format requirements)
  • Query escalation guidelines
  • Query reconciliation processes
  • Concurrent review reconciliation processes (coder-CDI staff communication)
  • Data collection/entry processes
  • Metrics and reporting

Program monitoring: The CDI staff and processes should be monitored on a regular basis to ensure work quality, verify program compliance, and identify opportunities for ongoing education. Every organization needs to develop its own methodology and determine which elements of the program to monitor and evaluate. These reviews should be conducted on a regular basis, retrospectively at minimum, and during the concurrent process when possible.

Collaboration: CDI is a team sport that includes the CDI specialists, coders, and physicians. Successful CDI programs establish synergies between these team players and depend on engagement, participation, and regular communication by all team members. Frequent and consistent communication creates a system of checks and balances that will promote program success. In addition, use regularly scheduled meetings to review complex cases and discuss other clinical coding issues.

CDI programs also have an opportunity to develop a collaborative effort between various hospital departments. In addition to DRG reimbursement, thorough, complete, and accurate documentation has a direct impact on patient care quality outcomes, medical necessity, and length of stay; it applies in the outpatient setting as well as physician offices.

The elements above are the cornerstones to success for every CDI program. Continuous assessments, monitoring, reporting, ongoing education, and communication can help ensure program success. All existing programs should periodically take a step back to ensure they employ the basic skills to monitor and drive their program forward.

Editor’s note: Clesi is the director of CDI services for Huff DRG Review, Inc., and an ACDIS advisory board member. She served on the 2013 ACDIS National Conference Planning Committee, is a member of the Louisiana ACDIS chapter, and earned the 2009 “Recognition of CDI Professional Achievement.” Contact her at wendy.clesi@huffdrgreview.com. 

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