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1. Super specialties: CDI programs which conduct record reviews for pediatric, neurosurgery, cardiovascular surgery, complicated repetitive surgeries with multiple diagnoses, or multiple trauma are advanced, De Vreugd says. Because many of these patient populations fall outside of government reimbursement (since most Medicare/Medicaid patients are older and have more typical ailments) CDI programs do not typically review these records. Identifying documentation improvement opportunities in these specialty areas helps with public reporting results and helps secure physician support across disciplines.
2. All-payers: Many fledgling CDI programs focus in on Medicare populations, and for beginning programs justly so, since Medicare represents the largest healthcare payer. An advanced program, however, has typically expanded CDI efforts to commercial or other payer reviews, because this affects quality and mortality reporting. Before CDI efforts started at Kindred in 2009, a primary commercial payer group listed Kindred’s mortality rate as 4.9% below the California state average, De Vreugd says. After implementation, by 2011, Kindred was 21% better than the state’s overall predicted rates.
3. Improving profiles: “We need to become more ‘advanced’ in how we tell the story of how CDI affects quality and revenue,” says De Vreugd. And advanced programs know how to make that argument to physicians and administrators using publicly reported data such as Physician and Hospital Compare, HealthGrades, and the like, she says.

Advanced CDI programs typically employ advanced CDI specialists—those with greater number of years’ experience in the role, advanced degrees, or additional (CDI specific) credentials or certifications. And older, wiser, more advanced programs often have a larger number of staff performing a kaleidoscope of tasks.

To keep such staff engaged in the program (particularly in light of the high employment demands related to ICD-10-CM/PCS implementation and other initiatives) advanced programs are increasingly offering more diverse career paths. For example, some programs align CDI specialists’ responsibilities with the experience, expertise, and abilities of their employees, and other CDI programs allow for career growth along a step scale, similar to traditional nursing career paths. ACDIS members can weigh-in on the debate regarding career path options in this month’s ACDIS Poll. Tell us how your CDI program provides for its team’s growth and we’ll offer some additional insight in the upcoming edition(s) of the CDI Journal.

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