Motivation for Clinical Documentation Improvement (CDI)?

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As we continue to build our Clinical Documentation Improvement (CDI) program in preparation for ICD-10 and a continued increase in audits (RAC, MIC, and Commercial Insurance), we’ve been doing a lot of discussing and research related to what objectives a CDI program might have.

  • Is it to increase reimbursement through assignment of CC’s and MCC’s?
  • Is it to improve coding productivity?
  • Is it to reduce the potential risk from recovery audits?
  • Is it to improve patient care?

Or, should it be a combination of the above?  Glenn Kraus, RHIA, CCS, CCS-P, CPUR, C-CDI, CCDS had some interesting thoughts on why we shouldn’t only focus on the reimbursement. 

There is almost always an opportunity to improve clinical documentation in any medical record chart from both a resource intensive reimbursement standpoint and quality of care and clinical outcomes standpoint. 

But just as the profession is gaining momentum and increased recognition in the business facet of healthcare, we have reached a crossroads and may be going down the wrong path.

The crossroads

For those of us who have been in the clinical documentation improvement arena for a long time, it is eye-opening to view the advertisements and promotional materials for clinical documentation improvement projects readily available at trade shows and appearing in prominent trade journals. The common promotional theme is increased reimbursement for the hospital, which is not surprising given the fact these clinical documentation improvement programs are marketed strictly on the basis of “reimbursement enhancement.”

Let’s not kid ourselves, every healthcare expenditure that is not direct patient care related must provide for a reasonable chance of return on investment, contributing to the organization’s financial performance in some form or fashion, whether it be additional revenue or at least cost avoidance.  But there has been some talk in the industry that some firms have worked into their CDIP contracts a guarantee of specified amount of increased reimbursement for the hospital with the implementation of their programs. 

The aftermath

Clinical documentation improvement programs can be structured to meet the documentation requirements required in the health record to financially sustain the hospital from a financial accounting and quality of care reporting perspective.  How the program is structured can dictate success or failure in the rollout and acceptance of the program by physicians and other ancillary service providers.

In speaking with a fellow colleague recently, I heard a valid concern that is worth mentioning regarding where the CDIS profession is now, and where it may be going. Once again it may be going down the wrong route. My colleague pointed out that in some instances, the clinical documentation improvement specialists appear to be focusing on reviewing the record solely for identification and documentation of “missed CCs and MCCs,” almost as if they were “CC/MCC scroungers.”

The very idea of CDIPs being promoted primarily as reimbursement mechanisms perpetuates and drives the ever-increasing viewpoint of CDIS as CC/MCC identifiers. In order to be directed down the right path, we need to stay attuned to the mission of the profession, which is to affect positive change in physician’s patterns of clinical documentation over the long term through provisions and actions of continued physician education. This relentless pursuit of physician clinical documentation education embraces a holistic approach with an emphasis upon the direct correlation between clinical documentation and the continued business financial viability of the both the hospital as well as the physician. A primary focus upon “getting that CC/MCC” documented in the record represents a very small cross sectional piece of what the CDIS can fundamentally contribute to a successful program.

 

Which way do you think it should go?

We are at the crossroads for CDI.  The direction we as an industry decide to take will guide the future.  Decisions made today will impact all of us in HIM and finance both tomorrow and well into the future.

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One Response to “Motivation for Clinical Documentation Improvement (CDI)?”

  1. Is it time for Clinical Documentation Improvement (CDI)? « Clear Matters Says:

    […] As we continue to build our Clinical Documentation Improvement (CDI) program in preparation for ICD-10 and a continued increase in audits (RAC, MIC, and Commercial Insurance), we've been doing a lot of discussing and research related to what objectives a CDI program might have. Is is to increase reimbursement through assignment of CC's and MCC's? Is it to improve coding productivity? Is it to reduce the potential risk from recovery audits? Is it … Read More […]

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