CDI: A Top Priority for the Bottom Line

I had the interesting experience not too long ago of speaking with someone in the financial world who apparently thought himself an expert in Healthcare Information Technology.

We were discussing the relative merits of Clinical Documentation Improvement (CDI). I confess that my mind had started to wander, as I was trying to recall who said “Better to remain silent and be thought a fool than to speak and to remove all doubt.”

Then, sure enough, he opened his mouth again and said that he did not find CDI interesting because “…it is not on the list of top priorities of a hospital CFO.”

I had two simultaneous reactions to this comment: (1) “the fool” quote must have been from either Abraham Lincoln or Mark Twain (it has been variously attributed to each of them, among others); and (2) thank you for giving me the subject of my next blog entry.

So what are some of the top priorities of a hospital CFO these days? Well, I am sure the total list could be quite long, but here’s a few that I came up with:

  • Increase revenues
  • Optimize Length of Stay (LOS)
  • Monetize lost opportunities
  • Improve quality of care
  • Improve Patient Safety Indicators (PSI)

The quality and Patient Safety items may seem out of place on this list, but are actually quite relevant to a CFO these days as we move to Merit-Based Incentive Payment Systems (MIPS) and Alternative Payment Models (APMs).

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Well, so far my conversation partner’s point is being born out, i.e., CDI does not appear on my proposed list. That said, let’s take a closer look at each of the items listed above:

Increase revenues: It is important for clinicians to document completely and precisely. This improves the quality of coding that can be done on the chart, and has a direct beneficial impact on reimbursement. CDI makes this happen.

Optimize LOS: Early in an admission, a CDI review can result in data that can calculate the expected LOS. This can be used to help redirect resources for patients approaching or exceeding their predicted length of stay. Analyzing LOS patterns can identify diagnoses where a hospital routinely stumbles, and that data can drive programs to mobilize resources right at the time of admission. CDI makes this happen.

Monetize lost opportunities: When a bill goes out for a patient where a physician query has not yet been answered, an opportunity to improve reimbursement has been lost. Tracking and pursuing the unanswered queries can have a major impact on reducing these lost opportunities and improving revenues. CDI makes this happen.

Improve quality of care: Quality Measures often compare how often something occurs (“Observed”) to how often it is expected to occur (“Expected”). This is known as an “Observed-to-Expected” rate, sometimes referred to an an O/E ratio. (see my blog entry on “The Role of CDI in Quality Measures,” August 26, 2015). Careful and complete documentation of comorbidities is vital to this process. CDI makes it happen.

Improve PSI: Many of the PSIs from the Agency for Healthcare Research and Quality (AHRQ) are significantly impacted by accurately determining whether or not a condition was Present on Admission (POA). The AHRQ PSI 90 Patient Safety for Selected Indicators, for example, is rich with examples of this (did the patient get admitted with a significant bleed, respiratory failure, pressure ulcer, etc.)? You guessed it : CDI makes it happen.

So, while the letters “CDI” may not appear on the list of top priorities for hospital CFOs, clearly it should be as CDI both enables and directly impacts everything that is on their lists.

Dr. Jonathan Elion is a practicing board-certified cardiologist in Providence, RI and an Associate Professor of Medicine at Brown University, and founder of ChartWise Medical Systems, Inc.

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