2017 Brings In Considerations of Outpatient CDI

February 3rd, 2017

As recently reported by the Advance Healthcare Network, a white paper published by the Association of Clinical Documentation Improvement Specialists (ACDIS) shows that only about 10 percent of hospitals currently have an outpatient CDI program.

At least, those were the results of a survey conducted in early 2016 to measure the extent of CDI implementation. The survey also showed that, while that number was low, more and more hospitals are making outpatient CDI a higher priority, with 20 percent reporting that they planned to cover outpatient and/or physician services within six months to a year.

While expectations of results are clear in terms of impact on reimbursement, quality metrics and value-based care, exactly how to turn those hopes into reality may be a little more hazy, experts say.

As with most worthy initiatives, there will be barriers to overcome before a workable process and the right people can be put in place. According to revenue cycle thought leaders, outpatient healthcare organizations can avoid some of those obstructions with groundwork that includes:

  • Establishing definite goals from the start. Prioritization of these goals can provide guideposts for where providers should begin and the steps required to take them to the end. These defined objectives also will provide something to measure against for ongoing assessment and improvement.
  • Getting senior-management and physician buy-in and finding a physician champion to serve as a leader and ambassador.
  • Instituting a working timeline, making changes where necessary but striving to make all the major stops on the dot.
  • Putting a focus on denials. Experts advise that outpatient CDI should initially concentrate on those areas most affected by denials, with organizations thoroughly analyzing trends and patterns to shine the light for action.
  • Putting a focus on high-risk, high-cost areas, such departments dealing with cardiac procedures and cancer treatment, and/or starting with the high-traffic Emergency Department.
  • Attaining data on, and assuring full understanding of, the organization’s baseline performance on hierarchical condition categories.
  • Appreciating the speed of the outpatient care flow, which leaves less time for documentation and requires getting it right quickly.
  • Assuring that appropriate staff members are thoroughly trained for the unique tasks and complex coding inherent in outpatient care.

In this new year, an increasing number of outpatient providers reportedly will gear up to create an effective CDI program to improve care and revenue and support compliance and organizational viability. We wish them all well and look forward to working with our clients to meet their educational needs.