CDI: It Should be a Top Priority

I had the interesting experience not too long ago of speaking with someone in the financial world who apparently thought himself an expert in Health Care 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.” Sure enough, he opened his mouth again and said that he did not find CDI worthwhile because, “it is not on the list of top priorities of a health care 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 article.

So what are some of the top priorities of a health care CFO these days? Well, I am sure the list could be quite long, but here are 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). So far my conversation partner’s point is being born out—Clinical Documentation Improvement does not appear on my proposed list. But let’s examine each of the items I came up with to see how CDI fits into health care organizational concerns.

• Increase Revenues: It is important for clinicians to document a care episode 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 Length of Stay (LOS): Early in the admission process, 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 those disease diagnoses where an organization routinely stumbles, and that data can drive programs to mobilize resources right at the time of admission. With comprehensive CDI, this is possible.
   
• Monetize Lost Opportunities: When a bill goes out for a patient where a clinician 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 aids in this process.
   
• 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 as an O/E ratio. Careful and complete documentation of comorbidities is vital to this process. CDI makes it happen.
   
• Improve Patient Safety Indicators (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 determines these answers.

At first glance, the letters CDI indeed do not appear on the list of top priorities for health care CFOs. But CDI enables—and directly impacts—everything that is on that list. It may not be on the list of top priorities, but it should be!