CDI teams: Collaborating for success

The importance of collaboration with clients

Health care organizations rely on coding and CDI data to measure outcomes and inform decision-making. Using this information at the juncture of clinical and revenue cycle outcomes ensures the care provided aligns to the appropriate financial, quality and revenue integrity outcomes.

To get a return on their investment, organizations will want to work with a strategic value advisor team with deep knowledge of a coding and CDI vendor’s solutions. Health information management, coding and CDI professionals should be part of this team.

“The partnership and initiatives that come from collaborating with this type of team improve coding and auditing, as well as CDI productivity and effectiveness,” Susie says. “They improve workflows and feature adoption and can enhance cooperative efforts for both coding and CDI teams. They identify opportunities to improve documentation, promoting the most accurate coding capture. This teamwork also drives changes in CDI review and highlights educational opportunities for coders, CDI professionals and treatment providers.”

All of this can help facilities improve organizational performance, create staffing efficiencies, and assure that documentation accurately reflects the patient’s condition and acuity. These improvements are equally important. And they’re achievable. This is true whether an organization functions under a value-based (pay-for-performance) model, a risk-adjusted payment model or a fee-for-service reimbursement model. Such improvements support the medical necessity of the treatment provided and reinforce the quality of care received. 

Using data to improve performance

To ensure proper coding capture and reimbursement, CDI leaders must rely on data, Susie says. Analytics can pinpoint key performance indicator (KPI) trends and help monitor peer-group comparisons. They can also assess end user adoption and employment of solutions. These insights help facilities better understand the productivity and impact of individual users and the overall team.

“Facilities should watch for negative trends, consider any potential expected changes, and think through how those negative trends might interact,” she says. For example, if a hospital’s case mix index (CMI) decreases, it may be related to several factors. Among other factors, CMI changes can be influenced by:

• Shifting patient populations
• Operational or provider differences like a change in volume of a particular procedure, or the gain or loss of a specialty provider group
• Reimbursement system updates
• Changes in operational policies or procedures
• CDI and coding staffing
• Performance variances and fluctuations in capture rates of certain conditions

“Data analytics can help dissect the complexities and indicate where the underlying cause or causes may exist. And they can guide where an organization may want to focus more resources with audits and education for their team members and providers,” says Susie.

Organizations can use these insights to proactively improve their performance.

“Teams should have at their fingertips a strong AI-driven solution at the point of care that provides data and allows organizations to proactively, rather than reactively, manage outcomes every step of the way. AI technology layered upon the EMR seamlessly unlocks data that might otherwise be inaccessible by applying clinical extraction and reasoning over the documentation almost as soon as the patient walks in the door,” she says.

“The collaboration with a vendor partner reviewing opportunities, root-cause analysis and action planning is strengthened by this type of technology. A technology-supported review process, paired with a comprehensive and holistic analysis of KPIs, is where facilities can dive in deeper. And that helps improve outcomes.”

Empowering clients to be heroes

A recent survey¹ of hospital executives found that the biggest challenges facing health care continue to be financial and staffing difficulties. Managing increasing operating costs and potentially crippling staffing shortages are ongoing concerns. Facilities constantly struggle to do more with less. Susie says that collaborating for better middle revenue cycle outcomes and challenging traditional silos helps health systems address these problems and enables facilities to be their own hero.

“These partnerships empower health care leaders to follow, own and leverage their organizational data to suit their facilities’ needs and goals,” she says. “Improvements in reportable code documentation often translate to accurate reimbursement, which often aligns with resource utilization.”

The downstream impact of greater documentation accuracy and code capture is greater revenue integrity and better financial performance for the overall organization.

“When those results materialize, the CDI and coding leadership — and their teams — are everyday heroes for their organization,” she says.

Communication and camaraderie create effective partnerships

There are challenges to creating partnerships that can effectively achieve this type of success. Facility leadership must be open-minded and curious to find the next opportunity to optimize operations or outcomes.

Susie suggests choosing a vendor partnership with an organization that stays a true partner after the service or solution is implemented. Embracing that partnership and sharing accountability among all parties is another key to success. Achieving positive results hinges on clear, ongoing communication about opportunities and the goals or initiatives for the organization and teams. Facilities that approach collaboration with a sense of camaraderie and trust will fare the best.

“An unwillingness to acknowledge the opportunity for improvement can be a significant hurdle,” she says. “These types of collaborations will struggle and fail in the face of resistance to change and poor communication between contributors.”

An Optum success story

As popular as CDI is in the health care industry, there’s little consensus around whether these efforts are feasible or cost-effective for smaller hospitals. Optum recently showed that collaborating on CDI can help even small, rural facilities.

Initially, the Optum client — a single community hospital — didn’t have a CDI program and they outsourced their coding. But after collaborating with Optum, they experienced significant improvements.

“Within weeks of their implementation, we saw upward trends in all their key metrics,” says Susie. “Most notably, within the first year, their case mix index improved so significantly that their expected reimbursement increased by millions of dollars.”

To date, the hospital continues to flourish.  As the program grew, query rates and provider engagement improved, reflected in increasing query response and agreement rates. The hospital also continued to see improved capture rates and CMI. With the help of additional resources, facility leaders have tackled the more nuanced aspects of CDI. As a result, the hospital has shown it continues to improve documentation, coding accuracy and revenue integrity.

Susie believes that CDI collaborations offer substantial value to a wide variety of health care facilities.

“Partnering with a professional CDI vendor gives client leadership the chance to be a champion for their individual organizations.”