Outpatient CDI: Understanding a Diverse and Impactful Role in Healthcare

EDITOR’S NOTE: Colleen Deighan will be conducting a Talk Ten Tuesdays Listener Survey on CDI today.

When you read these words, “outpatient CDI,” what comes to mind for you? Risk adjustment, documentation integrity for emergency department and observation services, medical necessity to support the next level of care, authorization, evaluation and management (E&M) services, or some other area of equal importance?

The American Health Information Association (AHIMA) CDI toolkit defines outpatient CDI as “a very broad concept and can describe any CDI effort not associated with an inpatient claim”.  Yes, I’d say that’s broad!

Hospital and healthcare systems have experienced the shift of care from inpatient to outpatient and from fee-for-service (FFS) to value-based payment models for the past 15 or so years.  All Medicare value-based programs are designed to change how healthcare is delivered and paid for.  

The goals of The Center for Medicare and Medicaid Services (CMS) value-based programs are to improve patient care, reduce healthcare costs and improve population health—sometimes referred to as the triple aim.  This shift is one of the key reasons outpatient CDI programs and clinical documentation integrity specialists (CDISs) have become an important and valuable resources for hospital outpatient departments and physician practices across the continuum of care. 

Implementation of an outpatient CDI program should be well planned out, involve key stakeholders, and align with overall organizational goals.  To ensure the biggest impact and return on investment (ROI), a key, first step is to start with a full assessment to determine which opportunities and gaps exist within your organization. 

An assessment begins with data including analysis of the data and validation of the data with chart reviews to identify gaps in documentation along with coding accuracy.  Once you have validated the data then you can begin to prioritize where to begin your organizations efforts and plan a timeline for implementation that includes a skills assessment, education and training of CDI staff, coding staff and providers. 

Just a few weeks ago the Association of Clinical Documentation Specialists (ACDIS) recognized the profession with their annual CDI week celebration.  As part of CDI week, a “state of the industry” survey was completed and included several questions about outpatient CDI. 

Over the coming weeks we’ll explore the diverse areas of outpatient CDI with the hopes of expanding awareness and need for documentation integrity within outpatient services.   The patient is at the center of everything we do.  The accuracy of the documentation and the accuracy of coded data impacts healthcare organizations and patient care.

The time is now for outpatient CDI. 

Programming Note: Listen to Colleen Deighan report this story live today on Talk Ten Tuesdays, 10 Eastern.