Clinical documentation improvement (CDI) is a provider’s best defense against payment denials, audits, and preserving revenue integrity—which is why the people sitting in the C-suite should know what it is and prioritize it. Attendees of AHIMA’s 2019 “CDI Summit: Advancing the Documentation Journey,” will leave many of the sessions with more strategies for conveying the value of CDI not just to the rest of their staff but also to their organizations’ decision-makers.
Angela Knight, RHIT, CHCAF, CHTS-IN, quality insurance manager at nThrive, who will be presenting at the Summit, says it’s the CDI specialist’s job to communicate a patient’s full clinical picture on a claim for many reasons.
It’s important for improving patient outcomes, ensuring continuity of care, and, of course, reimbursement. These factors are all top-of-mind for members of the C-suite, so CDI departments should be able to convey how their work impacts all three and the importance that their work holds for the organization.
“One example I use is the time I was on the [hospital] floor as a doctor was writing up a discharge summary for a patient whose chart I was reviewing. I nudged him to tell him the patient had a UTI since the doctor hadn’t seen the last set of labs. We couldn’t discharge a patient back to a nursing home with a UTI without antibiotics,” Knight says.
Discharging a patient with a UTI, or conditions such as congestive heart failure or pressure ulcers, increases the likelihood that the patient will bounce back to the hospital within 30 days— which comes at the cost of a financial penalty to the provider.
“A lot of times the provider knows what’s wrong with the patient—they did the chest X-ray, and list all the clinical indicators but never write the word pneumonia, or UTI, or document sepsis. And they’re still utilizing hospital resources to treat a condition that’s never documented,” Knight says, which can result in denials and lost reimbursement.
Lost reimbursement—and identifying the causes of that lost revenue—is an issue that resonates with healthcare organization leadership. Helping members of the C-suite understand how inadequate documentation contributes to issues with the revenue cycle is paramount to the health of an organization’s business processes as well as to the quality of care delivered.
Documenting for Quality and the Bottom Line
As the healthcare system continues to focus on quality care, quality ratings issued from groups such as Healthgrades and the Centers for Medicare and Medicaid Services (CMS) get a lot of attention from the C-suite.
Knight says at one provider where she previously worked, “all hell would break loose” when Healthgrades issued ratings that management viewed as unfavorable. A tendency of some providers, in response to poor quality scores, is to shift the blame to bad coding when they see high rates of hospital-acquired infections (HACs). Quality departments typically work on issues such as HACs, but eventually, Knight says, CDI had to play a role in teaching physicians how better documentation can lead to better HAC reporting.
“Hospital-acquired is hospital-acquired. You can’t not code it, you have to learn to prevent it. So you have to work on protocols when a patient comes in and make sure your documentation reflects it. You have to document signs and symptoms of a potential HAC if it’s present on admission. If I’m documenting signs and symptoms but don’t document a diagnosis until day three of an admission, it’s not hospital-acquired if you can catch it at admission,” Knight says.