As Senior Search Consultants who specialize in CDI and in the marketplace everyday, we see first-hand the successful role CDI professionals play in the healthcare industry. We are uniquely qualified to have witnessed several programs across the country that have worked well and others that have not. One of the key, recognized elements in most successful programs is the employment of full time, permanent specialists and using temporary positions to help jump start or supplement a program.
The growth in CDI programs
Quality initiatives have come to the forefront of the healthcare industry due to political ramifications being set forth by CMS (ex. 2009 Inpatient Prospective Payment System, RAC and other CMS guidelines) along with the debate over healthcare reform that continues to be front page news. Hospitals continue to be galvanized to improve their quality of care and optimize reimbursement with their current payor mix. The costs of healthcare are ever increasing and these costs cannot be continually absorbed for many hospitals and health care systems without identifying new ways to effectively be offset. Implementing an effective, sustainable Clinical Documentation Improvement Program is a key element to addressing this growing challenge.
The case for dedicated staff
There are many vendors who can help start the implementation of the program with hospitals and systems. Most rely on individuals who are willing to be involved rather than a strategic, dedicated person. The result is that these facilities tend to take significantly longer to see the benefits from the program.
Our experience shows that the most effective way to establish and sustain a program is to bring in permanent, dedicated staff who are experienced in the CDI market so they can establish the relationships necessary to get the desired results out of the program. This dedicated staff should consist of Clinical Documentation Specialists who are solely responsible for concurrent and retroactive review and have the capacity to establish long term relationships with all of the departments involved within a CDI program.
A successful program needs genuine buy-in from administration, physicians and HIM to see the desired results that an effective CDI program can bring. It needs to be integrated, not “added on.” Therefore, quality education and communication within a program are the cornerstones for which all successful programs are founded. Hospitals need permanent staff who are equipped with the necessary knowledge from both a clinical and HIM background along with the skills to influence multiple cross functional departments to make the program run efficiently.
Temporary or specialist vendors can be brought in to fill specific holes in the program or train on specific topics, but they are not in the best position to drive this initiative. Without effective and continuous communication and education for all parties involved, there is certain to be a breakdown in the program. This is why it is essential to bring on Clinical Documentation Specialists who realize the need to be part of a “cohesive unit.” It is much more difficult to do this with temporary or interim staff and get the necessary physician response rate, for example, needed to have successful results for the CDI Program. Also, when the temporary assignment ends, often times so does the momentum built along the way. Dedicated staff, supported by an Executive initiative, has a much better chance at success.
There are many schools of thought on which department should be in charge of a CDI program whether it be Case Management, HIM, or Finance. We have a view on this, but it is dependent on hospital specific factors and one solution may not be right for all. This is the subject of a separate article currently being written. However, one of the key elements is that there must be senior management (executive) support for the program. As mentioned above, our experience shows a successful program needs a dedicated staff specific to Clinical Documentation Improvement who has the ability to create a team environment with all departments within the framework of a self-sufficient program. It is the ultimate matrix management function. Regardless of where this function reports, an effective CDI program cultivates a cohesive partnership with all the key stakeholders involved in the hospital.
Measure the ROI
One tangible byproduct of an effective CDI program is the direct revenue that is generated for the hospital based on accurate documentation. There is an instant, measurable return on investment (ROI) affiliated with an effective CDI program, and it can be broken down even further for each Clinical Documentation Specialist on staff, based on his or her workload. In an environment of ever increasing costs within healthcare, and the costs associated with staffing for the healthcare world, we find it very satisfying to be able to bring quality candidates on board who result in a positive return on investment. This ROI is recognized instantaneously in both quality and revenue. This is unique in a hospital environment. It is not uncommon for a CDI professional to pay for themselves in only a few months and start generating income for the hospital in their first year.
When experienced, full time permanent professionals with a clear mandate to operate in a cross functional environment with the support of senior executives, the results are clear. The quality of patient care is increased on a daily basis. Accurate documentation usually results in an increase in overall CMI. Finally, overall patient satisfaction scores increase along with the census.
As a company dedicated to this market, we are experts in staffing clinical documentation leaders and are very knowledgeable of the key elements of successful programs across the nation. We look forward to continuing to set the standard by providing quality staffing solutions and adapting to the changing landscape within clinical documentation and coding guidelines markets.