April 2017 | Volume 22 | No. 2
ADVANTAGE
FINANCE YOUR EDUCATION PG 11 | GRACE AWARD UPDATE PG 13 | NATIONAL VOLUNTEER WEEK PG 14
HIM’s Role in Supporting CDI Across the Continuum

HIM professionals recognize that comprehensive clinical documentation improvement (CDI) programs are essential to delivering high-quality care and maintaining robust revenue-cycle processes. CDI programs also offer an opportunity for HIM practitioners to leverage their unique skill set and raise their profiles in their organizations.

One way that HIM professionals may offer particular value
during the next 12 months is by helping apply CDI beyond the
walls of the traditional, acute care setting.

A Big Picture View of CDI

“Over the years, there has been a tremendous evolution of CDI in the industry, including a shift in focus to include quality outcomes that are impacted by claims-based data and ambulatory settings,” says Wendy Clesi, RN, CCDS, CDIP, executive director of CDI services for Enjoin, Eads, TN.

This year, Clesi believes that many organizations will investigate strategies to leverage CDI across the continuum to improve quality measures that are essential for effective population health management. But before focusing resources on outpatient CDI, HIM professionals should make sure their organizations have optimized CDI in the inpatient setting. “Many inpatient

CDI programs are only touching the surface,” Clesi says. “They
may have a secondary review process looking at patient safety
indicators or readmissions and mortalities, but they are not
looking deep or at the big picture.”

She suggests that CDI teams review inpatient charts to identify
documentation and coding gaps that they could use as part
of a system-wide education process. They also should partner
with the organization’s electronic health record and IT teams to
improve documentation and coding at the point of care.

One challenge in approaching CDI across the continuum is that risk-adjustment methodologies often vary. “It is very difficult for one team to become experts in it all,” Clesi says. “Yet as the demands for CDI continue to increase in the outpatient setting, it is very important that we remain good stewards of our resources and consider alternative approaches to what we have done traditionally in CDI.” This might mean developing an “umbrella” CDI program that traces the patient across different settings, rather than having “siloed” CDI programs for the inpatient and outpatient settings.