Most hospital and physician group administrators understand that accurate clinical documentation plays an important role in the delivery of quality healthcare-from sharing key data among providers to optimizing claims processing. However, as the emphasis continues to shift from volume- to value-based care, effective clinical documentation improvement (CDI) programs need to be an integral part of every healthcare organization’s strategic plan – physicians, clinicians and health information management (HIM) professionals working together to improve communication, coding accuracy and care delivery.
Successful CDI programs rely on accurate, consistent and timely physician documentation to improve the quality of patient care and enhance communication among all healthcare providers. Without a well-established CDI program in place, healthcare organizations’ risk rankings and physician quality profiles may not reflect the true severity of their patients, negatively impacting cash flow and potentially jeopardizing an organization’s reputations. Hospitals and physician groups alike also risk falling short of achieving clinical documentation integrity which underscores how critical accurately delivered and documented care reflects the well-being of individual patients and the financial health of the organization.
Here are three reasons why implementing a CDI program can prove beneficial to your healthcare organization:
Quality reporting leading to accurate documentation
Appropriate documentation, including the reporting of severity of illness (SOI) and risk-of-mortality (ROM), as well as the accurate reporting of hospital-acquired complications (HACs), PSIs (patient safety indicators) and mortality outcomes, all account into quality measures that affect a hospital’s and physician group’s bottom line in a variety of ways. Medicare and the Centers for Medicare & Medicaid Services (CMS) incorporate these quality measures as a way to define reimbursements. Healthcare rating companies, such as Healthgrades and the Leapfrog Group, make these measures public for both physicians and patients seeking to determine where to work or where to go for a given procedure or course of care.
Quality care is increasingly tied to healthy revenue through accurate documentation that contributes to efficient cash flow and optimizes claims processing from payers that are considering factors beyond traditional length of stay. As insurers turn more toward a Medicare-based, MS-DRG payment model, incomplete and inaccurate documentation can result in lower payments. The spike in the growth of accountable care organizations, also based on the hierarchical condition category payment model similar to the Medicare/DRG payment model, is also spurring the need for more accurate and thorough coding.
CDI programs educate physicians on how to accurately and thoroughly document the care they provide as well as address the gap in perception of the role this function plays in their success. It’s important that physicians understand accurate documentation affects the profile scores they receive on www.Healthgrades.com and other publicly accessed physician benchmarking sites. Documentation and coding reflect a range of measures, including complication and mortality rates and patient satisfaction, which consumers and prospective patients as well as employers take into account when evaluating hospital reputations and comparing physicians to their peers. All of this makes its way, directly and indirectly, back to the bottom line.
Achieving positive brand awareness
Methodologies that result in hospital rankings, as determined by U.S News & World Report and other rating organizations, take a wide range of complex factors into account to determine a hospital’s rating. Increasingly, however, those factors-quality of care, patient safety, clinical outcomes, etc.-are direct functions of documentation. Depending on whether a hospital is an academic medical center or community organization, its rankings serve to attract patients, medical students, residents and physicians. In the long term, a hospital that attracts top talent will be in position to build the programs that increase its reputation-and its financial performance.
Minimizing room for medical error through improved communication
Improving communication through CDI education also breaks down operational and information silos by integrating workflows and information, which can result in improved physician engagement and increased staff productivity. CDI professionals work with physicians to ensure that they are both speaking the same language from the clinical perspective of evidence-based medicine. Education can also ensure the integrity of the coding staff and promote the accurate reflection of what physicians have documented-avoiding over- or under-coding. Communication between clinical documentation nurses and coders improves workflow process and provides an extra set of eyes that benefits all members of the coding team.
Despite other demands, hospital and physician group leaders are recognizing the need to implement CDI practices to achieve healthy financial performance. A strong and effective CDI program helps ensure that physician documentation accurately paints the patients’ clinical picture and thus reflects the integrity of the financial, clinical and quality outcomes. Conifer Health can help optimize CDI functions in your revenue cycle to drive better communication, reduce financial risk and improve quality reporting and effective care.