Prioritizing CDI on the Ambulatory Side of Healthcare Facilities
Prioritizing ambulatory clinical documentation information (CDI) solutions
Mostmedicalproceduresaremovingtooutpatientfacilities,thanksto technologicaladvancementsandminimallyinvasivesurgicalprocedures. Outpatientservicesinlower-costsettingshavealsobenefitedfromfinancial incentives,patientpreferences,governmentsupport,andotherpolicies.But value-basedcareincentiveshavebeenthedrivingforcebehindthistrend. Value-basedpaymentmodelsencouragepatientstouseoutpatientcare facilities.AccordingtoastudybyDeloitte,theaggregateshareofoutpatient servicesintotalhospitalrevenueincreasedfrom28percentin1994tonearly half(48percent)by2018.Patientpreferencesandclinicaladvancementsthat reducecomplicationsandallowpatientstoreturnhomesooneraredriving muchofthisgrowth.Becauseofthisgrowth,arobustoutpatientclinical
documentationinformation(CDI)systemisnecessarytomanagetheincrease inoutpatientservices.
Significance of Outpatient CDI
Astechnologieshaveadvancedandcostshaveskyrocketed,alargershareof medicalservicesareabletobeperformedasoutpatient–drivingtheneedfor improvedoutpatientclinicaldocumentation(CDI)programs.CDIprocesses shouldbeperformedduringapatientencounter,whichiswhyCDItechnology issoimportant.ThemainbenefitsofoutpatientCDIinclude:
• Diagnosisspecificityisasvitalintheoutpatientworldasinthe inpatientworld.Becauseitwillaffectthehierarchicalcondition category(HCC)assignment,eachdiagnosismustbedocumentedtothe highestlevelofspecificitypossible.
• Moredetailednotecaptureprocedure,whichallowsforaccurateCPT codeassignment.
• AccurateAmbulatoryPaymentClassification(APC)reflectsthe prospectiveoutpatientpaymentsystem.Outpatientdocumentation supportforappropriateAPCassignmentsisascrucialasinpatient documentationsupportforDRGassignments.
• CDIoffershigh-qualityclinicaldocumentationforreimbursement, whichisessentialforgettingaccurateoutpatientservices reimbursement.
• CDIensuresthatoutpatientservicesaredocumentedtothesamehigh standardasinpatientservicestocaptureaccuratequalityscores.
• AccurateandupdatedoutpatientCDIreducesthescopeofpayment denialsduetomissingdocumentationofthemedicalnecessity.
• AccuracyofHCCsandriskscoresforthepatientpopulationcanbe maintained.
• Improveddocumentationofinfusions,procedures,andsupportfor observationservices.
• OutpatientCDIfacilitatedbettercoordinationbetweentheprovider documentationandcodeddata.
• Comprehensivehealthrecordsforimprovedpatientsafetyand satisfaction.
Measures to prioritize CDI for Ambulatory CDI
OnceasolidoutpatientCDIhasbeenestablished,itcanbeextendedtothe ambulatorysetting.Thefollowingissuesmustbeaddressedtoachievethis:
• IdentifyareaswhereambulatoryCDIwillbehelpful.Ashiftinfocus fromacutetochronicmedicalconditionsisnecessary.
• RecognizemanyissuesthatmaynotbedirectlyrelatedtoCDI,suchas physicianevaluation,coveragedetermination,managementcoding,and soon.
• Determineacleardefinitionofwhatyouwishtoaccomplishandwhat obstaclesyouarelookingtoovercomethroughAmbulatoryCDI.Decide whichambulatoryCDIclinicswillbeimplementedandinwhatorder.
• DefinemetricsthatneedtobeusedintheprocessofambulatoryCDI. AppropriateKPIsmustbeestablishedbecausetheydemonstratethe effectivenessofanorganizationinachievingbusinessobjectives.The RiskAdjustmentFactor(RAF)isanexcellentmetricforassessing AmbulatoryCDI'simpact.
• IdentifythestaffingrequirementsforAmbulatoryCDI,assome programscanbequitelabor-intensiveassoftwareandtechnology evolve.
• Coordinationbetweenseveralprogramsismandatoryforasuccessful ambulatoryCDIprogram.Healthcaresystemsneedtolookbeyondtheir fourwallstounderstandoutpatientCDIrequirements.Theideasmust befloatedfromthetoplevels,andCDImanagersmustaddressissues regardingadministration,ROI,staffing,qualityofpatientcare,physician engagement,andsoon.
• Accuratelyidentifythepatientpopulationintheambulatoryclinical setting.OutpatientCDIsatisfiestheneedsofavarietyofpeople.Aside fromdeterminingthepatientpopulation,theorganizationmusthave clarityontheintendedgoalsbeforemovingforwardwithitsCDI program.
• Compliancechecksmustbeperformedbeforeanyprogramis implementedandrelevantdocumentationsubmittedtotheACDIS.
FindingresourcesforoutpatientCDIcanbedifficult.Itiskeyto networkwithpeersoutsidetheorganization.
• AteameffortisrequiredforanambulatoryCDIprogramtobe successful.First,theoperationalstaffwillchecktheimpactoftheCDI processonpatientcare.TheCDIteammustbefamiliarwithallthestaff members’processes.PhysiciansmustinteractwiththeITdepartment andCDIstafftomanagetheEHRrecordseffectively.
• HireandtrainCDIspecialists.SincethemaingoalforCDIisaccurate documentationandcoding,theambulatoryandtheinpatientteams reporttothesameleader.Weeklystaffmeetingsmustbescheduledto promoteideasharingandcollaboration.
It'simperativetounderstandorganizationalobjectivesanddevelopan ambulatoryprogramthatsupportsthem.ThesuccessofanyambulatoryCDI programdependsonstrongleadershipandtheabilitytoadapttochange.
Source of content: AGSHealth Blog - Prioritizing CDI on the Ambulatory Side of Healthcare Facilities