Know your CDI data: Statistics and Trends Analysis for Successful CDI Programs
Organizations often struggle with finding the right data to accurately validate their CDI program(s). This challenge goes side-by-side with trying to determine the financial impact of the program according to the healthcare facility’s goals. An effective analysis of CDI data trends and statistics surrounding such a program is essential in determining its success rate and positive effect on the organization’s quality documentation and financial impact. Does your organization need an effective, successful CDI program? Contact YES HIM Consulting today to discuss our auditing and consulting services, which will generate actionable insights for your team.
According to AHIMA, “Successful clinical documentation improvement (CDI) programs facilitate the accurate representation of a patient’s clinical status that translates into coded data. Coded data is then translated into quality reporting, physician report cards, reimbursement, public health data, and disease tracking and trending” (AHIMA, 2019).
Traits of Successful CDI Programs
Firstly, identifying trends in MS-DRGs is not enough to validate a CDI program. Key data, gathered and analyzed from principal diagnosis (PDX), complications and comorbidities (CC), major complications and comorbidities (MCC), and ICD-10-PCS code assignments, provide deeper insights and assist in an accurate validation of a CDI program and its impact on the bottom line.
Generally, CC/MCC capture rate correlates with query volumes. As CC/MCC capture rates increase, the query volumes normally decrease due to the need for increased specificity and comprehensive documentation. As external partners, we encounter scenarios where principal diagnoses (PDX) tend to be too vague, cases where specialty groups with symptoms or unspecific PDXs. We find cases where data shows a MS-DRGs based on symptoms trend, alongside the need for more specific MS-DRG assignments. In cases like these, reviewing the clinical documentation with the following objectives is essential:
- Determine if there can be a more specific PDX
- Identify missed CC/MCCs
- Decide if a physician query is needed to generate more specific clinical diagnoses
Monitoring ICD-10-PCS code assignments to make sure the most appropriate code has been selected based on the physician documentation is a necessary next step in order to calculate an accurate MS-DRG assignment. Furthermore, the right statistics and trends assist in measuring successful CDI programs and identifying opportunities to enhance it with a continuous improvement approach.
One way to actively communicate a CDI program’s effectiveness is to prepare statistics and trends in graphical format for executive leadership. We have compiled a series of examples of CDI data and trending reports that, our CDI team considers essential when analyzing a CDI program’s effectiveness and financial impact. Each example has pre-formulated questions that will help decision-makers find insights towards continuous improvement and the program’s validation.
CDI Program Metrics
Coding vs CDI MS-DRG mismatch reviews
In analyzing this summary report, the organization should:
- Examine the reasons why the reviewer agreed with coding / disagreed with CDI. Is there additional coding training or coding guideline education needed for CDI team?
- Evaluate the specific MS-DRGs where the reviewer agreed with CDI and/or did not agree with either (neither category). Is there an opportunity for additional clinical training for the Coders? Or additional queries required?
CDI query outcomes
In analyzing this summary report, the organization should:
- Assess the reasons why there was no change in the MS-DRG 47.64% of the time. Is there additional clinical training or coding guideline education needed for the CDI team regarding writing an appropriate query? Where there any specific MS-DRGs in this grouping category? Was there a specialty group that was more involved in the queries (i.e. cardiology, nephrology, internal medicine, etc)?
- Examine the specific CCs/MCCs added for opportunity for additional clinical training for the Coders? Or additional documentation education to physicians?
CDI Query Responses
In analyzing this summary report of CDI data, the organization should:
- Drill down to specific hospitals and specific physicians who answer the CDI query appropriately and those that go unanswered. Is there additional clinical training needed for the CDI team regarding writing an appropriate query? Was there a specialty group or individual physicians that need coaching from a physician advisor?
Financial impact of CDI query program
As we can see in these examples, CDI program metrics and trends can be used to identify missed opportunities to enhance a CDI program, prove the positive effect on your organization’s quality documentation and measure financial impact.
Next Steps
Lastly, does your organization need an effective, successful CDI program? Contact YES HIM Consulting today to discuss our auditing and consulting services, which will generate actionable insights for your team.
