Know Your CDI Data: Statistics and Trends Analysis for Successful CDI Programs

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 hand-in-hand 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.

Traits of Successful CDI Programs

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, and medical research” (AHIMA, 2024).

The identification of trends in MS-DRGs is one step to validate a CDI program. However, there are other key data trending items needed for a full validation process. For example, data trends 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, its documentation requirements, and its financial impact.

Generally, a key data trend is the CC/MCC capture rate, which correlates with CDI 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 also encounter scenarios where principal diagnoses (PDX) tend to be too nondescriptive and cases with symptoms or unspecific PDXs. We find cases where data shows MS-DRG based on symptom trends 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

Another key data trending group to monitor is the ICD-10-PCS procedural code assignments. Review these in detail to ensure that the most appropriate code has been selected based on the physician’s documentation. Validating the accuracy of ICD-10-PCS coding is a necessary next step 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 a graphical format for executive leadership. We have compiled a series of example CDI data and trending reports. Our CDI team considers these data points essential when analyzing a CDI program’s effectiveness and financial impact. Each example has pre-formulated questions that will help decision-makers find insights toward continuous improvement and the program’s validation.

Example CDI Program Metrics

Coding vs CDI MS-DRG Mismatch Reviews

In analyzing this summary report, the organization should:

• Examine the reasons why the reviewers agreed with coding / disagreed with the CDI team. Is there additional coding training or coding guideline education needed for the CDI team? Or is additional documentation training needed from the providers?
• Evaluate the specific MS-DRGs where the reviewer agreed with the CDI team and/or did not agree with either (Neither category). Is there an opportunity for additional clinical training for the Coders? Or are 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?
  • Were there any specific MS-DRGs in this grouping category?
  • Are there physician specialty group(s) that were more involved in the queries (i.e. cardiology, nephrology, internal medicine, orthopedics, etc.)?
  • Is there a high-volume of Unable to Determine query responses that impact the No Change category that should be trended?
• Examine the specific PDx Change (32.97%) and the CCs/MCCs Added categories (19.02%) for opportunities toward additional clinical training for Coders? Or is additional documentation education needed for physicians?

The Impact of Query Analytics: Increase Revenue

In these example summary reports, the use of a compliance query process, along with the implementation of query review, education, and analytical trending programs by YES, resulted in an increase in the number of queries and revenue generated by those queries. For instance, in year 1, a 450-bed hospital generated $1,078,142 in revenue without YES review and analytics, but in year 2, with YES review and analytics, the same hospital generated $2,500,443, resulting in a gain of $1,422,301 in increased revenue. These examples demonstrate how CDI program metrics and trends can be utilized to identify missed opportunities for enhancing a CDI program, demonstrate the positive impact on your organization’s quality documentation, and measure financial impact.

Next Steps Toward a Successful CDI Program

Lastly, does your organization need an effective, successful CDI program? Or does your current CDI program need assistance with data analysis and trending? Contact YES HIM Consulting today to discuss our auditing and consulting services, which will generate actionable insights for your team.