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Pinson and Tang CDI Pocket Guide
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The Impact of Your CDI Program on Quality Metrics

July 5, 2014

This is the first of a series of articles on how CDI Programs can contribute to their organization's success under CMS P4P metrics.

CMS P4P programs will impact up to 6% of your hospital's traditional Medicare reimbursement by 2017. There is no doubt that performance under these measures is high on your leadership team's radar. Many of the performance metrics used in these quality programs are derived from claims based metrics (yes - this means ICD codes), yet this is so new that few leadership teams understand the contributions the CDI program can make.

Let's look back to what we accomplished when CMS initiated MS-DRGs a few years ago. Leadership clearly understood that documentation and coding were the keys to survival under MS-DRGs. CDI programs were implemented to identify and address MS-DRG challenges. How did we get started? We:

  • Learned the high level nuances to understand what drives MS-DRG assignment
  • Analyzed our DRG distribution data against that of other organizations to determine where we looked different and to identify priorities for improvement
  • Investigated documentation and coding vulnerabilities for our improvement priorities and assessed our performance
  • Implemented action plans to achieve required improvements with initiatives such as provider education, documentation templates, concurrent documentation queries, pre-bill record discharge reconciliation reviews, retrospective documentation queries.
  • Measured our performance with CDI sensitive metrics on our CDI Outcome Performance Dashboard.

It is common in our consulting practice to find that CDI programs have expanded their efforts to impact quality, typically by expanding queries for conditions which do not impact MS-DRGs. Unfortunately, such approaches often mean CDI teams are working harder - but not smarter. The capture of additional diagnoses or additional specificity must be impactful. This requires a top down, data driven approach such as that we used under MS-DRGs.

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