Opinion: Put away the CC/MCC strawman, CDI critics

By Brian Murphy

It’s time to put away an old, oft-beaten strawman. CDI is way, way past the days of just CC/MCC capture.

I still see this myth perpetuated, often in the context of “CDI programs are out of touch and only capture CCs and MCCs. Now buy our product!”

I have no doubt your product or service is worthy. But you don’t have to sell it by diminishing CDI.

Some history.

CDI began largely as DRG optimization. In the early days CDI wasn’t a widely-used acronym, and nurses reviewing charts used “DRG assurance” to describe what they did. Which was accurate enough.

With the advent of MS-DRGs and its tiered severity structure in 2007, CDI exploded in importance. CC/MCC capture was the easy ROI, and it continued that way for some years.

But that is no longer the job description of a modern CDI professional. I would say by 2013 the model changed, in large part due to the advent of the Hospital Value-Based Purchasing (VBP) program in October 2012.

Make no mistake, comorbidity capture remains a big part of the profession. How could it not? CDI is mid-revenue cycle work; in the United States ICD-10 codes are used for disease tracking but also reimbursement. To ignore this is to ignore reality.

All work needs focus, and there is nothing wrong with focusing on high yield (i.e., high dollar) DRGs or diagnoses. CMS itself states in the 2009 IPPS rule:

“As we stated in the FY 2008 IPPS final rule with comment period, we do not believe there is anything inappropriate, unethical, or otherwise wrong with hospitals taking full advantage of coding opportunities to maximize Medicare payment as long as the coding is fully and properly supported by documentation in the medical record.”

Hospital C-suites are interested in outcomes and revenue, because keeping doors open is the most important metric of all. That means CC/MCC capture will always be important.

But diagnosis capture is only one piece of the modern, sprawling CDI dashboard.

In a recent ACDIS report “Redefining KPIs for Clinical Documentation Integrity,” survey data had financial query impact ranked 6th, and CMI change 8th… behind SOI/ROM, chart reviews, and response rates. A clean chart and well-depicted patient mortality were more important than revenue alone.

Today CDI specialists have a sprawling dashboard of KPIs:

• HACs and PSIs
• Performance on public scorecards like Healthgrades, Vizient, Leapfrog, and U.S. News and World Report.
• Readmissions
• Risk adjustment
• Mortality O/E
• Medical necessity of admissions/readmissions
• SOI/ROM
• Removing clinically irrelevant diagnoses
• Copy/paste prevention
• Provider education
• Denials management
• … And CC/MCC capture too.

All of these are related to revenue, directly or indirectly. But CDI focus has expanded to revenue protection, clinical performance, and quality outcomes. And above all, ensuring an accurate record of care.

What is the CDI job of today? Clarifying documentation that makes an impact.

References

ACDIS, “Redefining KPIs for Clinical Documentation Integrity,” https://acdis.org/system/files/resources/FINAL-3M_KPI.pdf

Norwood, “The increasing complexity of CDI begs the question: How can we simplify and move forward?”
https://www.norwood.com/the-increasing-complexity-of-cdi-begs-the-question-how-can-we-simplify-and-move-forward/