Outpatient CDI adoption, denials prevention and risk adjustment trending high in CDI

By Brian Murphy

 

CDI Week might be winding down … but I’m keyed up for the ACDIS Industry Overview Survey.

 

This annual “state of the industry” special report is worth reading, providing both the big picture of the profession and interesting year-over-year trends so you can see how the times are a-changing.

 

Here’s some things I found interesting.

 

• The slow but steady adoption of outpatient CDI continues. About 26% of respondents reported having a standalone outpatient CDI department staffed with dedicated outpatient reviewers (the other 74%? WTF. Let’s go!)

 

• CDI remains nurse heavy, but not nurse dominated. 70% respondents hold an RN credential, but this is down from 74% a year ago. We’ll see how this continues to trend. Nurses are perfectly positioned for CDI but that doesn’t mean others can’t succeed in the role.

 

• Revenue still rules. About 35% of respondents said their CDI department reports to revenue cycle, 18% to HIM/coding, 14% to finance, and 14% to quality. This doesn’t diminish the ever-increasing tie between quality outcomes and financial performance.

 

• Providers are getting more engaged. The percentage of respondents who reported their medical staff as “highly engaged” in CDI initiatives grew from roughly 13% in 2023 to 17% in 2024. I’d still like to see this number a lot higher, but MDs have a lot on their plates.

 

• Queries are not weary. In accordance with greater provider engagement comes better query response. The number of respondents reporting a 91%– 100% response rate to provider queries rose from 60% in 2023 to almost 70% this year. I suspect some of this has to do with improving technology/more user-friendly prompts. 

 

• Chart prioritization is fully mature. Some 76% of respondents use this technology to help get to charts with the most impact. I remember when this was cutting edge tech… which probably means I’m no longer cutting edge.

 

• Denials getting more attention. Respondents involved in denials prevention or the appeals process grew from about 59% in 2023 to 64% in 2024. The days of standalone denials departments without CDI input should be at an end. Sepsis (of course!) was the number one source of denials, with private payers UnitedHealthcare, Humana, and Aetna the biggest offenders for denied claims (boo hiss).

 

• Risk(y) business. About 62% of respondents indicated that their CDI department considers risk adjustment during chart reviews. CMS-HCCs optimization took the top spot of focus at 49%, followed by the Elixhauser Comorbidity Index and Vizient’s Risk Adjusted Index. With HCCs on the rise as a reimbursement mechanism and a reflection of patient risk I expect this trend will continue to increase.

 

• Pediatrics getting more play. Almost half of survey respondents (49%) perform pediatric CDI case reviews, a number which should warm the heart of my colleague Sandra Love. More than 21% of respondents lacking an ability to track the impact of their pediatric reviews will not.

 

Download the complete survey and analysis here: https://acdis.org/sites/acdis/files/cdi-week/Publication_Industry-Report-CDI-Week_0.pdf