State of CDI in 2023: Outpatient CDI, sufficient staffing still a work in progress; opportunities abound!

By Brian Murphy

CDI Week 2023 wrapped up in September and I thought I’d review the highlights (or at least most interesting bits) of my favorite annual ACDIS Survey: The CDI Week Industry Overview Survey.

It’s always worth checking out this survey to get a handle on ongoing trends and year-over-year changes in the CDI profession. This year’s survey was based on 781 respondents from the membership.

Query response rates going up—but not high enough. These who report a 91-100% response rate rose from from 55.97% in 2022 to 60.09% in 2023. 82% of respondents report above-average response rates (71%–100%). These are good numbers but I think the standard should be very close to 100%. My recent Off the Record podcast guest Dr. Nicole Fox believes in a 100% response rate and enforces it. Letting physicians off the hook or allowing them to ignore queries is a mistake, save in extreme circumstances of course. Broken windows lead to crime, etc.

About 14% of respondents don’t offer clinically indeterminable/undetermined in their multiple-choice queries. This surprised me. Physicians will not know enough to render a diagnosis, even probable/suspected, in certain situations. They are not programmed to offer ChatGPT hallucinated answers.

Lack of adequate staffing (and sometimes, advancement). Only 22.71% of respondents strongly agreed that they have enough staff for their department’s workload. And 53% report having no career ladder. Building a business case is a skill; see my recent OTR episode with Dawn Diven for her insights on how to do it and how to implement a career ladder. If you want to cover most/all admissions you can’t do it without adequate staff. Technology still needs a driver at the wheel.

Tracking outpatient CDI impact is a problem. 31.98% of respondents said they use a spreadsheet to track their impact (much better than nothing, but certainly not optimal) and 23.26% said they have no way to track their impact at all. You can’t grow in OP CDI/risk adjustment if you can’t measure your work, plain and simple.

Declining involvement in denials a head-scratcher. Compared to last year, the percentage of respondents involved in the denials or appeals process (58.72%) fell 10 percentage points, more in line with results from 2020. I’m surprised by this. CDI is well-positioned to help with denials. Perhaps hospitals are investing more in dedicated denials departments, or outsourcing this function? 

Computer assisted physician documentation (CAPD) adoption is rising. Nearly 13% of respondents plan to adopt CAPD in 2024, outpacing even the darling chart prioritization (the latter just over 9%). I still wonder about the long-term impacts of real-time CAPD on the CDI profession… but that’s for another day.

Lots of potential, everywhere. With outpatient CDI expanding, new technologies being adopted, denials to fight, compliant queries to write, CDI professionals will continue to be in demand. I see possibilities in the 2023 ACDIS CDI Week Industry Overview Survey.

What strikes your fancy? Any surprises? Link to the full survey below.

Resource

ACDIS, 2023 CDI Week Industry Overview Survey: https://acdis.org/cdi-week/2023-cdi-week-industry-overview-survey