The increasing complexity of CDI begs the question: How can we simplify and move forward?

By Brian Murphy

Clinical documentation integrity (CDI) has grown increasingly complex. We’ve all heard about the “quadruple aim” of healthcare (a framework whch I’ve never liked, four aims = no aim), but in comparison to CDI the quadruple aim=amateur hour.

Many CDI programs have more than a dozen aims.

Today a CDI department might track 15 or more metrics. In a session presented by Novant Health at the virtual ACDIS conference in February I noticed just how complex the situation has become. Started making notes and added to the list with my own.

My non-exhaustive list includes:

• CC/MCC
• MS-DRGs
• CMI
• HCC
• Profee billing/E/M
• O/E
• SOI/ROM
• NTAP (new technology add-on payments)
• PSIs
• SDOH
• Transfers
• Elixhauser
• Vizient
• Leapfrog
• Healthgrades
• S. News and World Report

To this you can add revenue protection metrics, including denials prevention and preauthorizations.

This list could probably go on forever.

The metrics multiplication should come as no surprise. As the bar to admission is raised patients are getting sicker. ICD-10 continues to grow more granular. Medicare Advantage has muscled its way alongside traditional Medicare, adding risk adjustment methodologies including HCCs and Elixhauser.

All of which means, more complexity must be captured. But now things are just … complex, and CDI focus diffuse. Technology is a big help but not a panacea.

Is this just the new reality? Or, can we simplify?

One innovative way of narrowing your focus comes from Leif Laframboise of Yale New Haven Health, who told me on an episode of Off the Record that his organization just focuses on capturing everything present on admission (POA). See this clip here.

Others including Cesar Limjoco beat the drum of diagnostic accuracy/clinical truth.

I really like the idea of simplification. I have found in my own life that if I pursue too many goals I make no progress. I succeed in getting busy but fail to move the needle. I wonder if CDI departments aren’t getting bogged down, too.

What do you think? How many metrics do you pursue? Does your CDI dashboard look like the cockpit of an F-22 fighter jet?

Or, are you trying so simplify—and if so, how?

Let us help

We can get your CDI program performing at an optimal level. Email us at consulting@norwood.com to set up a no strings attached discovery call and conversation.