Three tips for making outpatient CDI impact—the most important being, just do it

By Brian Murphy, Norwood Solutions

The latest episode of Off the Record dropped last week and the call to action couldn’t be clearer: Outpatient CDI is the missing ingredient in your healthcare organization.

We packed a lot into this episode, but here are three takeaways right off the top to get you moving.

1. Aggressively schedule patient visits. Capture all relevant conditions in compliant face-to-face encounters in the likes of annual wellness visits. This depicts patient acuity and leads to greater care funding. Revenue impact is a little harder to track in OP CDI but often comes through shared savings with your contracted Medicare Advantage payers. This step is preventive care in action, too, and can help with medication adherence, readmissions, and more.
2. Remove conditions no longer valid or otherwise unsupported. “ROI” or “impact” does not always equal revenue. Compliance is impact, risk mitigation is impact, clinical accuracy is impact. Put in hard stops for high-risk conditions (acute conditions that should be captured as historical, diagnoses lacking clinical support/associated medication or treatment, etc). LifePoint Health in 2024 nearly 19,000 conditions, both risk eligible and non-risk eligible, due to insufficient documentation. You’ll thank yourself later when the OIG or CMS comes knocking for an inevitable audit.

   Per podcast guest Jason Jobes:

   “Outpatient CDI seeks to make sure that your risk adjustment factor (RAF) score is as complete and accurate as possible. A lot of organizations want to want to see that RAF score go up. We are big believers that the RAF score should reflect the acuity of the patient.

   “More often than not, it means increasing it, but it also means making sure that you have checks and balances along the way, so that way it’s not artificially inflated.”

3. (And most important): Just do it. A recent survey of the CDI industry issued by ACDIS demonstrated that 31% of healthcare organizations report having a dedicated outpatient CDI department. That’s up from 26% last year, but implementation remains painfully slow. On the live show our poll showed 58% had a dedicated OP CDI department, much better but still not where it still it needs to be. Make the commitment. This will likely include developing a blueprint and workflow, hiring dedicated review staff (HIM/coding and/or RN) and investing in adequate review technology (AI/NLP) to help cover the much higher volume inherent in OP encounters and monitor progress.

Speaking of just doing it, I wanted to share a quick personal story.

I’m rarely ahead of the curve.

Most of the time I find myself observing trends as they pass, oblivious, wondering what I’m seeing as I slowly drift off the side of the road.

But once in a while I see the future.

I was ahead of the curve with outpatient CDI. Which is finally fully here. And I couldn’t be happier, for me or my Norwood colleagues.

A bit of history: I helped get the CCDS-O certification off the ground “back in the day” with ACDIS.

The CCDS-O exam was difficult, but fair. And the committee members who helped us develop and write it were excited. They knew it was needed. I knew it was, too.

But the credential was ahead of its time. There were very few OP CDI programs operating circa 2017. It was slow to take root.

Today? Different story. Medicare Advantage now covers more than half of the eligible population. Value-based care is slowly but steadily replacing fee-for-service, CMS-HCCs gaining prominence over MS-DRGs.

Outpatient CDI and risk adjustment are exploding. I know this because our partners are building and expanding their programs—and seeing demonstrable ROI.

I’m not a consultant, but I support a great consulting team. We prefer the term Solutions because that’s what we do: Solve complex problems. We make CDI directors and VPs of Mid-Revenue Cycle the heroes of their hospital.

Check that: They’re already heroes. We just help them shine a little brighter.

If you’re not already, follow Norwood. In the coming weeks we’ll be debuting a case study of how we helped one partner pilot a small OP CDI program, a small start in six clinics that is blossoming into something big.

One I’m proud to be a small part of.

If you’re not in this space we can help you. Because you need to be. OP CDI is here … finally! Don’t miss that curve.

Listen to “The ROI of OP CDI” on your podcast player of choice.