Note from the ACDIS Director: Signs of a strong CDI comeback

by Brian Murphy

A new and renewed place of prominence in the hospital revenue cycle. New hires and increased staffing. New job descriptions, focused on denials and quality. Merging with departments and creating a unified front against auditors, breaking down old and outdated silos.

Taken together these sound like the ideal state of CDI, and maybe a bit of a pipedream. But it’s what’s going on right now, according to a discussion that emerged from my recent meeting with the ACDIS Advisory Board.

The Advisory Board is a valuable lifeline, connecting me to leaders of high-performing organizations in the ACDIS membership. We met a couple weeks ago for an open discussion on what was happening at a ground-floor level in their respective organizations. Many reported taking a hit from the COVID-19 pandemic, but now appear to be in a CDI renaissance. It was very welcome news and left me with a surge of optimism for the profession.

Here are three broad trends that emerged:

1. Re-emphasis on CDI basics and financial and quality improvement, post-pandemic. One board member described a “CDI revival” in their organization. The COVID-19 downturn hit the organization hard, but that led to a doubling down on documentation. Service line chiefs and department chairs are now driving a huge focus on documentation not only for case mix index improvement, but also to ensure that provider profiling and value-based purchasing (VBP) are accurately portrayed. Calls from trauma, vascular, electrophysiology, and neurosurgery for specific feedback have come in. Work is busy!
2. Staffing has accelerated, and training is needed. Another organization has had a total of eight new positions approved, increasing their staff from 15 to 23. These include three new CDI specialists starting the week of June 7, three more starting next month, and approval for educator and clinical validation roles. The driving need for these hires was an increased focus on finance, quality, mortality, additional work with infection control on hospital-acquired conditions/patient safety indicators, and VBP (holistic review of all charts for quality), all the result of a change in administration who saw the value CDI can deliver. Another organization hired a physician education liaison to orient new providers and provide continuing education across the system, as well as four new quality liaisons, all since January. They’ve also hired nine frontline CDI specialists since January, another is starting in August, and they have three open positions. Hiring is booming!  
3. Like the many hospital mergers making headlines, CDI departments are merging with other departments and collaborating on critical responsibilities. This is driven in large part by a need for unified front to combat an increase in denials. One organization recently made the decision to integrate case management, utilization reviews, and denials under one roof with CDI. They have different roles, but all interact with each other on matters of medical necessity/length of stay and all things documentation. They’re also hiring physician advisors at each site to help combat the denials issue. Previously the groups were siloed—denials staff were asking for help with appeals in a scattershot approach and lacked knowledge about diagnoses that were being denied, and CDI professionals were sending appeals letters for DRG downgrades, only to see the whole case denied by a second, different auditor for reasons related to medical necessity of the admission. Now their approach is more comprehensive. “The sandbox has gotten much bigger—our friends are doing the same work as CDI, but there is an opportunity to collaborate further,” one board member said. “Everyone has a lane, but we’re all on the same highway.”

Now, perhaps this group is a bit self-selected for success, and their stories are a bit more optimistic than that of your average hospital. I’m sure this rosy picture does not match everyone’s story. And the upward trend in arbitrary denials remains a concern.

But I believe it’s also signs of a renaissance. With the pandemic receding into the rear mirror, CDI is a great place to be if you want to make an impact, and with ACDIS’ help and support I’m confident we’re poised to do just that for our nation’s hospitals.

Editor’s note: Murphy is the director at ACDIS. Contact him at bmurphy@acdis.org.