The Role Healthcare Executives Have in CDI 2.0 (Severity Reporting)

Healthcare executives play a crucial role in steering organizations toward their vision, mission, and strategic goals. Traditionally, CDI initiatives have not received the attention they deserve at the executive level. However, by understanding the metrics that executives monitor and the impact CDI can have on these metrics, it becomes clear that involving executives in CDI is essential for continued growth without diminishing returns.

Metrics Monitored by Healthcare Executives

Executives monitor several key metrics to assess the performance and efficiency of acute care organizations.

These metrics include:

• Length of Stay
• CMS Program Performance
• Readmission Rates
• Public Profiling and Star Ratings
• Mortality Rates
• Denial Rates
• Operating Margins

Each metric provides insights into different aspects of an organization's performance and quality of care. CDI initiatives have the potential to impact all of these key metrics.

CDI is a Controllable Factor

One significant advantage of CDI initiatives is that they are within the control of healthcare organizations. Unlike some metrics that depend on external factors, CDI provides an opportunity to optimize severity reporting data for the patient population being served. By focusing on accurate and comprehensive documentation, efficient CDI programs positively influence all of these metrics.

CDI programs earn recognition from healthcare executives when they demonstrate their value. Simply reporting on traditional metrics is often insufficient to garner ongoing C-suite support. Healthcare executives leading CDI initiatives can, however, help to align organizational goals and strategic objectives. Revenue cycle leaders should play a direct role in setting expectations for KPIs and target performances for all CDI initiatives, rather than simply waiting for monthly reports on CDI program efficacy.

Moving Beyond the Traditional CDI Model

Relying solely on the query process can lead to query fatigue among physicians, especially as the scope of severity reporting accuracy expands. A model that lacks physician participation and focus is unlikely to bring about long-term changes in documentation practices, resulting in repetitive queries and inefficient processes. The success of any CDI program hinges on active physician participation.

While this approach has its merits, it's essential to incorporate a top-down executive-led strategy to proactively impact metrics.

Traditionally, CDI 1.0 has followed a bottom-up approach, where initiatives focus on retrospective analysis and query-based interventions. Focusing primarily on charts has many limitations. The traditional CDI approach faces several challenges that hinder optimal severity reporting.

Limited resources, such as the number of CDI specialists, can limit the overall impact of traditional severity reporting efforts, particularly in large organizations. Senior leadership relies on limited insights from the bottom-up, such as query response rates, query impacts, and benchmarking. Despite using these metrics for over a decade, the same issues and questions persist, resulting in inconsistent and unsustainable outcomes.

Jumping The Curve with CDI 2.0 (Population-Based Severity Reporting)

Severity Reporting (CDI 2.0) is the disruption to the Bottom-Up approach that CDI has been using for decades. 2.0 uses a population-focused top-down approach that augments and surpasses the results achieved in CDI 1.0, in a lean manner with sustainable results.

For decades, advancements in technology and approaches in the CDI space have all focused on the activities of the CDI program being the main driver of severity reporting, with the unit of analysis being the actual chart/medical record. If the source of the documentation is the provider, CDI 1.0 should be just one of many strategies that help get results and a provider-focused approach should not be ignored.

The traditional approach (CDI 1.0) has limited the industry’s ability to consider this as a viable option since traditional metrics and insights are not physician-friendly, and oftentimes not a true reflection of the quality of the documentation of a provider, or groups of providers over time.

With population-based analytics, an acute care organization now has insights into performance relative to the patient population they had access to and not to a chosen cohort. This allows for SMART Goals to be set at the highest level of the organization, with CDI (1.0) being just one tactic for achieving the overall goals.

By recognizing the potential impact of CDI on length of stay, CMS performance, readmission rates, mortality rates, denial rates, and operating margins, executives should prioritize and support CDI programs. It's time for CDI to claim its rightful seat at the C-suite table and contribute to the overall success of healthcare organizations.

Watch our webinar "Rethinking CDI as a Healthcare Executive" to learn more!

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