Effective CDI Processes-Focusing on Communication of Patient Care

Typical key performance indicators (KPIs) of Clinical Documentation Improvement (CDI) programs do not effectively measure the performance the program  for several reasons. These same KPIs have become ingrained and are worshipped as the “bible” to measure CDI program performance at most hospitals and health systems. Chief Financial Officers have been conditioned by most CDI consulting companies to believe the significant dollars invested in CDI programs are providing a reasonable return on investment, based on KPIs that merely measure task-based, reactive repetitive activities. Task-based activities carried out by CDI bear no resemblance to the real measurable meaning of sustainable improvement in physician documentation. Standard CDI KPIs miss the mark for the following reasons.

1. Narrow Focus: Many KPIs focus solely on quantitative metrics like query rates or coding accuracy, which do not capture the broader strategic impact of the CDIs leadership and initiatives. There are a small number of CDI thought leaders that have embraced the strong potential CDI can bring to the table by reengineering their current CDI processes embedded in task-based activities generating high CC/MCC capture rates and CMI increases that amount to mere “Feel Good” money that does not necessarily materialize. The adage of “just because you billed a specific DRG does not mean you are going to be reimbursed the expected amount” is alive and well in this instance.
2. Lack of Context: Standard KPIs may not account for the complexity of individual cases or patient populations, leading to a misrepresentation of performance if viewed in isolation. Note the narrow focus above, a cookie-cutter approach to CDI does not account for nor reflect that the documentation improvement opportunities for each reviewed record are not the same.
3. Short-term vs. Long-term Goals: Many traditional KPIs emphasize immediate results rather than long-term improvements in documentation practices or clinician engagement, which are critical for sustainable success. The number of records reviewed and the number of queries generated are definite short-term goals that do not correlate with actual improvement in physician documentation. Queries are a stop-gap measure treating symptoms, with long-term goals supplanted by short-term goals of enhanced revenue as pointed out above that may not materialize. Long-term goals of physicians achieving true clinical documentation excellence sustainable over time take a back seat to immediate goals of enhanced CC/MCC Capture. As soon as queries are stopped, the CC/MCC Capture Rate falls. CDI consulting companies offering their CDI software to promote CC/MCC Capture are perpetuating the notion that more queries equates to generating more revenue, farthest from the truth.
4. Quality Over Quantity: KPIs often prioritize quantity (e.g., number of queries) over the quality of documentation. A high volume of queries may indicate poor documentation practices, rather than effective CDI management. Queries are a measure of defects in documentation
5. Ignoring Education and Training: Effective CDIs play a vital role in educating staff and fostering a culture of documentation excellence. Traditional KPIs may not reflect these qualitative contributions. An overemphasis upon traditional KPIs overlooks the opportunity to develop a sustainable physician documentation training program that engages physicians to be willing participants in any CDI initiatives as opposed to targets of queries
6. Stakeholder Engagement: KPIs may overlook the importance of building relationships and collaboration among clinical teams, which is essential for a successful CDI program. Remote CDI programs make it difficult for CDI to foster strong relationships with physicians, a prerequisite to engaging physicians in any CDI initiative. I submit to all CDI professionals and leaders; what physician wants to receive more repetitive queries as a form of “physician documentation training.” Where CDI is misguided the most is its belief that it can improve the integrity of the records. Logically speaking, the only ones who can improve documentation are the physicians with the assistance and guidance of the CDI professional serving as facilitators of better more effective documentation and communication of patient care
7. Inflexibility: Standard KPIs do not adapt to the specific goals or challenges of a healthcare organization, limiting their effectiveness in assessing CDI performance. The CDI profession must commit to efforts at pivoting and reengineering, rebranding, and reinventing CDI processes to the extent they alleviate self-inflicted payer denials, mitigating efforts of payers to second guess physicians’ clinical judgment and medical decision-making by denying the level of care and rejecting diagnoses by physicians who are seeing, observing, and managing patients
8. Outcome Measurement: Many KPIs do not correlate directly with patient outcomes or quality of care, which are critical measures of a CDI program's overall effectiveness. More meaningful measures of CDI performance include first-pass claims acceptance and timely payer reimbursement, reduced volume of payer requests for medical records to validate coding and medical necessity, level of clinical validation denials, amount of financial payer recoupments for medical necessity and coding after initial reimbursement to name just a few

Final Thoughts

 To better evaluate CDI performance, organizations must consider incorporating a mix of qualitative assessments, stakeholder feedback, and metrics that reflect both immediate and long-term contributions to documentation quality and patient care. Core-CDI subscribes to seventeen “alternate” Key Performance Indicators as measures of success of its “nontraditional” approach to physician documentation improvement. Contact us for more information and a list of these encompassing Key Performance Indicators. There is a far better way to CDI than current CDI processes that are misguided and misdirected at outcomes without the requisite improvement in physician documentation processes. What matters most is the quality and completeness of physician documentation.