Transforming a CDI Program for Maximum Quality and Revenue

Sept. 11, 2017

Transforming a CDI program to Optimize Quality and Revenue

Following our current class discussions on transformative leadership and culture in healthcare organizations, I read about how a the United Health Services, UHS, system based in New York conducted a change in their clinical documentation improvement, CDI, program. Senior management began this transition in 2001, and has continually improved their strategies for improvement since.

This article states four steps healthcare organizations have to take to improve their CDI program:

• Hire and retain the best and brightest clinical documentation specialists. 
• Establish metrics and measure outcomes to track the program’s effect organizationwide. 
• Engage physicians and other providers to drive comprehensive documentation and coding that accurately reflects patient status, resources used, and quality of care. 
• Equip senior leadership with the data and other tools they need to understand and promote the financial and quality improvements CDI can deliver.

I found it interesting that the ideas we have covered in class for successful transformations have showed successful in real-life organizations. Beginning the process, UHS brought in professionals to work with their medical staff to improve documentation accuracy and beginning understanding the change that they would undergo. From here, they implemented a 3-week course for physicians followed by working with seniors in the field on a case-by-case basis to ensure they could translate the information from the classroom into the clinic setting. After only 3 weeks with 2 full-time coders, UHS saw a revenue increase of $33,000. As staff increased, by 2005, they had an annual revenue increase of $1 million.

After 10 years, they didn't feel that they were reaching optimal revenue, and decided to raise their goals. They took in more coders and degreed registered nurses to form a hybrid group of clinical and coding staff to further improve the process. In 2 years, they reached $6.3 in annualized returns, far exceeding their goal.

I think the main take away from this article is how a strong base is key for improvement in healthcare. They have a very unified culture where everyone was working to improve UHS' CDI program. They have the coders work with physicians and vice versa to make sure everyone on staff knew what each other was working with and making a comfortable environment for everyone involved. This article also exemplified the time course for change. After 16 years, UHS is finding ways to improve their program still. Change is an evolving concept and cannot be accomplished overnight.