Clinical documentation improvement programs can help healthcare organizations improve outcomes, boost bottom lines and adhere to regulations governing the industry. And while many organizations already have a CDI program in place, there is always room for improvement.
Clear leadership structure
A solidified leadership structure is a key component of a CDI program, said Alison Bowlick, RN, assistant vice president of Ensemble Health Partners during a July 29 webinar. The webinar was hosted by Becker's Hospital Review and sponsored by Ensemble Health Partners.
The leadership structure for CDI programs typically includes:
1. A CDI team. While some organizations have an onsite team and others have an offsite team, Mrs. Bowlick suggests having a hybrid team that rotates CDI specialists between on-and off-site. This allows the team to remain visible as part of the care continuum, while also bolstering staff satisfaction since teams will be allowed to work some remote days.
2. An onsite supervisor. This leader is the "face of CDI" for a particular site, said Mrs. Bowlick. This is the person the team, site administration and providers rely on for any issues related to CDI and the program.
3. Regional manager. This leader oversees CDI needs on a regional basis, allowing teams from different sites to learn from each other. The regional manger can help share successes and failures with different sites across the region, preventing communication silos.
4. Director, educator and an analyst. This CDI leadership position is focused on helping build onboarding processes and generating reports that focus on daily, weekly, monthly and annual trends.
The directors, educators and analysts report to an assistant vice president of CDI. Additionally, some organizations have a physician advisor or champion, who can assist facility staff on a peer-to-peer level.
"It's important to recognize that a system's CDI department is not a one-man show," Mrs. Bowlick said. "This allows CDI teams to work together and be proactive instead of reactive. Many sites have good bones and its just building it from there to make it even better. An analogy would be putting the siding in a roof on a house for completion. Without that, the framework itself will not support the end goals of that house build. The oversight allows for clear-cut expectations."
Daily, weekly and monthly CDI program expectations
Mrs. Bowlick broke down some of the ways in which CDI managers can make sure the program meets its key performance indicators.
Daily expectations. These can include daily huddles, which can help teams outline their day. Teams can look at their workloads and check in with each other about challenging cases. They can also be made aware of any facility-specific updates. Also, daily rounding with teams can help improve visibility of CDI specialists in the facility and allow the team to address CDI-related issues that pop up on a daily basis.
Weekly expectations. Checking in on where the facility is with regard to CDI-related key performance indicators every week, on a month-to-date basis, can help CDI teams avoid any surprises at the end of the month.
"One thing we recommend is doing concurrent audits on cases to make sure that we are not then doing retrospective audits," Mrs. Bowlick said.
Weekly program expectations can also include the delivery of weekly summaries to leadership and involve ancillary meetings to identify opportunities for staff education. This allows the CDI team to move out from behind the scenes and get in front of healthcare facility staff.
Monthly expectations. Executive steering reports are an important monthly expectation. These reports are meant for both CDI leaders and C-suite executives, providing leadership with a bird's eye view of the program and its successes and failures. It is also helpful if CDI programs pull individual and team metrics, such as productivity and quality assurance, for review on a monthly basis so leaders can be sure that all team members are playing a part in achieving the overall goals of the program.
Engaging the C-suite in your facility's CDI program
In addition to monthly steering reports, meeting with C-suite executives can help ensure that a CDI program attuned to the needs of the organization.
"How often should you have steering meetings? Should they be monthly, quarterly — that really depends on where you are at with your CDI program and the type of engagement you would like to have with your senior C-suite," said Kathryn Vermillion, RN, senior director at Ensemble Health Partners.
When deciding how often to meet with them and what to include in the monthly reports to the C-suite, Ms. Vermillion suggests keeping these questions in mind:
• Does your leadership have a good understanding of what CDI is and what the initiatives are?
• Do they understand the reports and what data they are trying to convey?
• How much support or intervention do you need from your senior leadership and what kind of relationship can you garner from that?
When creating CDI program steering reports for C-suite leaders, it is important to know the audience and know what kind of data they are interested in, said Ms. Vermillion. Don't include more information and data than they need to know. Also, listen to the questions that are brought up once they have read the report. This will give you an indication of what kind of information the C-suite need.
It's also important to anticipate possible trend-related questions leadership may ask and have answers ready when you go in for steering meetings.
Some core elements of steering reports include: case mix index impact on only CDI-reviewed accounts, the top 20 diagnostic related groupings and a physician scorecard indicating physicians that are not actively engaged and not responding to clinical documentation requests.
Oversight and support from leadership can help ensure CDI programs are helping organizations improve documentation processes and yielding benefits.
To learn more about Ensemble Health Partners, click here, and view the full webinar here.