By Shirlivia Parker, MHA, RHIA, BS-HIM, CDIP
This article is the third part of a four-part series on the most important topics for health information professionals to be aware of in 2022. You can view parts one and two here.
As we look to the year ahead on the topic of clinical documentation integrity (CDI) and health information professionals, there is a lot to think about. The top four areas I believe will continue to impact us in 2022 include:
Computer assisted provider documentation (CAPD), its importance, and its impact on the provider community.
CAPD uses artificial intelligence (AI) to provide real-time alerts (i.e., computer-generated queries to physicians at the point of care). This software, if leveraged appropriately, will change the future of CDI and our partnership with the provider community by reducing the administrative burdens on physicians. With CAPD, the computer fires an alert of clinical conditions at the point of care, such as congestive heart failure. With physician partnerships and the use of AI, our ability to identify clinical patterns, reduce administrative burdens, and evaluate treatments for certain conditions to study populations and outcomes to continue to improve quality of care provided is limitless.
The changes CAPD will have on day-to-day operations for CDI.
CAPD provides the opportunity to streamline the query process, and I know CDI teams are up for the challenge. It will open the door for the CDI team to query on new measures and opportunities that impact quality. It will also allow for more data to analyze patient outcomes in population health. Ultimately, I believe it can strengthen the partnership of CDI professionals and the provider community. As mentioned, CAPD will allow for virtual communication with the computer at the point of care to provide the clinical decision support needed for the provider community when it comes to documentation.
Outpatient CDI programs.
My advice to anyone wanting to start an outpatient CDI program is to determine your area of focus and target population. Perhaps your focus is one of the following:
Ambulatory surgery and preoperative visits focusing on capturing chronic conditions, also known as hierarchical condition categories (HCCs)
The emergency department
Examples of target populations include (but are not limited to) the following:
Medicare Shared Savings Program (MSSP). This is typically managed through your population health teams. There are several aspects to this program, but one area CDI professionals can impact is the shared savings component of demonstrating severity by capturing HCCs. The goal is to manage cost. We manage cost by primary care physicians’ management of chronic conditions, engaging the patient, and coordinating proactive services.
Alternative Payment Method, where payment is based on performance and risk adjustments are incurred by HCC capture. The goal is the same as the above: to manage costs by better coordination of care on managing HCCs or potentially receive a 10 percent deduction of payment.
Clinical validation denials and the controversy of Sepsis-2 versus Sepsis-3.
Now that the Surviving Sepsis Campaign is out and endorsing Sepsis-3, what is our next step? I believe our goal should be to focus on our query process and what clinical definitions are used by the CDI team to query. Perhaps with the changes recommended in the recent Critical Care Medicine journal, Sepsis-3 is the way to go.
Continuing to Evolve and Understanding the ‘Why’
As we look to the exciting opportunities ahead, we should always remain open minded and continue to evolve and change. We are resilient. Leading CDI professionals through this change is what we know how to do best. Looking at the four topics highlighted above is something I know HI and CDI professionals can tackle and manage without question. It is time to eliminate any notation of something not being possible. With the knowledge and expertise provided to us through our experiences, education, national organizations, and partnering with our colleagues and vendors, there is nothing we cannot accomplish.
I also encourage you to think about the “why” in any project and endeavor you are looking at approaching in 2022. Second, always be ready to explain the why. This is the winning component. It brings people—like the CEO, CDI, physicians, coding managers, population health, quality directors, etc.—to a level of understanding and buy-in that is always helpful. Third, the why is a reminder of something we all know to be true: Everything we do is about patient outcomes and for our organizations’ longstanding survival to serve our community. Hospitals’ operating margins are minimal. As a result, capturing the severity of our patients and demonstrating quality of care is always important.
In healthcare, change is constant. We must rethink and adapt how we do things constantly. One thing I know is that we will always continue to evolve. I believe CDI and HI professionals alike are great at evolving, thinking out of the box, and implementing new processes to meet the needs of your organization and team.
Shirlivia Parker (firstname.lastname@example.org) is an AHIMA Approved ICD-10-CM/PCS Trainer and vice president of compliance and education at Medovent Solutions.