Guest Post: Beyond CC/MCC capture for compliant CDI efforts

Editor’s Note: Let’s call this week’s guest post from “a ghost of ACDIS’ past.” Those who’ve worked in the profession for some time will no doubt remember with some fondness the teachings of founding ACDIS Advisory Board member Robert S. Gold, MD, who sadly passed away in the spring of 2016. The following was a note sent some years before that, encouraging ACDIS and the CDI professionals it represents to advance their efforts beyond traditional CC/MCC capture to ensure complete and accurate medical record. 

It so often seems that all CDI programs have been developed based on MS-DRG maximization. Such short-term focus however defeats the goals (and challenges) of healthcare in today’s society.  When CDI develops from the Medicare revenue perspective, rifts grow quickly between the coders and the CDI because so many of the teachings don’t line up.  Rifts develop between the CDI folks and the docs, too, because docs feel like they are targets and are always wrong. Rifts develop between the CDI team and quality team because CDI queries seem to encourage the reporting of complications even when complications don’t exist. And massive holes exist in the patient’s database because of CC/MCC capture concentration which leaves all of the patient’s chronic conditions unsought after and unreported.

Too many instruments support the old, obsolete concepts and too few encourage people to go beyond their silos. All of the initiatives that are needed to drive us into the future will fail if we don’t expand our expectations beyond these past, financially focused, efforts.