Guest Post: CDI Reporting Structure

by Cara Belnap, MS, RN, CCDS

As I embark on the start-up of a new CDI program for my health system, I face a number of operational decisions that have to be made. One of which is reporting structure.

According to the CDI Week Industry Survey, 45.5% of respondents report to HIM/coding, followed by case management (23.5%) and finance/revenue cycle (17.9%). I would propose a new reporting structure—our own. Hospitals whose budgets only allow for combining CDI duties with other functions then it may make sense for the CDI to report to that department, and true enough that many of our duties and functions cross over into many departments within the health system.

Do CDI programs report through to HIM/coding, because that’s the best fit or are we traditionally house CDI staff in that department for fear of conflict if we don’t.  In the book, Using Conflict in Organizations, authors C. DeDreu & E. Van de Vliert propose that “conflict is a way of confronting reality and creating new solutions to tough problems. Conflict, when well-managed, breathes life and energy into our relationships and strengthens our interdependence and makes us much more innovative and productive.”

CDI staff do work very closely with HIM and coding staff and lean very heavily on each other for support, functions, staff and provider training/education, workflows, and policies/procedures. That would still be the case if we were two separate but equal departments. Collaboration and communication is an essential skill set for any CDI specialist. Perhaps if CDI specialists, whether coder or nurse by background, were housed in their own department, we would lessen some of the ongoing debates about roles and functionality. We would simply be CDI specialists.

The ideal reporting structure, in my opinion, is a CDI director/manager who reports to a chief medical officer (CMO) or chief financial officer (CFO). This allows the CDI department to set its own goals, mission, and vision, all while collaborating alongside their health system counterparts of HIM/coding, case management/utilization review, quality, revenue cycle, nursing, ancillary departments, non-physician providers, and physicians.

I know this can be a controversial topic, so I’d love to hear what you have to think.

Editor’s note: Belnap, at the time of this article's original release, was Regional Operations Manager, CDI for Samaritan Health Services.