Serenity CDI: Process improvement

By E.S. Damalie, MD, FACHE, FHFMA, RHIA, CCDS, CDIP, CCS

Too often programs embark on process improvement without first obtaining a comprehensive investigation into current practices within the facility and comparing them to industry standards. Talking about process improvement without understanding or walking through the current CDI activities—their successes and struggles—is hardly any form of process improvement but just mere process change. Process change is not process improvement. Change simply for change’s sake only serves to keep the CDI team off balance.

To avoid making unnecessary changes, assess a process or program by putting in specific targets to monitor and/or measure it. Set goals for items such as query rates, physician response rates, agree rates, and record reviews. Establish a peer review process for CDI queries to assess query effectiveness and identify areas for educational opportunities. Of course, not everyone has the analytical knowledge and skills necessary for this task but hard facts need to be obtained before drawing any sweeping conclusions regarding your CDI program’s growth opportunities.

Second, take the time to understand why certain policies and/or procedures were originally put into place at your facility. Simply applying processes seen elsewhere to an existing program may not work. Similarly, organizations shouldn’t rush to replicate the one CDI project at other divisions of the organization without involving the parties that helped ensure the project’s success.

As interesting as these scenarios may sound, they remain a hindrance to the blossoming of CDI programs in many organizations. These and many more are some of the challenges CDI staff deal with on a regular basis. Overcoming some of these challenges will involve organizational reorientation and an advocate who can be the mouthpiece for the program. How loud this mouthpiece can be depends to a large extent on the credibility the program has built over the years. Guarding and holding such credibility in the highest regard can be a game changer.

Editor’s note: Damalie, a physician and CDI specialist, is currently affiliated with Serenity CDI+ Solutions, which offers CDI, appeals and denials management, coding and auditing, and other revenue cycle services. Currently a fellow of both the America College of Healthcare Executives and Healthcare Financial Management Association, he also serves on the ACDIS CDI Practice Guidelines Committee, and as chairman of the Certification Committee for the Southern California Chapter of HFMA. The opinions expressed do not necessarily reflect those of ACDIS or its advisory board. Contact Damalie at serenityCDIplus@gmail.com.