Journal excerpt: Avoid scope creep

Scope creep is “really the whole sentiment that since we’re already in the record, we can do more and more,” says Lara Faustino, RN, BSN, CCDS, a CDI specialist at Boston Medical Center. “It happened gradually for us.”

As CDI programs mature, they move away from the easy-to-reach documentation improvement targets and expand into new areas, Faustino says. Hospital administration begins to add duties—mortality reviews, denials management, DRG reconciliation, clinical validation, quality, medical necessity testing—looking to capitalize on CDI capabilities.

While advanced CDI programs have a lot to offer facilities in moving beyond CC/MCC capture, program leaders need to be mindful of staff productivity, effectiveness, query efficacy, and burnout.

“I had my hands full already and I was being asked to do more and more, which I don’t mind, but I want to do a good job,” says Jennifer Garrison, RN, BSN, CCDS, a CDI specialist at Dupont Hospital in Fort Wayne, Indiana.

“In my experience, scope creep happens pretty innocuously,” says Fran Jurcak, MSN, RN, CCDS, vice president of clinical innovations at Iodine Software in Austin, Texas. “Since the CDI specialist is ‘already in the chart,’ it becomes easy to ask them to look for things outside the typical CDI issues.”

A few precautions can help CDI programs avoid scope creep and safeguard their program, however.

First, develop a mission statement. A concrete CDI mission statement enables programs to effectively communicate goals to stakeholders and measure success based on the targets expressed. When a program starts its life with a clear goal and mission in mind, it’s much easier to say no to additional duties that do not appropriately coincide with CDI expertise and yes to ones that align well, says Jurcak.

A mission statement “outline[s] the department’s present state and defines its purpose,” according to the ACDIS position paper “Developing effective CDI leadership: A matter of effort and attitude.” The statement should be “a short paragraph that summarizes the mission of the group as aligned with that of the organization.”

It also needs to evolve with the program, the paper states. By reevaluating the departmental mission statement on a regular basis (often annually), program managers and directors can ensure duties are aligned.

Editor’s Note: To learn more about developing a CDI mission statement, instituting effective policies and procedures, and safeguarding your CDI program from scope creep, take a look at the March/April edition of the CDI Journal today.