Q&A: CDI reporting structure

Q: Which department do CDI programs typically report to and why?

A: Program reporting structures have remained status quo, according to the 2018 CDI Salary Survey, with the plurality of CDI departments reporting to HIM. However, the percentage of respondents working in stand-alone CDI departments increased by 3% from 2017 to 2018. (Click here to take this year’s survey.)

Stand-alone CDI departments have been a long-dreamed ideal for many in the field. As far back as 2015, Cara Belnap, MS, RN, CCDS, then CDI regional operations manager for Samaritan Health Services, wrote on the ACDIS Blog that her preferred structure would be a stand-alone department with a CDI director/manager who reports to a chief medical officer (CMO) or chief financial officer (CFO). This, she explained, would allow 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, etc.

Programs which are just getting started, those considering a shift in reporting, or those planning a total program re-boot should consider creating a steering committee to gather data and evaluate the pros and cons of various reporting structures. This could include broad baseline data from HIM, patient financial services, and case management including case mix index, number of discharges, unpaid claims, denials from commercial payers, Recovery Auditor denials, and so forth to determine pain points and program focus, as explained in the CDI Road Map.

For many CDI programs, their reporting structure stems from their program mission, vision, and goals. For example, a program that’s more closely aligned with documentation improvement opportunities related to present on admission, patient safety indicators, or other quality measures may benefit from a close working/reporting collaboration with the quality department.

As nearly all of ACDIS’ CDI salary surveys show, however, HIM/CDI need to continue to have strong bonds regardless of which department reporting structure is implemented.