Note from the ACDIS Director: CDI professionals, be proud of your response to COVID-19

by Brian Murphy

As director of ACDIS, I could not be prouder of the way our members and the CDI community as a whole have stepped up in the midst of the worst pandemic since the days of the Spanish flu. COVID-19 has overwhelmed emergency departments and ICUs, exposed flaws in our healthcare system, and most tragically killed thousands of people across the globe.

The CDI profession has not been spared. As I’ll be covering on next week’s Quarterly Conference call, ACDIS’ impact of COVID-19 on CDI survey of some 800 CDI professionals reveals that more than 80% of CDI departments nationwide have been hurt by organizational cost-saving measures due to the wave of COVID-19. These impacts include staff redeployment, furloughs, pay reductions, and in some cases layoffs.

But CDI professionals are also responding with incredible flexibility and ingenuity, even selflessness and grace. Our survey shows that in organizations with low patient census, they’ve stepped up with deep mortality reviews, begun to review observation cases, and pitched in with concurrent coding. They’ve helped with patient registration, and assisted with personal protective equipment (PPE) collection, distribution, and fitting. And in some organizations CDI professionals with clinical backgrounds have returned to the bedside, putting themselves and their families at heightened risk in order to treat the sick.

But they’ve also absorbed some unfair criticism. One of the more troubling, and angering, responses I’ve seen in some corners of the internet has been the insinuation that hospitals (and though unmentioned, by default, CDI professionals) have been artificially inflating the number of COVID-19 cases solely to increase reimbursement. I bristle at that. It hurts in my core, because it flies in the face of what I know the vast majority of CDI professionals stand for: accurate representation of the patient in the health record. Clinical truth and honesty. Integrity. That last word directly in our association’s name; you could think of it as the heart of what we do.

These accusations demonstrate an ignorance of our healthcare reimbursement system, and moreover a willful misrepresentation of the art of medicine. CDI specialists and coding professionals must report conditions to their highest degree of known specificity. It’s not their job to report “pneumonia, unspecified” and call it a day. That’s the easy thing to do—and the wrong one. So, they do their best to clarify documentation with busy physicians—frontline healthcare workers who are often pushed to the brink of endurance, diagnosing patients with all their skill and from tests plagued by false negatives.

Many studies are also showing that COVID-19 has been dramatically underreported. Many Americans are dying at home, in nursing homes, and in long-term care facilities without ever being tested.

We play with the cards we’ve been dealt, including the MS-DRG system and how hospitals are paid. If we don’t like it, we make our voices heard during the rule making process, which is so critical to do. But in the end, we must play by the rules of healthcare or we put our organizations, professional, and personal reputation at risk. CDI specialists know this, and certified CDI specialists have read and agree to abide by the ACDIS Code of Ethics, which states that clinical documentation integrity specialists shall, “Facilitate accurate, complete, and consistent clinical documentation within the health record to support coding and reporting of high-quality healthcare data,” and, “Avoid participation in, condone, or be associated with dishonesty, fraud and abuse, or deception.”

CDI specialists get to the truth of the patient encounter, and therefore play an imperative role in the war against COVID-19. Detection and diagnosis are a critical part of the epidemiological chain. Accurate diagnosis helps researchers track disease incidence and outbreaks and helps with the development and efficacy of preventative measures and treatment. CDI specialists are doing their part to get our country back on its feet again.

Will there be some future Office of Inspector General audit or CMS contractor review that casts a disparaging light of the capture of U07.1? Undoubtedly. There are always a few bad actors in every profession. Please show me a profession where that is not the case.

I feel rock-solid in my belief that CDI professionals are working hard to get the right documentation in place, reviewing lab results and clinical indicators and asking the difficult questions of their harried physicians. It’s hard, but they know the job is critical. It’s what they’re trained and credentialed in.

In short, be proud of what you do, CDI professionals. Know that I am, incredibly so.

Editor’s note: Murphy is the director of ACDIS. Contact him at bmurphy@acdis.org.