Journal excerpt: Home health communication, reporting structures

CDI programs launching in the home health space need to understand the communication dynamics at play within this setting and how separate departments with separate reporting structures can still work together. A hospital CDI program often has physicians and other departments all under one roof and readily available for questions and collaboration. Home health does not provide this luxury, and that can cause strain for new CDI programs.

“There’s a lot less communication in home health than inpatient,” says Dorene Cowans, HCS-D, COS-C, director of coding with NHC HomeCare in Murfreesboro, Tennessee. “In the hospital, if you need additional documentation about a patient, it’s much easier to get in touch with a provider than in the home health setting where you have a list of people to go through in order to get that communication.”

Working with the coding department can also be a struggle for new home health CDI programs. On the inpatient side, many CDI departments operate under the same umbrella as their coding peers or have robust communication avenues and shared education. This is not always the case in home health.

“In home care, it’s more spread out,” says Cowans. “There are different departments doing different things. Our compliance department isn’t just over the CDI segment or auditing aspects—that’s all under the management side instead of the compliance side.”

Unlike inpatient CDI programs, the majority of home health programs find themselves housed under the compliance umbrella. There are, however, a few other options for reporting structure that could complicate communications between departments. Because CDI work touches quality, clinical, operations management, and financial management, Sharon Litwin, RN, SHSH, MHA, HCS-D, senior manager of coding and consulting with Healthcare Provider Solutions, Inc., in Nashville, Tennessee, says any of those departments may offer natural reporting structures for the CDI department.

Regardless of the reporting structure chosen,  Litwin says the first step in developing a program should be self-assessment, usually through a survey or audit process. Doing an assessment illuminates vulnerabilities and key areas that have caused deficiencies and denials.

“From that, you can go and set up your quality indicators or performance improvement project (PIP),” Litwin says. “You really want to work backwards to set up the program.”

Editor’s note: This article is an excerpt from the May/June 2021 edition of the CDI Journal.