Measuring and Valuing Quality

In the early days of the clinical documentation integrity (CDI) industry, the focus was overwhelmingly financial in nature. CDI professionals reviewed records focused simply on capturing comorbid complicating conditions (CC) and major CCs (MCC) for accurate code assignment and reimbursement. With the advent of value-based purchasing programs and other pay-for-performance measures, many CDI teams have shifted their focus to a more holistic review process for accurate quality reporting.

In partnership with 3M, the Association of Clinical Documentation Integrity Specialists (ACDIS) CDI Leadership Council asked several of its members to evaluate the results of a nationwide survey on measuring and valuing quality and asked members to discuss their organizational approach to this topic. In this industry report, readers get a full inside look at the quality measures CDI teams most often review, the priority placed on financial and nonfinancial key performance indicators (KPI), quality measure benchmarking and measuring impact and collaboration with the quality department!

Three biggest talking points:

• When it comes to reviewing quality measures, nearly 60% of survey respondents put the most weight on concurrent severity of illness (SOI)/risk of mortality (ROM) and listed it as a primary metric.
• Roughly 46% of respondents said they put nonfinancial and financial KPIs on equal footing, and about a quarter each said although they track both, either financial or nonfinancial KPIs are of primary importance.
• While roughly 97% of respondents said they review for quality measures, more than 17% said they don’t track quality-related impacts at all, likely because tracking quality impacts is notoriously difficult.