Note from the ACDIS Director: No better time to get started in outpatient CDI than now

by Brian Murphy

According to the 2021 CDI Week Industry Overview Survey, only 20.6% of organizations have a standalone outpatient CDI program. That number is far too low… but I get it. Outpatient/ambulatory CDI is a different beast than inpatient, and therefore intimidating to get into. Hospitals are still in a trial-and-error mode, searching for the best review cadence, diagnoses and documentation to target, and key performance indicators (KPIs) with which to track their progress. Tools and support are lacking, as compared to the mature CDI technology we have in the inpatient setting.

There’s also been several high-profile audits of Medicare Advantage companies and other entities submitting diagnoses for the purposes of risk adjustment. I’ve been covering this regular stream of reports from the Office of Inspector General on the ACDIS Podcast. More than ever, compliance is critical.

Given the opportunities, and vulnerabilities, we know that outpatient is an area CDI departments should be in. The biggest unanswered questions for most are, how do I start, and, how can I demonstrate impact?

We can now answer these questions for you. Or, at least provide you with some actual strategies for getting you started down the path.

Our members have come to love the ACDIS Apprenticeship and using that same template we’ve created the brand-new ACDIS Outpatient CDI Apprenticeship. As the name “apprenticeship” implies, the content is focused on learning the ropes from peers and experts. This online course includes three modules devoted to key concepts and responsibilities of outpatient CDI specialists, two case studies of successful outpatient programs, and two panel interview sessions with three outpatient CDI professionals who launched or ran thriving outpatient CDI departments.

The ACDIS Outpatient CDI Apprenticeship also includes additional reading and an adaptable job description. Passing a final exam at the end awards the prospective apprentice with an “ACDIS Approved Outpatient CDI Apprenticeship” designation and digital badge. While not a credential—that is where our CCDS-O certification comes in—achieving this designation is a great way to get started. I’m particularly happy with the couple panel interviews conducted with three experts from the trenches—Jessica Vaughn from Norwood, Tracy Boldt from Essentia Health, and Yvonne Whitley from Novant Health. All three have either started successful outpatient programs, or served as outpatient CDI professionals, and their real-world expertise is invaluable.

If you’re looking for more ideas I recommend the final installment of our risk-based CDI series, When Worlds Collide: HCCs and Risk Adjustment Strategies. Written by members of the ACDIS Advisory Board (hat tip to board members Jennifer Eaton and Aimee Van Balen for principal writing of this final installment), this paper offers strategies in the ambulatory setting, areas of joint opportunity with inpatient reviews, and common risk-adjusted conditions that can serve as a starting point for your reviews. CMS claims-based quality measures also use diagnoses from outpatient claims, and over a 12-month period, which means that your only opportunity to capture risk may be during patient’s annual wellness visit. From the paper:

For CDI professionals, this means ambulatory documentation and coding integrity not only influences HCC scores, but also serves as the only opportunity for risk adjustment related to hospital quality measures. In other words, to be used for risk adjustment, certain diagnoses must appear on a claim prior to the inpatient admission triggering the quality measure. This methodology aims to promote comprehensive disease management, including documentation and coding of those diseases in the ambulatory space to promote quality of care, and appropriate chronic disease management.

The challenge with ambulatory CDI is the promotion and implementation of documentation and coding integrity strategies outside the four walls of the hospital.

Of course, I also have to mention the ACDIS Outpatient Pocket Guide, of which we recently published our 2022 edition. It’s a treasure-trove for OP CDI professionals, with a table of contents of more than 80 conditions including updates to listings such as HCC 1: HIV/AIDS; HCC 39: Bone/Joint/Muscle Infections/Necrosis; HCC 55: Substance Use Disorder, Moderate/Severe; and HCC 58: Reactive and Unspecified Psychoses.

CDI beyond the safe, comfortable walls of a hospital is a challenge, but ACDIS is committed to helping you step out of your comfort zone, and succeed. Make it a 2022 goal.

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