This is what a good outpatient CDI program looks like

By Jason Jobes 

This, right here. 

You should be focused on risk score accuracy by simultaneously evaluating how to maximize revenue and mitigate risk. 

We believe that every organization should get every penny it deserves, just not a penny more. 

Many organizations have started outpatient, or ambulatory, CDI programs focused solely on risk score maximization. Don’t do that. If you aren’t trying to ensure the accuracy of the medical record and the patient’s risk score then you are doing it wrong. You should be looking for ways to capture what the patient has and not capture those conditions that are no longer clinically relevant.

The organization pictured started their CDI program with 3 CDI specialists across 6 pilot departments. The CDI team has reviewed over 9,000 patients through October. Each day they track what they did and bucket activities into three groups: 1) opportunities, 2) clarifications, and 3) risks. We segment the volume of this by provider and clinical category to drive education back to the clinicians. This creates a feedback loop for providers, supports medical record accuracy, and enhances compliance efforts.

The results are that this organization has seen complexity rise, all but eliminated any compliance risk for the CDI reviewed patients, and engaged providers by getting rid of excess noise in prompts at the point of care.

Oh, we also estimate that by year end it will drive $9.6M in care funding into their value based care contracts. 

Need help or some friendly advice on your 2030 value-based care roadmap? You can find me on LinkedIn or via old-school e-mail at jason@norwood.com