TrustHCS attended and exhibited at the 11th annual Association of Clinical Documentation Improvement Specialists (ACDIS) Conference on May 21-24 in San Antonio. It was a great professional experience with meaningful education across three information-packed days.

Our team also had the pleasure of meeting with knowledgeable professionals who are passionate about what they do. This is true for many healthcare conferences, but clinical documentation improvement (CDI) kicks it up a notch.

 

Expanding CDI Took Center Stage

Building CDI programs outside of the acute care hospital setting was at the center of many conversations and educational sessions. Children’s hospitals, critical access hospitals (CAHs), and, of course, outpatient care settings are ready targets for CDI expansion in 2018.

Healthcare leaders outside of the CDI department are recognizing the benefits of clinical documentation services provided in nontraditional areas. With the traction CDI seems to be gaining, programs are sure to experience stronger importance and relevancy within the healthcare reimbursement ecosystem going forward.

 

Sharpening CDI’s Role in Value-Based Care

Clinical validation and quality have been discussed a lot lately, and this year’s ACDIS was no different. Risk adjustment and hierarchical condition coding (HCC) were highlighted more than ever at the 2018 event. Here are key takeaways from four of the educational sessions dedicated to this topic.

  • HCCs: Meeting Compliance Demands

Richard D. Pinson, MD, FACP, CCS, reviewed the role of HCC diagnoses in risk-adjusted quality and cost measures that can affect the provider’s payment. He emphasized the need for documentation to match the outpatient encounter. Documentation must be relevant to each visit. Providers can’t simply document “history of x”. The diagnosis must be directly addressed during the outpatient visit.

 

  • Advancing CDI: The Quality Story

Jennifer Eaton, RN, MSN, CCDS, and James Fee, MD, CCS, CCDS, also stressed the importance of focusing on CDI and risk adjustment.

Because the integrity of documentation affects reimbursement and quality, avoids denials, and promotes patient-centered care, Dr. fee encouraged CDI professionals to capture the accurate complexity of the patient, not just the patient encounter. Eaton discussed optimization of risk adjustments by suggesting CDI specialists should not just look at severity of illness and risk of mortality (SOI/ROM), because this can be a false sense of security for Centers for Medicare and Medicaid Services (CMS) risk adjustments. Even if a case has multiple CCs/MCCs with an overall SOI/ROM of 4/4, additional queried diagnoses may increase the risk adjustment.

 

  • Pediatric Risk Adjustment for CDI Professionals

In this session, Mark N. Dominesey, RN, BSN, MBA, CCDS, CDIP, CHTS-CP, focused on the many ways risk adjustment is used in the pediatric hospital. This includes reimbursement, contracting, population health, comparisons, and profiling.  He stated that the future of pediatric risk adjustment is here, and it includes items such as pay-for-performance and enhanced ambulatory patient groups (EAPGs) in the outpatient setting.

 

  • The Ins and Outs of HCCs: How HCCs Affect the Inpatient Stay

Tara Bell, MSN, RN, CCDS, CCM, and Lisa A. Farhar, RN, MSN, MBA, CCDS, discussed the role of HCCs for inpatient CDI programs. About 42 percent of the 2017 codes are not MCC or CC, but those codes can still affect the record in other ways, such as HCCs or readmission and mortality statistics. Speakers reiterated how conditions such as the absence of a great toe or colostomy status are not normally targeted by inpatient CDI, but they may affect the HCCs and APR-DRGs.

In all, there were many very specific knowledge nuggets and CDI takeaways that will inform our work and discussions with customers in the year ahead.

For more information about how TrustHCS is working with hospitals and health systems to expand CDI programs beyond inpatient Medicare cases only, read our recent blog post on all-payer expansion and interview with the Journal of AHIMA from September 2017.