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Profiles in Healthcare is a thought leadership/industry focused blog that highlights key roles within Curation Health teams who help our customers succeed in the transition to value-based care and in prospective risk adjustment, HCC capture and outpatient CDI.

We first featured, Elizabeth Morgenroth, RHIA, CPC, Curation Health’s Director of Outpatient CDI, when we shared a piece focused on why providers need to demonstrate a sense of urgency when it comes to creating an outpatient clinical documentation improvement (CDI) program. We outlined the “why” behind this critical investment previously and wanted to also share the “how” in follow-up.

When it comes to creating an intelligent outpatient CDI program, there are three basic questions that      health system leadership should prioritize:

  1. Who are the right stakeholders?
  2. Do we have the right organizational structure in place?
  3. Can our current technology successfully support an outpatient CDI program?

This may sound trite, but people, process and technology are the three core concepts that healthcare leadership teams should consider as they look to implement an outpatient CDI program plan. I’d like to clarify that in this context, outpatient CDI means outpatient facility services as well as the outpatient clinic setting which supports risk-based contracting.

People – The Stakeholders

When it comes to stakeholders, it’s important to select the right team members and determine where knowledge deficits reside. By analyzing where gaps of expertise may exist, you can more easily troubleshoot and plan in advance for potential roadblocks in overall project planning. This type of staff-based gap analysis is critical early on because it can help prevent delays and also support advanced budget planning for areas where hiring or external resources may be needed.

Clearly, provider organizations are already complex based on the variety and nature of the patient support they provide. With this in mind, and on the heels of the pandemic, adding an outpatient CDI program can at first feel overwhelming but it is mission-critical. As patient care volumes shift to outpatient from inpatient care, providers have no time to waste with prioritizing an outpatient CDI program.

Process – Organizational Design to Support Workflows

For some organizations, CDI is found in the Health Information Management (HIM) team, which reports to the CIO or CFO. Other organizations place CDI within their quality programs team which may report to the CMO. The reality is that each organization is unique and therefore must decide where outpatient CDI best fits into their current organizational structure.

Based on my experience, HIM is often a safe bet considering that department’s typical focus on mid-level revenue cycle operations. Regardless of where you place outpatient CDI, I have found that there are advantages to placing it under a single management structure along with existing CDI and coding operations.

Technology – The Tools We Use to Do Our Jobs more Effectively and Efficiently

The final and third piece of guidance to help streamline creation of an outpatient CDI program is to consider your technology stack and whether current related workflows can support an outpatient CDI program. To be clear, if you are assessing technology you need to also closely consider current and future workflow impacts.

Frontline staff and support teams will likely need access to new tools and services so that they can document the full value of care without adding new administrative tasks which may distract from  patient care. Your outpatient CDI program shouldn’t hinder clinician work, it should facilitate it.

In summary, successful outpatient CDI programs: 1) Keep the goal of improved patient care front and center, and 2) Ensure additional burdens or new workflows are not hindering the clinicians providing patient care.

Join us in late June, when we’ll be exploring the specific elements that make up a best practice outpatient CDI program on our blog or read the first in Elizabeth’s blog series.

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