Combine CDI and Case Management Model

willarl@ah.org

There is a possibility that our CDI program is going to combine with Case Management. We are encouraged to become CDI certified and we will be trained to do InterQual. Do you know of any hospitals where CDI does utilization review? If so, how effective it is and how does it work?

Thank you.

Lissette

tnelson

Hutchinson Health Hospital (MN) does both UR/CDI.  We are a fairly small hospital and this model works great!

Tami Nelson, RN CDI/UR Team Lead

jennwalts

We had a combined CDI program and had issues with it. All of the department resources and education were geared toward the case managers. The CDI staff was floundering and had a negative financial impact. The month after we were moved under HIM with a new director and coordinator we met our financial goal for the year. 6 months later we have well exceeded our yearly financial goal. I am sure it can work well but I think you need management that understand the value of CDI. We were also ,moved from the director of nursing to the director of finance.

evanspx@sutterhealth.org

My belief is that in order to be effective as a CDI one needs very specific education, support and guidance.  Nothing at all is meant to be negative regarding the value of using a person with a CM role in CDI; indeed, that experience can be serve one very well in the CDI role.  But, some Executives may innocently underestimate the precise nature and skill and level of education anyone needs in order to work compliantly as a CDI professional.  The 'more' one expects from the CDI team, (support of compliant billing, support of Mortality, HAC, PSI, and other quality measures) the more time, support, education and energy a CDI should be provided to meet expectations.

P. Evans, RHIA

stayrookgt@gmail.com

When I started in Case Management 5 years ago, I learned Utilization Review as well as CDI.  My UR always took priority and our CDI program struggled.  2 years ago our facility decided that they would have a person dedicated to CDI. We are a small community hospital.  I still work under Case Management, but I am the only person that reviews charts, I no longer do UR.  I think there are some pros and cons.  Pro being I am now doing more with quality queries and clinical validation and able to review more charts. Also I have access to Interqual and that can be beneficial.  I am certified as both a case manager and cdi.  I think the more you learn about the revenue process the better and more valuable you are to the organization.  The con is that when I am off, no one reviews the charts, but we are now planning on training a case manager to review charts, while I am off. 

lprescott1

I also am concerned a bit about compliance when you have one persons working both roles. In my mind the case manager is considered part of the patient care team- involved in discharge planning efforts, etc. The CDI should not be active as part of the care team. This could be seen as the CDI influencing the care to manipulate the DRG assignment. the roles mirror each other but have a different focus. that said, i visited organizations where the role is shared- sometimes it works- sometimes it doesn't. 

cynthia.mead@nahealth.com

We found that when CDI and UR were combined that the UR role always took precedence. I think it might work at smaller hospitals when admissions wouldn't support a full time role but it didn't work well at our 300 bed system.