Outpatient CDI information

Would anyone have information about their outpatient CDI program they would be willing to share?  

For instance, what areas in the facility are you reviewing as part of you outpatient CDI (ED, Same day surgery, hospital owned physician practices)??  

Does outpatient CDI include those patient in the hospital who are currently observation status (occupying a bed)?  

If your facility does not have outpatient CDI, do your inpatient CDI's review those patient who are in observation status? 

We currently only review inpatients (all payers, self pay).

Thanks in advance

LeeAnn

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Comments

  • Hi LeeAnn,

    I started down the OP path about two years ago. All of these areas, as you know, are considered OP but I had to determine where to start. I did that by looking at a lot of data (denial, payor contracts, etc.). Our facility owned physician group had contracts with Medicare Advantage payers, and there was a bonus opportunity there if we improved our RAF score. This is where we found our biggest opportunity right off the bat. We are now part of an ACO and participate in a MSSP. So there is significant opportunity. Our OP CDI program is expanding to the larger medical group this summer. We started out small in one region with just family medicine and internal medicine physicians and then expanded it to Cardiology and plan on expanding further to endo and neuro. We have shifted from reviewing MA patients to Straight Medicare, and our other ACO products.

  • Thanks for your info...  Does your inpatient CDI review the observation patients in house?  We currently employ a CT surgeon and soon adding pulmonologists..


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