Separation of review types - quality vs. financial

angela.price@uchealth.comangela.price@uchealth.com
in General

We have recently taken on the responsibility of evaluating cases for opportunities to improve our expected mortality number in Vizient which in turn can improve our Vizient mortality index. As a result it was suggested that we break CDI review up into two separate processes, one for review for financially-impacting diagnoses and another for mortality and other quality-related diagnoses. Has anyone ever tried that? If so what was the conclusion? Did it have merit? We believe it would be duplicative and confusing but would appreciate any comments about the suggestion. Thanks.

Comments

  • Kelly.Sutton@hcpro.com Kelly.Sutton@hcpro.com

    Hi Angela,

    I have heard of quite a few organizations that have a concurrent review process to capture as many impactful diagnoses as possible and they have an additional retrospective review process to perform a second level review on mortality cases. These retrospective reviews are completed to help identify any missed diagnoses that would impact quality/mortality O/E.

    Hope this helps.

  • angela.price@uchealth.comangela.price@uchealth.com

    Thanks Kelly. Appreciate the feedback. In your examples, were CDI reviewers divided up into two lanes - ones that do concurrent review for financial only and then ones that review for PSI documentation or expected mortality diagnoses?

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