ACDIS 2013 Conference: Migrating to Outpatient Ambulatory CDI: A Road Map to Getting Started

Comments

• katysuegood@gmail.com

  June 2013 edited May 2016

  Hi Glenn,
  
  Great talk at the conference, it was very interesting and definitely had my team thinking (and overwhelmed ).
  
  We are getting pressure from Sr. management to expand to outpatient CDI for the purpose of ICD-10 readiness. What are your thoughts on OP CDI with this goal in mind? Who is integral to the process and what are the immediate goals? Most OP CDI programs I have heard discussed started in HIM and are led by coding staff or CDI's with a coding background. Is this essential to success in your opinion?
  
  I of course see significant opportunity in outpatient CDI however I have concerns about initiating a new program at this time (we just underwent rapid expansion with 2/3 of our staff being new CDS', pending ICD-10, new expanded coverage goals with several new initiatives still to come) with the goal being ICD-10. I want to make sure before we jump in over our heads that we have thought this through.
  
  Thanks!
  
  
  Katy Good, RN, BSN, CCDS, CCS
  Clinical Documentation Program Coordinator
  AHIMA Approved ICD-10CM/PCS Trainer
  Flagstaff Medical Center
  Kathryn.Good@nahealth.com
  Cell: 928.814.9404
  
• Unknown

  June 2013 edited May 2016

  Katy;

   

  There are definite opportunities for clinical documentation improvement in the outpatient arena. The success of any CDI initiative in the outpatient setting, similar to the inpatient environment, is engaging physicians in the process as opposed to their seeing outpatient CDI as another attempt in targeting them in yet another project. The physicians must recognize the material benefit of improving their documentation and undoubtedly there are numerous opportunities for physicians to improve their clinical documentation in support of their clinical judgment, analytical and problem solving skills and medical decision-making, all necessary to support the physician's medical necessity for performing the E & M service, surgery or diagnostic test(s) ordered.

   

  Goals and objectives of any outpatient CDI initiatives include helping the physician help the patient obtain the medical benefits he/she is entitled to based upon the physician's clinical judgement and medical decision-making, and improving documentation to best reflect medical necessity, clinical diagnostic specificity and measures of physician efficiency, defined as ordering and providing a level of service that is sufficient but not excessive to meet the healthcare needs of the patient, taking into account the patients health status. Focusing as a primary goal of improving clinical documentation for ICD-10 readiness as an initial goal is a lesson in futility as CDI in the outpatient setting is predicated upon earning the respect and trust of the physcians, equally as important as any CDI inpatient program. Demonstrating to physicians that an extra effort on their part in real improvement in documentation benefits their own business of the practice of medicine and generally helps their patients is paramount to successfully starting any outpatient CDI program. Once you have earned the trust and respect of the physicians over due course, then you can mend in CDI from an ICD-10 perspective. Focusing upon ICD-10 initially will turn off physicians, they really do not care about coding per se.

   

  Now, who should be involved in any CDI outpatient initiative. Well, obviously CDI professionals, physicians, as well as hospital nursing staff and physician office staff. Outpatient CDI requires an expanded audience and participation by all of the above mentioned individuals as it requires a team effort in Adition to the efforts of the physicians. I will post shortly some of my successes in effectively improving CDI in an outpatient treatment center within the hospital to give you an idea of where to perhaps get started first as a segway for ICD-10 preparation.

   

  Thanks

   

  Glenn

   

   

   

  
  

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