EDITOR’S NOTE: The following a part of a series on outpatient clinical documentation integrity (CDI). Part II was published on April 25, 2017 in the ICD10monitor eNews.
Critical to the successful rollout of an outpatient clinical documentation improvement (CDI) program is the selection and hiring of employees to staff the program. Identifying the right people for the position cannot be overemphasized, given the nature of the work and the need to establish a solid foundation for growth and development of the program right from the very start.
Ample time must be devoted to the hiring process after the initial preparation for the rollout to ensure that the program is staffed with people in the right roles and with the right fit.
Inpatient versus Outpatient CDI
As I mentioned in my previous articles, the essential skill sets, core competencies, and knowledge bases of proficient outpatient CDI specialists are strikingly dissimilar and notably different from those of inpatient CDI specialists. Generally speaking, one cannot simply place an inpatient CDI specialist into the role of the outpatient CDI specialist and expect a smooth transition with impressive performance.
Why is this? The role, duties, responsibilities, and expectations of an inpatient CDI specialist are for the most part divergent from that of an outpatient CDI specialist. In the inpatient arena, the established framework is much more structured, rigid, predictable, and defined. While there exists some variation in the stated framework of inpatient CDI, the daily work duties and responsibilities are for the most part stable, with pre-established parameters and expectations such as the number of queries issued, number of charts to review, and number of follow-up reviews, to name just a few metrics.
The focus of an inpatient CDI is primarily upon seeking clarification and securement of diagnoses, clarifying hospital-acquired conditions and present-on-admission indicators, and assigning and reconciling working MS-DRG listings. On occasion, CDI specialists are tasked with working with core measures and other added assignments. Querying is the mainstay of inpatient CDI, serving as the heart of most programs.
Outpatient CDI offers a totally unique working environment, again, requiring diverse skills sets, core competencies, knowledge bases, and thought processes. There is less emphasis upon diagnoses and more focus devoted to various process improvement goals, objectives, and responsibilities.
An outpatient CDI specialist’s vision and outlook must embrace role-based thought processes and actionable knowledge sharing with physicians as a major provision of their duties. This requires a business leader exhibiting strong thought leadership capabilities, with recognition that outpatient CDI is not just a job that allows one to collect a paycheck.
Instead, outpatient CDI is a role that must be treated as being critically important. Having said that, an outpatient CDI specialist views the role as a career, with the willingness and commitment to ongoing learning, clinical expertise, and commitment to maintaining relevancy. Ideally, this individual will have earned a business degree with real-life, hands-on business experience and demonstrated accomplishments in the business world.
Clinical knowledge is an essential component of the position, yet equally as important is the business mindset component, serving as the foundation for fulfillment of the widely expanded role outpatient CDI plays in affecting measurable, valid, and sustainable improvement in the communication of patient care.
Operationally, outpatient CDIs are fluent and variable in nature, ever-changing with the transitional healthcare landscape and the ongoing advances in clinical medicine. Adaptability and constant readiness with a proactive approach and outlook, incorporating the ability to predict trends in a business environment, is a prerequisite for successfully fulfilling the role.