CDI program financial value often lost on staff

$500,000. That’s what facilities expect as their CDI programs’ annual return on investment (ROI), according to 58% of more than 1,660 respondents to a recent ACDIS website poll (www.hcpro.com/acdis/readerpoll_results.cfm). When pressed for their opinion regarding the results, those ACDIS interviewed replied:

• “Surprised.”
• “Shocked.”
• “Disappointed.”

“This seems like a good poll, and statistically speaking a lot of people participated, and yet what it demonstrates doesn’t seem to reflect reality,” says Paul Evans, RHIA, CCS, CCS-P, CCDS, manager of regional clinical documentation and coding integrity at Sutter West Bay in San Francisco. Evans estimates his three-person team provides about $2.2 million annual ROI.

A similar estimate comes from Kerry Seekircher, RN, BS, CCDS, CDIP, CDI supervisor at Northern Westchester Hospital in Mount Kisco, New York. “When I looked at that poll, I felt pretty proud of us and our little team,” she says. “I mean, we’re just a small community hospital and we have a ROI of about $2 million. So, while I thought those results were weird, I figured we must be doing pretty well.”

In fact, ACDIS Advisory Board member Walter Houlihan, MBA, RHIA, CCS, director of HIM and CDI for Baystate Health (BH) in Springfield, Massachusetts, and president of the Massachusetts Health Information Management Association, successfully argued for six ROI; the next year was even higher, at $4.3 million. BH leaders approved the request for additional CDI staff even before Houlihan finished his presentation.

In Massachusetts, a CDI professional earns $100,000 a year in salary and benefits, Houlihan explains. If each staff member brings about $1 million ROI to the facility, “why wouldn’t you hire them? The key is to create an optimal process to gather the right and accurate metrics over time” to provide appropriate evidence of the CDI program’s success. Nevertheless, “despite this revenue driver, I firmly believe CDI reviews should center on documenting an accurate picture of the care rendered for the continuity of care  for each patient,” Houlihan says.

He is also implementing a unique natural language processing software, different than the typical  computer assisted coding which will “scour” the electronic medical record to identify documentation opportunities and place them on the CDI worklist, to increase efficiency, potentially by 200%, according to Houlihan’s business analysts.

Although firm ROI numbers can be difficult to pin down, many argue an individual CDI professional could expect his or her annual ROI could be between $500,000 and $1 million. That might be the rub in terms of the polling results—participants may not have read the question carefully and might have accidentally entered what they estimated their own ROI expectations to be, says ACDIS Advisory Board member Fran Jurcak, RN, MSN, CCDS, senior director in CDI practice at Huron Healthcare in Chicago.

Another possible explanation for the disconnect between the poll results and program expectations may stem from the industry’s de-emphasis of the financial benefits of CDI in recent years, says Jonathan Elion, MD, FACC, founder of ChartWise Medical Systems, Inc., in Wakefield, Rhode Island

“We preach to CDI specialists that all they have to do is focus on getting the most specific, accurate information into the medical record. We tell them not to worry about the financial aspect of it. We tell them to think about quality improvement, capturing severity, and so forth. At the end of the day, however, we have to be able to present a snapshot of how we are doing financially,” Elion says. “While these two concepts seem contradictory, CDI specialists nevertheless need to understand how both concepts matter.”

Editor's Note: This article is an excerpt from the July 2014 edition of The CDI Journal.