When implementing outpatient CDI in a physician practice, there are 10 steps you must follow to be successful.
- Assess Current State
- Define and Align
- Set Program Goals
- Determine Return on Investment
- Staffing Infrastructure
- Define Workflow
- Communicate and Educate
- Performance Expectations
- Monitor and Track
- Ongoing Evaluation
However, the following steps are considered keys to an effective implementation.
Assess Current State:
As a first step, it is important to identify documentation opportunities (which may be related to denial rates, low RAF scores, or quality metrics). Your organization is unique, so it will have different problem areas than others. To establish an action plan, you should first conduct a comprehensive assessment of the current state, including the following:
- Investigate all documentation and coding processes
- Evaluate HCC data over 2 years
- Select patients to review based on data-driven criteria
- Verify data with baseline patient record reviews
Determine Return on Investment:
To establish a sustainable outpatient CDI program, it is important that you define a mechanism to calculate the return on investment (ROI) of the program. Determining this number will help you demonstrate ongoing success. For example, if your focus is HCC capture, you can demonstrate the value of your program by extrapolating the financial impact of HCC changes. The formula to calculate that is:
(Potential Missed HCCs) X (RAF Score for the HCCs) x (CMS Annual Base Rate) = Potential $ Opportunity
Monitor and Track:
Once you have begun the outpatient CDI program, you will need to establish mechanisms to monitor and track your data (e.g. documentation and RAF score capture rates) and explore ways to improve the program on a weekly or monthly basis. You should establish clear expectations for documentation improvement and define key performance indicators (KPIs) for individual staff productivity.
For the full explanation of each step, click here to view Staci Josten’s presentation “Key Steps to Successfully Implement Outpatient CDI in a Physician Practice.”