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The 3 Main Differences between Inpatient and Outpatient CDI

January 25, 2021

Inpatient and outpatient clinical documentation improvement (CDI) share a common goal: to ensure accurate and complete documentation that reflects the care given to the patient. Inpatient and outpatient CDI also have individual goals such as:

  • Inpatient- Accurate and appropriate diagnosis-related group (DRG) assignment by capturing comorbidities (CC) or major comorbidities (MCC) and quality metrics like severity of illness (SOI) and risk of mortality (ROM).
  • Outpatient- Optimizing the risk adjustment factor (RAF) score by documenting and reporting appropriate hierarchical condition categories (HCC).

Below are 3 differences between inpatient and outpatient CDI programs.

  1. The Volume of Patient Encounters – Physician office visits are dramatically higher than inpatient encounters. CDS Fast Stat states that physician office visits in 2018 was 883.7 million while in the same year hospital admissions were at 36.3 million. This means that in the outpatient setting not every chart can be reviewed and queried- the volume is too vast.
  2. Different Payment Methods and Workflows – The outpatient setting typically entails multiple payment methods and workflows.  The outpatient settings typically operate independently and each office or practice may operate differently while inpatient settings typically have been centralized, therefore, operate consistently.
  3. Return on Investment (ROI) Calculations – ROI calculations are seen at different moments of the revenue cycle. For outpatient CDI, it is not instantaneous- the return is not realized until the following year because of the Risk Adjustment Factor (RAF) score impact. Whereas with inpatient CDI, results can be seen at patient discharge based on a positive DRG difference.

Understanding the similarities and differences between inpatient and outpatient CDI is the first step for your organization to start or expand CDI to physician practices.

Need help with establishing your outpatient CDI program?  UASI has helped hospitals across the country establish or maintain quality CDI programs.  Contact us now at info@uasisolutions.com to get started.