Analytics to Enhance Your CDI Program

Health Solutions

May 13, 2016

The value of big data and its ability to provide insights are clearly becoming hallmarks of the 21st century. As healthcare managers seek to understand what is happening at their organizations from a real time perspective, they are turning to data (and the metrics that can be developed from them) to get a clear picture of where they are and where they want to be. Increasingly, providers and payors are focusing on understanding how data can be leveraged to educate, assist, and transform Clinical Documentation Improvement (CDI) programs within the healthcare environment. To monitor the success, performance, and sustainability of its CDI program, an organization must incorporate analysis of Key Performance Indicators (KPIs). This analysis should include: evaluation of MS and APR DRG Payor Groups and their corresponding core metrics, real time assessment of Value Based Purchasing criteria and measures, and optimization of ICD-10 coding accuracy.

Medicare Severity Diagnosis Related Group (MS DRG)

The traditional Clinical Documentation Integrity (CDI) model focuses on MS DRGs in the Medicare system. An initial and ongoing focus here will assist the organization in understanding and improving its CDI program.

Having an established methodology on metrics such as Case Mix Index (CMI), Complications and Comorbidities (CC/MCC Capture Rates) and overall volume analyses in the medical and surgical arenas will lead to a focused approach in documentation and coding improvement. This focus will improve a hospital’s bottom line and assist with achievement of higher quality scores.

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