In recent years, the evolution of healthcare regulations has driven care away from the inpatient setting, while simultaneously increasing administrative and clinical documentation burdens for providers. As a result, many healthcare organizations have started expanding their clinical documentation improvement (CDI) efforts to outpatient settings by finding opportunities for increased reimbursement, enhanced quality, and improved patient satisfaction. However, this process also brings with it new challenges, far different from those faced with inpatient CDI.
Among the most explicit challenges that organizations face when pursuing outpatient CDI efforts are larger case volumes and markedly shorter clinical visits, which in turn generate far less usable data per patient. Additionally, that data is often collected by multiple team members during a narrow window, increasing the opportunity for costly errors. This dynamic underscores the need for efficient workflows that enable accurate, timely and comprehensive documentation.
As organizations explore optimizing outpatient CDI efforts, here are four factors to consider:
- Timely collaboration is crucial. Outpatient CDI efforts require a higher level of physician engagement, as well as an increased emphasis on workflow efficiency to ensure that accurate documentation is produced concurrently with the provision of care.
Fostering collaboration between providers, coding and other administrative staff is vital to any CDI effort’s success. These team members must understand how their roles align in order to support, create and sustain a culture of operational efficacy.
- Improved quality, care, and reimbursement go hand-in-hand. Streamlining organizational compliance from the point of care to the submission of a claim allows outpatient clinics and physician groups to optimize efforts with diagnosis coding and Hierarchical Condition Category (HCC) capture. It also helps them improve the Physician Quality Reporting System (PQRS) and Group Practice Reporting Option (GPRO) scoring and reduce error-driven medical necessity denials for patients.
- It’s critical to analyze and agree on goals and targets. A central component of fostering collaboration and improving metrics is first understanding specific organizational needs and identifying areas that need the most improvement. By focusing on collaborative resources in these areas, outpatient CDI efforts can be organized to ensure desired outcomes.
- Every organization’s needs will be unique. Key areas of improvement will vary from one organization to the next. Operational needs—from staffing to education to technology—will likewise be unique.
Designing your organization’s outpatient CDI efforts is a significant undertaking. To learn more about PracticePerfect, a platform to help you address outpatient and ER CDI, contact Saince.