Securing the Future: The Imperative of CDI in Healthcare

Australia's private and public health systems are currently facing immense pressures that threaten their sustainability. These pressures, driven by escalating costs, workforce shortages, and rising demand, highlight the importance of effective and sustainable clinical documentation improvement (CDI) programs.

Private hospitals are facing unprecedented challenges. The erosion of earnings since 2019 has left many private facilities struggling to meet their operational costs. Despite positive tailwinds of an ageing and growing population, increasing prevalence of chronic illness, and delayed care during the pandemic, private hospitals are experiencing heightened financial pressures due to increased competition, rising costs, and declining margins. Several private hospitals have already closed or are on the brink of closure, as rising costs outstrip revenue growth.

Public hospitals too are similarly grappling with significant deficits due to rising costs and increased demand for health care services. The funding provided by the Commonwealth and State health departments has been insufficient to match the pace of demand, leaving many public hospitals financially stretched. These deficits have been exacerbated by workforce challenges, as the health care sector struggles to recruit and retain staff. The growing burden of chronic diseases and increasing patient expectations have placed additional strain on public health systems, creating an environment where hospitals are stretched beyond their means.

A CDI Strategy must be on your roadmap

In this challenging landscape, the importance of a sustainable CDI program has never been more apparent. CDI programs primarily aim to improve the accuracy, clarity, and completeness of clinical documentation to directly impact patient care and safety.

However, given the activity-based funding model of Australian hospitals is undergirded by concise and complete documentation, CDI programs can have an enormous impact on hospital revenue to ensure that hospitals are funded for the complexity of care they provide – nothing more, nothing less. Even at a local hospital level, millions of dollars per annum is being left on the table, with high-complexity, high-cost episodes being drastically underfunded.

CDI programs have proven effective in increasing activity in public hospitals and patient revenue in private hospitals by accurately reflecting the complexity of care. These programs do not involve fraudulent claims or obtaining funding for care that is not provided. Instead, they ensure that documentation of diagnoses to support the clinical coding process ensure that the correct diagnosis related Group (DRG) is assigned based on the complexity of care for each episode.

Many hospitals in Australia have embarked on their own CDI journey, recognising these benefits for hospital financing, data quality, and patient safety through improved communication. However, some health care organisations remain hesitant, or have yet to realise the full potential of CDI by only dipping their toe in the water.

The Importance of a well-implemented CDI Program

Given the current pressures on the health system, it is crucial that hospitals have a well-implemented and sustainable CDI program that focuses on changing the culture and behaviour of clinical staff, including doctors, nurses, and allied health professionals.

A successful CDI program requires a multifaceted approach:

1. Conducting Concurrent Reviews: For a CDI program to be effective and sustainable, Clinical Documentation Specialists (CDSs) must conduct concurrent reviews of medical records. This proactive approach allows for real-time identification and rectification of documentation gaps. Concurrent reviews help ensure that patient records accurately reflect the care provided, thus enhancing patient safety and care quality. The immediate feedback provided by CDSs can also serve as a learning tool for clinicians, reinforcing good documentation practices.
   
   
2. Shifting Entrenched Behaviours in Documentation: At the heart of a well-implemented CDI program is the transformation of how clinical documentation is perceived and executed. This involves shifting entrenched behaviours among clinicians. Clinical staff must understand the direct impact of accurate documentation on patient safety and hospital revenue. This shift can be achieved through concurrent CDI, consistent education and engagement, highlighting real-world examples where improved documentation has led to better patient outcomes and improved financial performance.
   
   
3. Focusing on Patient Safety and Quality: A well-implemented CDI program places patient safety and quality at the forefront. Accurate and thorough documentation is critical for ensuring that patients receive appropriate care. Proper documentation supports clinical decision-making and continuity of care, which are essential for patient safety. By prioritising patient safety and care quality, hospitals can achieve significant downstream benefits, including improved data quality and increased funding.
   
   
4. Utilising Technology: Leveraging technology can greatly enhance the efficiency and effectiveness of a CDI program. Electronic Health Records (EHR) systems with integrated CDI tools can streamline the documentation process, making it easier for clinicians to comply with best practices.
   
   
5. Monitoring and Measuring Success: Regular monitoring and evaluation are necessary to measure the program's impact and identify areas for improvement. KPIs above and beyond DRG change rates and revenue capture such as monitoring LOS and complexity profiles should be tracked to assess the program's effectiveness. Feedback from clinicians and other stakeholders should also be solicited to ensure the program remains relevant and effective.

Conclusion

A well-implemented CDI program is essential for addressing the financial pressures faced by Australian hospitals. By focusing on changing entrenched behaviours, engaging and educating clinicians, conducting concurrent reviews, and prioritising patient safety and quality, hospitals can realise significant financial gains. Improved documentation not only enhances patient care but also ensures accurate hospital funding, making CDI a crucial strategy for achieving financial sustainability in the current healthcare landscape.