The Merriam-Webster dictionary defines “bandwagon” as:
I had to check the definition to make sure that I am using the word correctly when I say, “Everyone seems to be jumping on the ‘Ambulatory CDI’ bandwagon.” It has become a common topic of conversation in the Clinical Documentation Improvement (CDI) world, but most of the time when I ask someone what they mean when they mention it, I am not able to get a discrete answer.
My own approach to the conversation is to begin by narrowing the scope of the discussion as follows:
Phew! Now we’re left with a class of visits where a patient is electronically registered to see a health care provider at a hospital-affiliated clinic. To date, everyone I have spoken to on the subject seems to agree with that definition.
The next area of confusion seems to be the definition of exactly what constitutes a visit. I confess that this one caught me off guard. In the inpatient area, things are much better defined. I know when a patient gets admitted (although I still roll my eyes at the concept of a “bedded outpatient”!), and I know when the patient is discharged or transferred. The boundaries of a hospital visit are well-established.
But in the ambulatory world, it is not uncommon to have “re-occurring” or “open accounts” (they seem to go by different names at different facilities). In this situation, there is one account number for visits that may extend over many months for such things as wound care, IV therapy, Physical or Occupational Therapy, etc. Bills are not sent each time that patient is seen at the facility rather, one is sent periodically, or when the account or series of visits is officially closed out. There does not seem to be consensus about how this should be handled in a CDI workflow.
So, if you’re thinking of jumping on the “Ambulatory CDI” bandwagon, here’s a few things for you to consider:
There is a lot of consensus still to be reached while we’re all sitting on the Ambulatory CDI bandwagon (hopefully not the one in the circus parade). In a future blog I’ll discuss how Hierarchical Condition Categories (HCCs) can play a role and help to define how we can move CDI into the ambulatory world.
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