CDI Programs Drive Up Case Mix Index, Revenue
Feb 17, 2015 | VIA BLOG | Posted 5:50 PM by Dr. Jon Elion

Succeeding with Computer-Assisted CDI

When Summit Healthcare Regional Medical Center in Show Low, AZ, implemented a computer-assisted CDI tool on July 1, 2014, the hospital’s finance leaders were trying to accomplish four goals: to improve revenue cycle workflows, to capture and effectively measure successes, to produce enough quantifiable progress to justify the need for the CDI program, and to find a tool that was compliant with both ICD-9 and ICD-10.

Before installing the CDI software, Summit relied solely on paper records and Excel spreadsheets, which made it nearly impossible to organize workflows and measure success.

“Computer-assisted CDI is somewhat new on the block as far as healthcare is concerned, but there are a lot of advantages to it as reimbursements move from being quantity-based to being value-based. It gives a better story on what physicians are really doing with the treatment of patients, and we’ve seen our case mix index improve, which is a way of combatting lower reimbursements,” says Layne Sherman, Summit’s director of charge capture.

“Part of it was a language barrier. Our docs are doing a good job, but we just have to show it in the documentation. CMS is saying, ‘This is the wording, and you guys are missing it.’ So, the documentation as it was before wasn’t correct.”

The results to date have been better than expected at the 89-bed hospital, Sherman says. The hospital’s case mix index has increased by about 20%, with a financial impact of roughly $558,000. Additionally, the complication and comorbidity capture rate has increased 22.8% and the major complication and comorbidity capture rate has increased 37%.

So far, Summit has been focused on improving documentation for patients with sepsis, Sherman says, noting that he and other leaders have been buoyed by the early success of the CDI program to look at other opportunities for enhancements.

“In the first four months, we captured $500,000 in additional revenue because there’s a big difference between sepsis and sepsis with complications, and we are capturing that now,” he says.

“It’s a progression, and we are now evolving to look for additional opportunities. Next, we may capture an additional $200,000, but it will have a different scope, and it will be in different areas.”

Benefiting with or without ICD-10

While there is still doubt about whether or not ICD-10 will go into effect later this year, Sherman says the added specificity that Summit is now capturing in its clinical documentation will benefit the organization regardless.

“I don’t think we’ll worry about ICD-10 either way,” he says. “ICD-10 is wanting more specificity, but right now, working in ICD-9 codes, moving toward more specificity actually increases revenue. Reimbursements are heading that way no matter what.”

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