What does it take to build and run a successful CDI program?  Many leaders face the dilemma of whether to develop their CDI solution from scratch, total outsource, or blend the two to fit their unique situation?  Over the next three blog posts, we will reveal several approaches to build, buy, or blend to assist with this critical decision.

As of early 2019, an estimated 53.2% of all healthcare facilities have an established outpatient or ambulatory CDI program.  While it may seem simple, whether you are implementing an Inpatient CDI or Outpatient CDI program, determining the right solution to this complex process can be daunting.  As with all major decisions, leaders must outline each of the following before making any final decisions.

  1. Program Strategic Goals
  2. Existing and Needed Systems and Staff Support
  3. Necessary External Partner Support

Inside each of these areas, consider the following to help evaluate what makes the most sense for your CDI program.


Program Strategic Goals


  1. Identify the core business requirements

A core business requirement is one that must be supported by the program to continue. It takes effort to identify business requirements, but it is vital to focus on the long-term goals and business needs in establishing these elements. Setting a short-term requirement for the program can lead to lack of perceived program value in the future.

  1. Performance metrics – know the impact of your program

Establishing goals and identifying metrics to meet said goals is essential. Identified benchmarks to monitor and measure the value of your CDI program should include at a minimum; case mix index, DNFB, claim denial rates, and DRGs.


Existing vs. Needed Systems and Staff Support


  1. Examine existing CDI solutions

When looking at existing systems related to CDI, evaluate not only capabilities but also effort needed to modify the solution to fit a CDI program expansion. Questions to consider asking include:

    • Does your existing system support a complex CDI program?
    • Are the components adequate?
    • Does the new CDI implementation program require any customization?
    • Will it be difficult to accommodate your new program requests?
  1. Understand existing resources to support the new program

Assembling an experienced, multidisciplinary team of specialists should include CDI specialists, a Physician champion, a CDI leader who will bridge the departments between coding, documentation, health information management, revenue cycle, case management, utilization review, and administration. As expansion takes place in other care settings, some of these roles may require additional resources to operate effectively. As an example, a single Physician champion may need additional champions to help expand into outpatient or ambulatory coverage.

  1. Validate EMR/EHR program support

In today’s healthcare environment it goes without saying that any program decision should take into consideration EMR/EHR support. This is true with CDI program expansion as well. Determine if your EMR/EHR has the ability to support your program and what adjustments may be needed to make it operate appropriately.


Necessary External Partner Support


  1. Budget for Support

A significant factor that reduces the ROI of a CDI implementation is the lack of available personnel with the proper skill set.  Often, decision-makers see the significant, yet short-term cost difference between letting existing staff gain the new skills and experience needed versus hiring experts to jump-start their CDI project.

Partner support should be budgeted to include costs for additional labor required to implement the project. It should also include adjustments to your existing technology or implementation of new programs or system changes.

Understanding your internal business characteristics, such as culture, long-term strategic goals, and external partners is critical and can’t be skipped.  Consideration of these characteristics will help determine if a build, buy, or blend option is the right choice for your facility.

Our next blog will outline the transformation of one large health system’s CDI program and multi-partner team implementation.  We will highlight their methodology and the positive financial impact on the facility.