The Story of CoxHealth’s CDI Expansion


Are you considering the buy, or technically speaking, “outsourced” option for your new CDI program?  So whether you are implementing a new program or enhancing your existing program, partnering with a reputable vendor may be the best option for your facility.  The following is an example of a successful partnership between CoxHealth and TrustHCS to support their “outsourced” decision.


Internal Challenges Influenced Partnership Decision


CoxHealth, located in Missouri, includes six hospitals and more than 80 clinics. The CoxHealth executive team was keenly aware of the emerging trend in CDI—expand programs beyond traditional Medicare and Medicare HMO cases to encompass all payers. Program expansion quickly became a central goal. CoxHealth decided to expand CDI services to include all payers. However, losing its CDI manager and other key members of its CDI team in 2017 presented significant issues.


Attracting and retaining credentialed and experienced CDI leadership is difficult.  CoxHealth needed a partner that could provide consistent and robust leadership along with expert and reliable staff to support program expansion. CoxHealth tapped into the CDI specialist and management talent TrustHCS had to offer. By engaging in a CDI manager from TrustHCS, CoxHealth gained a high level of industry insight and CDI best practices.


During this partnership, CoxHealth received guidance from TrustHCS on the following:


  • Meeting quality improvement and quality assurance metrics
  • Using productivity standards to measure performance
  • Realignment of nursing units and CDI coverage
  • Re-education of staff and physicians to improve documentation patterns


TrustHCS’s ability to provide the CDI expertise that CoxHealth needed also helped the health system achieve its productivity, documentation improvement and program expansion goals.


Improved Communication Between a Cohesive Team


Not only was the newly expanded CDI program a success, CoxHealth coders now have complete access to all CDI documentation and quickly communicate with the CDI specialists of any mismatches or questions.  This new collaboration implemented by the TrustHCS team encourages direct and efficient communication between both the CDI and the Coding teams.


Outsourced Option Includes Significant Program Advancements


The partnership between TrustHCS and CoxHealth advanced the organization’s CDI program to where it is today:


  • CDI leadership and program guidance by TrustHCS
  • 8 seasoned CDI professionals employed by CoxHealth
  • 7 outsourced CDI specialists provided by TrustHCS
  • Average of 9,600 reviews per month across the combined team
  • Establishment of initial, subsequent, discharge, and reconciliation review as applicable for each case
  • Mortality reviews for 100% of inpatient ensuring the correct SOI and ROM
  • Integrated coding and CDI teams


Example of Three Outstanding Benefits of the All-Payer CDI Program from CoxHealth

Partnering with a trustworthy vendor can provide big benefits for your CDI program. However, your program plan must include executive support, and budget to warrant an outsourced vendor.  The significant wins for CoxHealth’s all-payer program include:

  1. Increased average Case Mix Index by 0.04
  2. Sustained CMI equates to $9 million in overall program impact annually
  3. Expanded average queries from 650 to 1,300 per month

Since both coding and CDI teams report to the director of health information management, secure communication, and collaboration boost productivity, minimize post discharge queries and expedite billing.


As a result of the TrustHCS and CoxHealth partnership, the newly expanded CDI program is expected to produce a $9 million impact on their CMI.


For more information about TrustHCS and our CDI expansion program, please visit To read the CoxHealth case study in its entirety, please go to