CDI and coding strategies for revenue improvement in a short-staffed world

Health systems have been facing significant financial pressures since COVID. Clinical documentation integrity (CDI) and coding are key to complete reimbursement, but these functions have been especially impacted by challenges recruiting and retaining talent.

In an executive roundtable at Becker's Hospital Review's 13th Annual Meeting sponsored by 3M, Barbara Sparkes, director of consulting and outsourcing for 3M's Health Information Systems Division, shared insights into making the most of CDI and coding resources, and led attendees in a discussion about trends and techniques in the area.

Three key takeaways were:

  1. A number of factors are affecting the costs and labor supply of CDI and coding. Regulations around coding have gotten more complex. And the push toward value-based care necessitates more quality metrics. In addition, the pandemic led to many early retirements and people leaving the healthcare profession because of burnout, including coders.

    According to the Bureau of Labor Statistics, there are roughly 14,900 coding openings each year in the United States, and industry demand for coders is expected to grow by 7 percent between 2021 and 2031, meaning that 12,300 more coders will be needed. "Everybody in the business has openings they can't fill," Ms. Sparkes said. This perception is confirmed by a study of physician practices that cites medical coders as the most difficult position to fill.

    Impacts of coder shortages include delayed and lost revenue, an increase in denials, inaccurate quality and mortality metrics and more. Impact of CDI shortages include lost revenue, missed query opportunities, wasted time on re-reviews focused on coverage and inaccurate quality metrics.

  1. Four key CDI and coding strategies can help improve revenue. During the pandemic, many CDI nurses were pulled back into patient care, some for a year or more. And some never went back. That led thought leaders at 3M to develop strategies to help healthcare organizations make the most of their reduced CDI and coding workforces. Four strategies are:
    1. Encourage collaboration. "The most successful organizations you see dealing with this are great at collaboration, not just from executive leadership, but with physicians," Ms. Sparkes said.

    2. Physician leadership. "If physicians don't like it, they're not going to use it," Ms. Sparkes said. "So they really have to be involved in the technology, selection and setup."

    3. Performance measurement. Performance measurement is important to quality initiatives, and also to gather intelligence about the organization and benchmark it against national and state benchmarks and even competitors.

    4. Education and training. Running audits will help target revenue leakage and provide valuable opportunities for training.

  1. Use an "adopt" rather than an "implement" approach to leveraging advanced technology like 3M's. That means solutions should readily integrate into existing workflows so that these technologies are a natural part of the workday for CDI professionals, coders and physicians. With technology like 3M's, that includes prioritization of worklists that use artificial intelligence (AI), evidence sheets that are auto-linked to queries, autonomous coding and AI-based nudges.

Like other areas of healthcare, CDI and coding have been affected by labor shortages, an increasingly complex regulatory landscape and financial pressures. Working with sophisticated solutions like 3M's can help healthcare organizations deal effectively with CDI and coder shortages and achieve the best possible financial and quality results.

 

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