Measuring & Valuing Quality: Does Your Organization Have an Effective Quality Measure Review Plan?
A clinical documentation integrity (CDI) program is intended to improve documentation integrity and clearly record the patient’s stay. A strong program also can help produce a financial return by improving clinical support for comorbid complicating conditions and major complicating conditions. New payment models such as value-based purchasing are overlapping with traditional CDI work efforts, which aid in reporting both accurate diagnosis related groups information and quality scores. As the industry continues to move from quantity to quality, the role of the CDI professional is evolving to support this change.
Benchmarking your facility internally and externally is a good way to identify improvement opportunities. The CDI team should work with departmental leaders from quality and case management while maintaining strong relationships with coding and revenue teams. The team should review the Program for Evaluating Payment Patterns Electronic Report and similar CMS databases to identify potential changes and expand understanding of core quality measures by asking these questions:
- Are quality metric penalties becoming financially material?
- How does our organization review quality measures?
- Which quality measures are reviewed?
- Are we leaving money on the table tied to commercial payer’s quality incentives?
BKD’s Health Care Performance Advisory Services team is available to assist with improving CDI and quality metric performance. For more information on how we can help, reach out to a BKD Trusted Advisor™ or submit the Contact Us form below.