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CDI Programs Drive Up Case Mix Index, Revenue

By Rene Letourneau  
   February 16, 2015

Better clinical documentation can lead to immediate financial returns. Physician buy-in is key, ICD-10 is not.

As hospital and health system finance leaders look for ways to enhance revenue in an era of shrinking margins, many are turning their attention to their organization's case mix index. A higher CMI means more reimbursement dollars for providing care because it indicates that a hospital is treating a sicker patient population.

Increasing the CMI hinges on having clinical documentation that accurately reflects the severity level of patients' conditions. Without thorough records, hospitals can miss out on substantial revenue.

Employing Documentation Specialists

Heritage Valley Health System, a two-hospital, $450 million integrated delivery network based in Beaver, PA, set out about two years ago to improve its CMI, among other metrics.

When HVHS executives began working with a consultant in early 2013, they quickly zeroed in on the idea of rolling out a new clinical documentation improvement program built around CD specialists, says Joann Hatton, director of the utilization management/clinical documentation program.

"The CD specialists are actually out on the patient care units reviewing physician documentation and working closely with the medical staff to enhance the documentation in real time, doing a concurrent review," Hatton says.

"They can have a face-to-face interaction, as well as get clarification on paper, to ask physicians if they were thinking it could be this diagnosis or another and asking the physicians to agree or to provide another explanation. When they are able to get more clarification and specificity, then it helps the coders to code more accurately."

Rene Letourneau is a contributing writer at HealthLeaders Media.

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