With the ever increasing number of CMS quality measures required for hospital payments, some healthcare systems may be taking steps to interface clinical documentation improvement with quality measures collections functions. There are a few approaches that may make sense, depending on your organization's structure and political environment.
You can find out more about current updates and existing measures at Quality Measure Reporting Updates. Theoretically, there is really no difference between record/documentation review for quality measures versus that for clinical documentation improvment. In each case, the ultimate goal is to ensure high quality clinical documentation so the care provided by your health care organization is accurately reflected in the subsequent data produced by that documentation - whether it is coded data or data abstrated for CMS quality measures. As a practical matter, an organization may separte these functions because the final activity (i.e. coding versus abstracting quality measures) is different.
Ultimately, the question should not be whether CDI staff are involved in quality measures review.....the question should be how CDI staff are involved. As you work through the planning stages of integrating these activities always keep at the forefront that your plan should demonstrate, at a minimum, the following two qualities (1) how the plan will save the organization money and (2) how the plan will show an improvment in quality over the organization's current achievements. Without improvements in quality and economics, making changes will not make sense for you or the organization. But because these two functions are so integrally related, you owe it to yourself and your organization to analyze the possibilities.
One way to approach the task of integrating CDI and QM functions in the initial stages is to look at the degree of involvement of the CDI staff on a spectrum from 1 to 5 - with 1 being the smallest degree of involvement and 5 being the greatest degree. For example, at the low end (say a 1 or a 2) CDI staff can review documentation for certain high priority quality measures, like smoking cessation counseling (smoking status is also included in the first wave of the EHR meaningful use criteria). Or, for AMI patients, aspirin and beta blocker on arrival and thrombolytic agent within 30 minutes of arrival. This is really no different that reviewing clinical documentation to ensure appropriate coding once the patient is discharged. In this case, CDI staff may be revieiwng either prior to, or after the QM staff, depending on what makes sense for your organization.
At the highest end of the spectrum, CDI staff will take on all clinical documentation review activities for quality measures. Abstracting may still be performed by a separate group of professionals - much like coding is performed outside of the CDI function in most hospitals. One of the biggest challenges many organizations have is obtaining high quality clinical documentation for short stay patients admitted through the ED. If the CDI and QM functions were merged, it is likely that review in the ED would be, of necessity, performed for QM purposes. The CDI staff member's comprehensive skillset would enable improvement not only in QM measure documentation, but also in overall clinical documentation - whether for coding, planning, research or continuity of patient care.
