The Future of Clinical Documentation Integrity: Insights from Fran Jurcak (Part II)

You can read Part I of this interview here

Fran Jurcak, MSN, RN, CCDS, CCDS-O
Chief Clinical Strategist
Iodine Software

Fran Jurcak is an accomplished senior executive with over 30 years of success in healthcare practice, education, consulting, and technology. She is currently the Chief Clinical Strategist at Iodine Software where she has worked for four years and has assisted in bringing artificial intelligence machine learning model technology to CDI and coding workflows. Jurcak currently sits on the ACDIS Advisory Board, serves on several other advisory boards, and received the 2017 ACDIS award for Professional Achievement. Prior to joining Iodine, Jurcak was a healthcare consultant, leveraging her clinical and coding knowledge to support process improvement in the mid-revenue cycle, particularly in the clinical documentation integrity space. These process improvements allowed her clients to successfully minimize mid-cycle leakage and accurately report outcomes of care. Additionally, she is the author of the CCDS Study Guide and has co-authored several papers for ACDIS and AHIMA, both organizations which recognize Jurcak as a national speaker.

Q: Some health systems have furloughed CDI staff during COVID-19. Do you think organizations can afford to have smaller CDI teams going forward?

A: In my opinion, it would be smart for programs to evaluate where they are from a staffing perspective in order to make the right decisions moving forward, and I hope they leverage strong data to make these decisions. Now is the time to identify team members’ skill sets and ensure they are aligned in the most appropriate roles. Healthcare leaders should also consider if staff can be leveraged to cross-cover the areas with lower availability or assigned to non-traditional CDI areas of review such as pediatrics, obstetrics, psychiatry, observation, and others. 

In order for CDI programs to survive in this new world where smaller teams may be the norm even as census increases, it will be key to identify the right cases that warrant review. It is more important than ever to leverage technology that creates efficiency and effectiveness in the CDI workflow. Artificial intelligence machine learning models excel at identifying cases where clinical evidence of a condition is present but documentation is lacking specificity or accuracy. Marker-based approaches, on the other hand, partition individual cases into lists based upon the rule but do not identify the likelihood that a true documentation integrity opportunity exists. This can be accomplished through use of machine learning models. It is very important that when we talk about utilizing technology we talk about leveraging the right technology to ensure the right cases are identified at the right time for CDI review.

Q: How can healthcare leaders leverage CDI as they prepare for an uncertain future?

A: There is no doubt that documentation will still be key for reimbursement and quality reporting moving forward, at least in the current world. Regardless of the EHR and the underlying case use, documentation is still vital. Whether it’s an inpatient prospective payment system or an outpatient evaluation and management system, everything is driven by what is documented in the medical record, and that relevancy is not going away, at least not in the short term. Unless there is a major change in the way we pay for healthcare in the United States, documentation of all conditions being monitored and treated is still key – whether it be capturing risk, reimbursement, or quality, it is all driven by the documentation in the medical record. How we document may change moving forward, but the importance of documentation is not going away. It will continue to be vital to identify an efficient workflow that includes technology designed to support accurate, complete and timely documentation for every patient encounter. 

Q: As a leader in the CDI space, how do you think revenue cycle leaders should be thinking about CDI given the impact COVID-19 is having on hospital revenue and reimbursement? 

A: As impactful as the past few months have been for all of us, this is the perfect time for revenue cycle leaders to re-evaluate the expected outcomes of their CDI program and ultimately identify efficiency processes for their program. I think the value of a CDI program is abundantly clear. If anything, I think its value has been heightened by this outbreak. Moving forward, there is a huge opportunity to determine the “new” workflow for CDI.  This starts with identifying the appropriate  technology, the best workflow, and the necessary staffing levels to accomplish the health system’s desired outcomes. Finances are always a key component of a health system’s goals, but I think there are additional quality metrics and concerns that need to be addressed, and this is the perfect opportunity to refocus priorities.

The current healthcare situation highlights the value of CDI programs. Now is the time for hospital executives to reassess their programs and determine which technology best creates workflow efficiency, identify the best people to utilize the technology, and realign expected program outcomes. Knowing that we are all in the midst of a financial crisis, it is truly important to ensure that we have the right tools and staff to achieve the maximum financial and quality outcomes. Now is the time!