The Power of Clinical Documentation Improvement (CDI)

An Interview with Venanzio Arquilla, Chairman and Managing Director, Claro Healthcare

Venanzio Arquilla, the Chairman and a Managing Director of Claro Healthcare, a leading healthcare consulting firm in Clinical Documentation Improvement (CDI), Hospital Operations and Revenue Cycle, joined the Kaufman Hall family in October 2022.

Venny is a nationally recognized expert in CDI, Revenue Cycle, and Hospital Operations. He recently spoke with Kaufman Hall Chief Communications Officer Rob Fromberg about current challenges for health system finance and quality of care, the role of physicians and supporting staff in implementing impactful CDI initiatives, and the ways in which CDI can advance the mission of improved community health and patient care.

Rob Fromberg: Welcome to Kaufman Hall. We’ve really enjoyed the first few months of working with you and your colleagues at Claro Healthcare. Can you elaborate on why you decided to join the Kaufman Hall family, and what you think this partnership can accomplish?

Venny Arquilla: Thank you. We’re looking forward to doing a lot of important work together on behalf of our clients. From my perspective, there are multiple synergies between Kaufman Hall and Claro Healthcare and our complementary approaches to improve the financial health of the organizations that work so hard to improve the health of their patients and communities. My expectations entering this partnership so far are being met in my experience with my new colleagues at Kaufman Hall: they’re professionals who are committed to excellence and to client service, and they’re very collaborative.

Fromberg: When you talk with health system CEOs, CFOs, and other leaders, what do they tell you is keeping them up at night?

Arquilla: Over the past six months to a year, many of our clients have been behind budget. There are several factors with respect to pressure on reimbursement, high labor cost, high contract nursing costs, inflation, and a variety of other factors. There are several solutions which can help an organization navigate these tough times. Reducing operating expenses, facilitating accurate and complete documentation, making operational improvements which all resulting in improving the quality of care and the viability of our clients.

Fromberg: I assume you have some conversations about CDI (clinical documentation improvement) where people might say, "Yes, we've got that covered; we have a great technology in place.” What do you say when you hear that response?

Arquilla: Health system leaders who say that CDI is already covered are probably talking about their inpatient CDI efforts. And if you look at a health system's revenue stream and business model, inpatients are an increasingly shrinking part of their business. Our experience indicates that we can help most health systems with their Inpatient CDI efforts from a quality reporting, compliance and reimbursement perspective. We are the industry leader in CDI.

Meanwhile, for many organizations, the outpatient and physician enterprise are growing parts of their business. In many cases, organizations aren’t even addressing the quality of clinical documentation in those areas in a thoughtful, strategic, and systematic way. We are the only firm that offers a Comprehensive CDI offering with the right mix of services and technology.

Fromberg: What are some of the quality and revenue benefits from implementing CDI well?

Arquilla: In each setting of care, whether it's inpatient, outpatient, physician billing, the coding rules are different. To get credit for the care you're providing, you must be as specific as possible in the documentation of that care.

The more specific you are with your documentation across the health system, the more the more reimbursement as well as the reflected quality of care. Conversely, incomplete documentation results in less reimbursement and lower quality scores.

Fromberg: What are some of the ramifications when organizations don’t accurately document treatment and services and how does that translate to the quality of service?

Arquilla: Healthcare organizations are letting the outside world draw the conclusion that they’re not a high-quality organization, and many organizations are acutely sensitive to that type of benchmarking. What is the message here? At academic medical centers in particular, quality scores are especially important. Also, at any hospital or health system, if your data shows you’re not providing high-quality care, you can really lose out from a market share standpoint in addition to the financial cost of not documenting as completely as possible.

Fromberg: What's the role of the clinician in making the CDI process really work?

Arquilla: For any physician that practices in a health system, whether independent or employed, it's important they understand the importance of complete documentation and how the CDI process can help. Their data and the hospital’s data speaks to the quality of care being provided.

Hospitals can either educate all the physicians on the appropriate coding and documentation rules or they can put in place a supporting CDI process and infrastructure that can consistently better and more completely reflect the acuity of their patients in a consistent and sustainable manner.

This must be clear and direct. With appropriate executive team and physician leadership engagement, physicians will understand what they’re going to be asked to do, why they're being asked to do it, and what the impact will be. Many organizations will naturally say, “Well, the key is to get the physicians on board. The key is to be able to convince these tough physicians that we have.”

Our opportunity is to work with all relevant parties in the health system to build and operate a complete CDI process and infrastructure that addresses people, process and technology.

Fromberg: How can CDI support a healthcare organization’s mission?

Arquilla: The organizations we serve are doing amazing lifesaving, innovative things: everything from double lung transplants during the height of the COVID-19 pandemic, to life-saving cancer treatment, just to name a few. There’s great work being done everywhere, whether it's a community hospital or a major academic medical center. We take great pride in being able to help fund their mission, and the good they’re doing in the community.

One of our clients is a safety net hospital in an underserved area. A CDI initiative helped them secure more than $50 million in incremental net revenue in a two-year period. This initiative made a material impact allowing them to do their great work in their community, and it's incredibly impactful and rewarding to our people.

Fromberg: Thank you, and again a warm welcome for Claro Healthcare to the Kaufman Hall family. I look forward to sharing with our audience more of your insights and your team’s expertise in the months and years to come.

Arquilla: Thank you, Rob. We’re excited about the opportunity to help healthcare organizations meet the challenges that confront them.