By Melissa Varnavas

For roughly five years now, the CDI industry has toyed with various ideas about what constitutes an “outpatient” program and how to effectively take successful inpatient programs to the proverbial next level by expanding into “ambulatory” services. Over time, a consensus of sorts has arisen with the term “outpatient” providing a counterbalance to “inpatient” as an overarching phrase equating to any type of program reviewing records not principally reimbursed by Medicare’s Part A (hospital) funds. Outpatient CDI efforts include the ED, hospital-based outpatient services, ambulatory surgical centers, and physician practices, to name a few.

A 2017 ACDIS poll showed approximately 10% of hospitals possessed an outpatient (defined as hospital ambulatory or physician services at the time) CDI program with 24% of respondents indicating at the time that they plan to cover outpatient and/or physician services in the next 6–12 months. Nevertheless, preliminary results from the 2019 CDI Week Industry Survey show less than 2% of the more than 600 respondents identified as working in outpatient/physician practice setting, and just under 40% say they review any type of outpatient records.