Australia’s CDIA proves six degrees of separation from US CDI

The Talk Ten Tuesday co-host accepts an invitation to take part in an Australian podcast series.

Have you ever played Kevin Bacon’s Six Degrees?

It is a board game played where players choose an actor, and the other players have to think of an actor who has appeared with that actor in a movie, thus continuing this in an iterative process until the player finds a actor linked with Kevin Bacon. The challenge is to do it with a minimum of connections, but the concept is that it can almost always be done in six steps or less. This stems from the six degrees of separation theory that two individuals on earth can be connected through their network of social acquaintances.

Almost all of my business opportunities and ventures are only a few degrees away from Talk Ten Tuesdays or ICD10monitor. I wrote an article titled “The clinical documentation process has become longer, more repetitive and less informative“, published on ICD10monitor November 30, 2021. As a result, Dr Felicity Sinclair-Ford, a physician employed by Clinical Documentation Improvement Australia (CDIA), contacted me and asked if she could abridge and distribute my article to providers in Australia. I was flattered and delighted. In my response, I told him that I would be interested in learning more about CDI in Australia.

His response was to invite me to be the inaugural guest of CDI in Conversation, a podcast his company was launching for the CDIA community. Naturally, I eagerly agreed, but told him that I wanted to be able to share the conversation with you, our readers and listeners. Felicity agreed, and we recorded six hours of conversations exploring the similarities and differences between clinical documentation integrity in the United States and Australia.

It was fascinating! I mistakenly believed that the US was the only country to base reimbursement on coding. The Australian system is different (or “to”, depending on whether you are Australian or American!) from ours; it is more like the All Patient Refined (APR) Diagnosis Related Group (DRG) system than the Medicare Severity (MS-DRG) system. Conditions have a variable risk adjustment based on primary diagnosis/basic DRG – secondary diagnoses define “division”. And funding varies depending on whether it is a public or private hospital.

Felicity found the concept of denial of clinical validation intriguing because it’s not a thing out there…yet. CDI is still young in Australia, and they haven’t moved on to “integrity” as opposed to “improvement”. One of the biggest shocks to me was that, to be a codable diagnosis, almost any condition must have resulted in the initiation or adjustment of treatment. In other words, if a patient presents with almost any chronic condition and is taking their home medications unchanged, that condition does not enter into the calculation of DRG severity.

These conversations were eye opening for me and Felicity was a lovely partner to explore this topic with. I would like to invite you all to connect and experience it for yourself at CDIA website. The only thing that would have made it more fun would have been an invitation to do it in person, downstairs. Maybe next time!

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