When everything is a quality priority, nothing gets prioritized

Healthcare organizations face pressure to improve quality from every direction. Risk of mortality (ROM), readmissions, length of stay (LOS), patient safety indicators (PSIs), risk adjustment, severity of illness (SOI) and publicly reported rankings all matter. For chief quality officers and chief medical officers, the question isn't whether these measures are important. It's where to focus first.

You can't improve every measure equally at the same time. Sustainable progress requires you to identify the measures that matter most, understand where the greatest opportunity exists and align clinical, documentation, coding, provider and quality teams around a focused path forward.

Recent ACDIS survey findings show how broad the quality mandate has become. Respondents identified challenges across risk adjustment factor (RAF) scores, LOS, readmissions, PSIs, Elixhauser, ROM and SOI. RAF scores were the most frequently selected challenge at 41.44%, followed by LOS and readmissions, both at 36.94%, and PSIs at 30.63%.

The interpretation matters. CDI teams are being asked to influence a broad and growing set of measures. That reflects CDI's expanding role, but it also creates strategic fragmentation. When every measure feels equally urgent, teams struggle to improve the ones that matter most.
 

Quality improvement starts with focus

For quality and medical leaders, improving outcomes doesn't mean solving every quality measure at once. It means selecting the measures that matter most to your strategic goals, rankings and patient population, then aligning teams around those priorities.

The ACDIS survey showed that organizations rely on multiple quality frameworks, with respondents ranking Vizient, CMS Star Ratings, U.S. News & World Report, Leapfrog, Premier and Healthgrades among those used. That creates complexity for teams responsible for documentation, coding and quality reporting. It also makes prioritization essential.

A focused approach helps you ask better questions:

• Which quality rankings or programs matter most right now?
• Which measures have the greatest impact on patient outcomes and reputation?
• Where do documentation and coding gaps distort performance most?
• Which opportunities can our teams realistically improve first?

The answer varies by organization type, market position and strategic goals. Vizient may be top of mind for many academic medical centers, but it doesn't directly drive payment. CMS Star Ratings can indirectly affect reimbursement. Leapfrog and Healthgrades may matter more for some community hospitals. U.S. News & World Report may remain highly visible for reputation.

The goal isn't to ignore other measures. It's to build momentum by improving the right measures first. Starting with two or three can help you demonstrate progress, learn what works and then scale.
 

Risk adjustment connects documentation to quality credibility

Risk adjustment belongs at the center of this conversation. For CQOs and CMOs, it isn't simply a coding or reimbursement issue. It's one of the ways you ensure reported outcomes reflect the true complexity of the patients you treat.

If clinical documentation doesn't fully capture patient acuity, outcomes may appear worse than the care delivered. Mortality, readmissions, LOS and other comparisons suffer when the coded record fails to reflect clinical reality.

The survey found that C-suite understanding of CDI's role in capturing risk adjustment factors and improving quality rankings averaged 3.79 out of 5. Awareness exists, but the connection between CDI, coding, risk adjustment and quality outcomes may still need to be more visible across the organization.

That creates an important question for CDI and coding leaders: Does the C-suite understand the work your teams do, and can they see how it improves quality? Too often, teams stay so busy defending productivity, query volume or reimbursement impact that they have less time to show the work strengthening documentation integrity and improving risk-adjusted outcomes.

Moving from defense to visibility requires transparency. Your teams need ways to show not only what work was completed, but what changed because of it: which measures improved, which documentation gaps closed, where risk adjustment became more accurate and how those efforts connect to broader quality priorities.
 

CDI can't improve quality alone

Another takeaway from the survey is that CDI programs are often expected to influence outcomes they don't fully control. Documentation quality depends on providers. Coding accuracy depends on consistent workflows. Quality reporting depends on complete, accurate and timely data. Improvement requires collaboration across clinical, quality, CDI, coding, provider and revenue cycle teams.

That collaboration starts with a shared understanding of how the work connects. Complete clinical documentation supports accurate coding. Accurate coding supports appropriate risk adjustment. Risk-adjusted data supports more credible quality reporting. And credible reporting helps you see where performance is strong, where gaps exist and where to focus next.

When that connection isn't clear, frontline teams may not see how their daily work affects quality rankings, patient outcomes or executive priorities. The result is misalignment: quality leaders focus on outcomes, CDI teams focus on queries, coders focus on productivity and executives struggle to see a unified picture.
 

Analytics should help teams prioritize, not just report

You don't need more static reports. You need analytics that help quality, CDI and coding teams understand where performance falls short, why it matters and what to address first.

A more effective analytics strategy helps you:

• Identify where performance differs from expectations
• Benchmark outcomes against relevant peer groups
• Prioritize the measures and populations with the greatest quality impact
• Drill into supporting details to understand root causes
• Track progress over time and demonstrate measurable improvement

Connected analytics and benchmarking can turn complex performance data into clearer, more actionable insight, supporting focused improvement across documentation, coding, risk adjustment and quality outcomes.

The survey also points to opportunities in foundational practices. While 68% of respondents selected SOI and ROM as quality program goals, 64.86% selected present-on-admission status on all codes and 58% selected complete code set reconciliation. If these aren't consistent priorities, ask where quality accuracy may be at risk.
 

From quality overload to measurable progress

The path forward isn't asking CDI, coding and quality teams to improve everything at once. It's helping them focus. That may mean starting with risk adjustment, readmissions, length of stay, mortality or another measure tied closely to your strategy.

Improving quality doesn't require solving every measure at once. It requires choosing the measures that matter most, aligning the people who influence them and using insight to prioritize action. Once your teams see progress, they can scale. Start by naming your top two or three priorities, align the teams who shape them and let measurable wins build the momentum for what comes next.

Cheryl Manchenton is a manager of inpatient consulting services at Solventum.