Recent Articles
Recruitment firm grows in tandem with CDI programs
Editor’s Note: Those of you who were on the ACDIS Quarterly Networking Call Thursday, November 19, may have heard the discussion about what makes a good CDI specialist. Scott Entinger, an executive recruiter for Portland, OR-based NHS Solutions, Inc., specializing in CDI leadership, dialed in and offered his assessment of what hospital administrators are looking for across the country right now. ACDIS members can listen to past conference calls at their convenience online. The November 19th program will be posted soon.
Mr. Entinger has agreed to post occasionally items of interest here to the ACDIS Blog beginning with his first post below. You can find more information about current CDI career developments in the CDI Journal and peruse or post job openings at our special job posting site.
NHS Solutions has been actively focused on CDI staffing since the day we opened our doors. The company was founded to serve this market. As a silver sponsor of the ACDIS annual conference, we have supported the industry from our beginning.
Like ACDIS, we are relatively new. But that is because the industry is new. However, we have clearly established ourselves as the leader in the staffing solutions for this market. As I write this, we have more CDI positions posted on our Web site that we are actively recruiting for than any other staffing company in the nation (www.nhsscorp.com/careers/jobs).
We already have several of the top healthcare facilities and systems as our clients for CDI positions and we are growing that number every month. Our specialists spend most of their time on this market, are extremely knowledgeable and have a very robust network of professionals on our books. We are moving fast because this segment is moving fact.
We are one of the few staffing companies I know of that are actually growing in the backdrop of a difficult economic environment.
To contact us, visit our Web site at www.nhsscorp.com.
ACDIS launches 2009 CDI specialist salary survey
Nearly 300 people have already responded to the 2009 ACDIS annual CDI salary survey. In the survey, we ask for your open and honest input to help us develop the most accurate picture of the CDI profession today. Your answers help illustrate the average salary clinical documentation improvement specialists receive. Your answers help illuminate the design of a “typical” CDI program. Your answers help depict the average experience of CDI specialists.
Please only take this anonymous survey if you are a CDI specialist. If you are not a CDI specialist, please ask the CDI specialist(s) in your hospital to fill out this survey. Visit www.zoomerang.com to take the survey. A complete analysis of the survey will be provided to ACDIS members on the association Web site www.cdiassociation.com.
Here’s a sample of the results so far.
Don’t let surgical complication documentation get complicated
There’s still time to sign up for Friday’s (November 20, 1 p.m. EST) audio conference: Surgical Complications: Clinical Documentation Improvement for Compliant Coding and Accurate Quality Measures with Robert S. Gold, MD, and Lena N. Wilson, RHIA, CCS.
Wilson is the HIM operations manager of the clinical documentation improvement program (CDIP) and inpatient coding at Clarian Health Partners in Indianapolis. In her current role, Wilson is responsible for the CDI program at Clarian’s three facilities in downtown Indianapolis, and the inpatient coding operations for the downtown facilities and the two suburban hospitals.
And while many in the CDI world think that Dr. Gold requires no introduction, let me nevertheless tout his expertise as founder and CEO of DCBA, Inc., in Atlanta, GA, a consulting firm that provides physician-to-physician education programs in clinical documentation improvement. He has more than 42 years of experience as a physician, medical director, and consultant.
Surgery documentation is an area rife with concern from both the physician point-of-view as well as from the CDI and coding perspective, like Dr. Gold points out in this Friday’s presentation. Too often CDI programs improve a facility’s risk adjusted mortality index but negatively impact a surgeon’s physician profile. Such outcomes make it difficult to get physician support for CDI. He outlines the following three “Golden Rules:”
- If it is a complication of surgery, it is either a complication or surgery
- If it is a manifestation of a disease unrelated to the surgery it is not a complication of the surgery
- If it is not treated it may not be codable—but it may
Individual effort equals organizational success
The role of the clinical documentation specialist has been in a state of flux for the past few years. We
Make a difference by getting involved.
wear many hats including that of nurse, coder, teacher, auditor, statistician, politician, and sometimes therapist. How many times have you had to evaluate the mood of a doctor prior to discussing a documentation issue, or been caught up listening to their problems in the office or with a colleague. The job description is constantly shifting.
Our profession has faced changing DRG’s, dealt with the complex nuances of the query process, and the avoidance of “leading queries.” There are additions to the list of Hospital Acquired Conditions, to contend with, concerns about Recovery Audit Contractor reviews, and the advent of ICD-10 to worry about. And that’s not to mention the transition and implementation of Electronic Medical Records.
During these stressful times, it has become apparent that CDI specialists are resilient, intelligent, resourceful, and indispensable! With these changes however comes stress. An article from MED Indiana, on Life Stressors That May Lead to a Cardiac Event listed several stress factors that may be faced in the clinical documentation workplace. They include:
- Changes in work hours or conditions
- Trouble with your boss
- Change in work responsibilities
- Change in work
- Major business readjustments
These situations may sound familiar to you and since most CDI specialists tend to be “long in the tooth,” or seasoned, as they say, we may be more affected by changes than most. This is one of the reasons that the Association for Clinical Documentation Improvement Specialists (ACDIS) organization is so important, for it gives us a forum to communicate, commiserate and share business practices throughout the state. It is a source for education and team building. A presentation at the 2009 National convention titled Restarting or Revamping Your CDI Program: A Case Study by Catherine O’Leary and Colleen Gary discussed various issues relevant to a CDI programs such as:
- How to hire the right team?
- How to retain your team and provide motivation? And…
- How to measure success?
One major issue addressed in the article seemed to be staff turnover. Not everyone can do this job and not everyone enjoys CDI work. It can be a thankless job. Occasionally we are perceived to be in the adversarial position of “Chart Police.”
The Clinical Documentation Specialist role should be well defined and program goals should be set and if needed, reset, again and again. Ongoing education and growth is fundamentally necessary in all professions and CDI is no exception. Involvement in ACDIS and other educational forums helps us get up to date information regarding our profession. And it helps prevent stagnation and boredom.
The experience of our membership is varied: Some have been working in CDI positions for many years in well established CDI departments and others are new and developing their programs from the very start. We need to reach out and help newcomers and they in turn can then help others that join our group in the future. There is strength in knowledge and there is strength in numbers. The ACDIS organization has the potential to someday have a major role in setting CDI policies and protocols.
In the words of Vince Lombardi: “The achievements of an organization are the results of the combined effort of each individual.” ~
Agenda for week ending Nov. 20
Hi y ‘all (although I’m a New Englander I thought I’d practice my southern drawl. They tell me the plural of y’all is all y’all. )
Here’s a look at a few events coming up this week:
November 18:
Clinical documentation improvement specialists in Connecticut meet at the Hospital of Central Connecticut, Bradley Memorial Campus, at 9 a.m. Meeting frequency and format, as well as a casual sharing of common CDI problems and strategies for success, top the agenda. For information, contact MaryAnn Shanley.
November 19:
ACDIS quarterly conference call 2-3 p.m. EST. This is a members-only call and dial-in instructions were e-mailed out to our membership list. If you did not receive an e-mail notification, and you are an ACDIS member, please e-mail ACDIS member relations specialist Sue Calabro at customerservice@cdiassociation.com. Sue will provide you with the dial-in number and passcode.
November 20:
The Maryland CDS Workgroup meets. Contact Christine Mobley, RN, Director of Clinical Documentation, Prince George’s Hospital Center at 301/618 6507 or by e-mail at Christine.Mobley@dimensionshealth.org.
Surgical Complications: Clinical Documentation Improvement for Compliant Coding and Accurate Quality Measures, 1 p.m. For information, call toll free 800/650-6787 or e-mail customerservice@hcpro.com.
Tip: Update physicians on change to consultation E/M code changes
CDI specialists are always looking for ways to build business relationships with physicians. One way to build a good professional relationship is to update them when changes occur to the physician fee schedule. And there’s a big change coming that’s just about to occur.
Effective January 1, 2010, CMS eliminated consultation codes, and rolled payment previously associated with these codes into existing office visit and initial hospital and facility visit E/M codes. From a CMS fact sheet:
CMS is also finalizing its proposal to stop making payment for consultation codes other than the G codes that are used to bill for telehealth consultations, and to redistribute the resulting savings to increase payments for the existing evaluation and management (E/M) services. CMS will adjust the payment for the surgical global period to reflect the higher value of the office visits furnished during the global period.
Provide physicians with this table from the proposed physician fee schedule, which crosswalks payment for the previous consultation codes into E/M codes (scroll down to “downloads,” and you will find the table in the link “Budget Neutrality Mappings for the Consultation Codes.”
You can view the final rule at the Federal Register Web site: http://www.federalregister.gov/OFRUpload/OFRData/2009-26502_PI.pdf
Dazed and confused? Or Encephalopathy?
Altered mental status, dementia, or encephalopathy: What’s really going on with your elderly patient that presents with confusion?
The typical scenario is the elderly patient with some minor dementia, who has been living fairly independently, who is described as being more confused than usual. A work up does not indicate any acute neurological conditions but the patient is admitted with altered mental status. Further work up often reveals an underlying infection or metabolic condition. After treatment of the underlying concern, the patient’s mental status returns to baseline and the patient is discharged back to their usual living arrangements.
Don't let dementia documentation confuse you.
The resources consumed in treating this type of patient often include a head CT, neurological consult, neurological checks, EEG, sometimes even a bed in the intensive care unit. But if the physician only documents altered mental status or dementia and not a type of encephalopathy, the true severity of illness of the patient may not be accurately reflected.
So what is encephalopathy?
As defined by the National Institute of Neurological Disorders and Strokes, National Institutes of Health, encephalopathy is a term for any diffuse disease of the brain that alters brain function or structure. Encephalopathy may be caused by an infectious agent, metabolic dysfunction, brain tumor or increased pressure in the skull, prolonged exposure to toxic elements (including solvents, drugs, radiation) chronic progressive trauma, poor nutrition, or any reason for lack of oxygen or blood flow to the brain.
The hallmark of encephalopathy is an altered mental state. Depending on the type and severity of encephalopathy, common neurological symptoms are progressive loss of memory and cognitive ability, subtle personality changes, inability to concentrate, lethargy, and progressive loss of consciousness. Other neurological symptoms may include tremors, muscle atrophy and weakness, dementia, seizures, and loss of ability to swallow or speak.
Coding Clinic provided a definition in the first quarter of 1988 (pages 3-4):
Leading the question
Clinical documentation improvement specialists continue to have trouble discerning between leading and non-leading physician queries. The question often comes down to an understanding of the various previous “lives” of professionals. Nurses are used parrying over clinical decision making, so why should their queries regarding documentation be any different from the clinical questions they’re used to asking? Quite simply: because there’s money involved.
Sure it’s true just as Robert S. Gold, MD, founder of DCBA, Inc., in Atlanta, said in his
Questions remain over leading queries
article “Is asking for clarification ‘leading’?” that the government never clearly defined the term “leading” and many experts continue to banter over the logistics of the language. However, CDI specialists need to shine a bright light on the differences between the leading and non-leading query to protect themselves and their facilities from the coming onslaught of government auditing agencies.
While the likelihood of true healthcare reform legislation seems to be dwindling, President Barack Obama nevertheless continues to push against apparent payment abuses throughout the system. CDI professionals are meant to be a facility’s first line of defense against such abuses. It a CDI specialist’s job to make sure what was documented in the patient’s medical record is the most accurate description of the care the patient received.
Yet we still hear of facilities focused on Medicare only patients. We still hear about CDI programs directed to only look at records of a certain dollar value. We still hear tales of CDI professionals requesting specific language from physician simply due to some administratively imposed financial quota.
Inappropriate, leading queries, not only open your facility to an inordinate amount of risk but also jeopardize patient care. Generate policies and procedures for your facility that outlines the purpose and intent of your CDI program. Include your administrators, HIM leaders, physician liaisons, and compliance officers in the process. Create standard query forms that allow for the physician to further explain his or her documentation and even to disagree with the reason for the query.
For more information about physician query best practices and the legal architecture on which current query practice is based, read the Physicians Queries Handbook.
Georgia ACDIS group set to meet
There’s less than three days left before Georgian clinical documentation improvement specialists converge on the city of Atlanta. And even though it’s their first meeting, organizer Bonnie I. Epps, MN, RN, manager of Clinical Documentation Improvement at Emory Healthcare, Inc., in Atlanta certainly hit the ground running.
Take a trip to Atlanta Friday for some CDI fun.
Friday’s meeting, which takes place at Dobb University Center at Emory University Hospital from 10:30 a.m. to 3 p.m., includes sessions on coding changes for 2010, RAC, and the physician’s role in CDI programs. Plus, Epps planned networking, door prizes, lunch, and a tally of results from an informal survey she conducted. That’s a lot to pack into a first meeting!
Since many participants will drive a long way, Epps planned the event for a Friday hoping to encourage a little extra tourist interest. “Hopefully many of you will take advantage of a trip to Atlanta to do some shopping and playing! I look forward to meeting you,” she said in her e-mail invitation.
The last time I was in Atlanta was just after undergrad. My girlfriends and I took a road trip from Boston to Atlanta. We’d originally aimed for New Orleans but thought better of it and settled for sightseeing the capitol of Georgia. One of my favorite memories was our visit to the Atlanta Botanical Gardens. If you have time, be sure to visit. An exhibit on display there now was ranked by TIME magazine as among the top 10 museum exhibits in the country!
Like Epps says: Come for the great CDI sessions, stay for a little shopping in the city, take a relaxing stroll through the Garden before heading back to your CDI program full of great ideas, ready to go.
NC Chapter offers meeting in the mountains
North Carolina ACDIS Chapter’s next meeting takes place Friday, November 13, 10 a.m. to 2 p.m., at the Appalachian Regional Healthcare Watauga Medical Center in Boone, NC.
www.blowingrock.com
“I love the fall,” Taylor wrote in an e-mail. “It is my favorite time of year.” So she’s particularly excited to be traveling to the mountains for the NC ACDIS group’s final 2009 meeting. “I’m sure many will decide to spend a long weekend in the mountains of Boone and Blowing Rock,” she says.
The scenery makes these locations among the most popular in our National Park System. Doing a little digging I found out that the Crestwood Inn in Blowing Rock has a wine club that meets at 7 p.m. on November 12th, so guess where I’d be staying! But alas! Although Taylor did her best to entice me, I’ll be diligently performing fall’s not-so favorite task of raking up those autumnal vestages this weekend. Hope I can get my nephews and husband to help with the raking!
If leaf-peeping and sweeping vistas don’t encourage you to join the group, rest assured they have a full clinical documentation improvement agenda that includes changes to 2010 ICD-9 codes, and CCDS certification tips and study groups.
Earlier this year the NC Chapter suggested a friendly contest to see which ACDIS chapter could gather the greatest number of CCDS certified professionals among its memberships by the time the 2010 ACDIS Conference rolls around. With current membership around 55, they challenged themselves to see if they could get 20% of their members to take and pass the exam. Taylor and her cohort Jennifer Love aim to facilitate that goal by organizing study groups to help NC members if they chose to take the test.
In 2010, the NC group will alter its meeting format slightly. Instead of meeting quarterly, the group will plan biannual meetings augmented with teleconferences to discuss best practices. The biannual meeting will most likely be an all-day educationally focused event in the spring and fall. The meeting locations will rotate to allow for transportation needs and to encourage greater participation, Taylor says.
For information, e-mail j.love@novanthealth.org or leah.taylor@iredellmemorial.org.