Long flights home are never easy, but encountering a medical emergency on yours certainly makes it more difficult. That’s what happened to Miriam Sereno, RN, CCDS, Director of CDI at South Nassau Communities Hospital in Oceanside, New York, on her way home from the 2014 ACDIS Conference in Las Vegas. In the air for roughly an hour, the flight attendant asked the passengers if any medical staff were on board. Sereno raised her hand and went to help.
“We didn’t have to speak to each other,” Sereno says, “we just went to work.”
A physician, another nurse, and an EMT also helped and the team determined that the patient needed immediate medical attention. Sereno told the flight team to land at the nearest airport which they did.
Although she didn’t get her name, the other nurse was also an ACDIS attendee, Senero says. She noted the signature conference bag when leaving the plane.
Sharing. Giving. Helping. CDI specialists embody these attributes. We’ve heard stories similar to Senero’s before of ACDIS attendees lending medical assistance in emergency situations but also of giving in other, smaller ways too.
In Nashville, in 2013, Mark LeBlanc, RN, MBA, CCDS, Director, CDI Services, at The Wilshire Group, jumped behind the registration desk to help hand out conference bags when the booth was busy. In 2012, in San Diego, an ACDIS attendee asked if he could take the left over boxed lunches out to a homeless shelter he knew in the area.
Every year we return from the conference with amazing stories of attendees’ generosity. This year was no different. Even before the conference got started attendees offered tips and tricks on how to get the most out of this year’s conference “app” and reached out to each other to network on a variety of topics. On site, ACDIS staff caught dozens of CDI professionals showing their CDI spirit playing along with the theme of the day wearing their signature ACDIS purple and orange and, on Day 2, their home team jerseys.
I may be stereotyping CDI professionals but so be it. As a whole, you are phenomenal, amazing, wonderful, caring group of individuals and I feel blessed to have been able to spend the past week among you.
Thanks for another great year! See you in Atlanta!
Editor’s Note: In social media memes, Throw-back Thursday generally means sharing an old high school photo, something you most likely wish had been left unpublished. We’ve picked up the theme going back into our archives to highlight some salient tid-bit. Today, in honor of it being the last day of our 2015 annual conference, we wanted to look at a piece from the 2012 conference special section in the CDI Journal. We chose to highlight last year’s professional of the year winner, Cathy Seluke, RN, BSN, ACM, CCDS, and her piece, “Cathy Seluke pushes for CDI focus on quality.”
The only person at MaineGeneral Medical Center surprised that Cathy Seluke, RN, BSN, ACM, CCDS, was selected as the ACDIS CDI Professional of the Year for 2012 was Cathy herself. Seluke is supervisor for clinical documentation compliance at MaineGeneral’s Waterville and Augusta campuses. She received nominations from nine of her coworkers, an unprecedented effort to put her commitment and devotion in the national spotlight. While honored by the recognition and humbled by the respect her colleagues demonstrated, Seluke kept her sense of humor—she showed up at the 2012 ACDIS Conference in San Diego sporting a tiara.
“I was pleasantly shocked when [ACDIS Director] Brian Murphy called to tell me I was the CDI of the Year,” she says.
Seluke built on her experience in quality improvement and medical staff performance improvement when she moved into a multi-role case management/information review/CDI position in 2001. “CDI was a new program at MaineGeneral,” she says. “I was interested in the case management aspect, and CDI was an ‘add on.’ The hospital had hired a vendor and we had training on CDI, but it was really very financially focused at the time.”
The program went through multiple evolutions. Case management initially included utilization review (UR)/CDI nurses, social workers, and discharge planners. Then staff were given roles where everyone did everything (“a total disaster,” Seluke says); later, CDI and UR were combined into a separate role. Finally, in 2008, CDI became a stand-alone unit. Seluke calls it “the best move we ever made.”
Seluke thanks her team for helping her capture the CDI Professional of the Year award. Perhaps they did. Either way, it was Seluke’s commitment to her hospital’s CDI success that earned her honors as the 2012 CDI Professional of the Year. And she’s got the tiara to prove it.
Editor’s Note: On Tuesday, May 19, ACDIS honored CDI Professional of the Year Karen Newhouser and Recognition of CDI Professional Achievement award recipients Mary Margaret McGrady and Amy Yung at its 8th annual national conference awards ceremony in San Antonio, Texas. Our sincerest congratulations go out to them.
Q: What information do you have about physician response to ICD-10-PCS? I am getting some push-back from surgeons. The response I received from a surgeon was, “I want to choose my own words for the surgery that I performed” and “I don’t want a coder picking the words, ‘removal or extraction or insertion.’ I want them to code my words.” He went on to state that he wasn’t going to change his language, which I reassured him that he didn’t have to do, according to the directive from CMS. Have you heard any complaints about the coders translating what the surgeon writes into the appropriate ICD-10-PCS code?
A: I think it is too soon to ascertain the overall reaction to ICD-10-PCS by surgeons. They may be unaware of how their documentation codes out in the inpatient setting under PCS, since their reimbursement works differently. You are right that the provider doesn’t have to use the root operation terms—the coder must interpret the surgeon’s documentation into one of the root operations. I guess it may become an issue for the surgeon if it affects a quality measure. Until then, who knows?
I think PCS is going to be a big challenge for most organizations, but they may not realize it, yet. Also, remember that, traditionally, CDI has been able to work around surgeons, because we often query about diagnoses, which can be based on the documentation of other providers as long as the surgeon is silent. So it might be helpful to go back to basics with the surgeon to let them know what CDI does, why it can and does affect them, what a query is, etc.
Further, in the Physician Advisor’s Guide to Clinical Documentation Improvement, Trey LaCharite, MD, writes (pp. 193-194):
“Surgeries/surgeons represent the largest financial drivers at most facilities and yet these individuals are notorious for providing limited documentation regarding their efforts and for non-compliance with CDI initiatives. Any increase in documentation from this physician group represents a total paradigm shift since a once universally perceived benefit of a career in surgery was less note writing. As the old joke goes, “where do you hide $100 from a surgeon? In the medical record!”…
“To win them over, focus on their nature. Surgeons are data driven, competitive, and worried about their public quality report cards. Show them, both individually and as a group how the facility down the street seems to have better performance scores (higher SOI/ROM, higher expected-to-observed mortality ratios, lower LOS, etc.) for a given procedure than your facility does. Additionally, if you have multiple surgeons or groups of physicians within your own facility performing the same procedure, show how one of them seems to be doing a better job than his or her colleague. The surgeons will do the rest since they are not used to being anything but ‘top of the class.’”
Editor’s Note: Cheryl Ericson, MS, RN, CCDS, CDIP, AHIMA Approved ICD-10-CM/PCS Trainer, Associate Director for Education at ACDIS and CDI Education Director at HCPro in Danvers, Mass responded to this question.
We hope everyone is excited for the first official day of the conference! As you get the lay of the land and enjoy the first few sessions, we wanted to start our Tuesday with one final speaker discussion, in case you haven’t decided who you’re going to see tomorrow. This week, we spoke with Rachel Mack, RN, MSN, CCDS, CDIP, who, along with Natalie Esquibel, RN, BSN, CCDS, will be presenting “No Orientation Manual Needed … Oh Wait, That’s Not True: The Struggle and the Triumph of Orienting a New CDS.”
Q: Why is training an integral part of the CDI specialist’s role?
A: We desperately need new CDI specialists. Since every site does things so differently, it’s different orienting new CDI specialists to their role than other nursing roles. The basics of CDI are of utmost importance to teach, including clinical indicators, understanding the DRG system, identifying CC/MCCs, and developing relationships with physicians. But it’s so much more than that. They also need to be aware of many different factors, such as what electronic documentation tools the hospital uses (if any) and whether they have physician support. This is especially important because we want those doing CDI to be immediately successful—or at least operating mostly independently within a couple of months. Teaching CDI in a way in which a new staff member can be successful is too important for it to not be a focus of a program.
Q: How is your topic important for everyone in the CDI role, regardless of professional background?
A: The training and success of new CDI specialists is important for all aspects of CDI. The first six months of a new CDI specialist’s experience solidifies their standing in the hospital. Providers have to know that the people asking them documentation questions really know the ins and outs of CDI and coding. They need to be able to trust them. Getting new CDI specialists up and running with the right education and introduction is crucial for the hospital to be successful.
Q: As an RN, how does your perspective differ from other professionals performing the CDI role?
A: My perspective differs in that I feel the role comes down to “seeing” the clinical picture. My background is in ICU, so, when I’m reading records, I feel as though I can literally “see” what’s going on with the patient. I think that helps tremendously with record review.
Q: What do you think is the most important quality for a CDI professional to have?
A: Their ability to fixate on detail and be flexible. Chart review is all in the details. A CDI specialist’s ability to organize, review charts daily, and understand what’s important and what’s not is of vital importance for a CDI specialist to be successful. Being flexible is also important. This comes into play when you have to reschedule your entire day because something gets cancelled or changes, or a lot of patients come in. A CDI specialist must be able to navigate this with ease.
Q: Why do you think attending the ACDIS conference is important?
A: The ACDIS conference is not only important, it’s fun! The ACDIS conference really gets people excited about CDI and gives CDI specialists the ability to network with a group of professionals. It’s also a great place to see what’s happening across the country in CDI. I feel like it’s easy to get caught up in the “silos” of our own hospital. The ACDIS conference is just a great way for so many light bulbs to go off for new and old CDI specialists alike.
You asked, and we heard you! By popular demand, we will be offering not one but two panel sessions at this year’s annual conference. Each session will offer audience members an opportunity to engage in a live discussion with multiple CDI professional. The panels will be led by ACDIS experts, who will help facilitate the discussions.
The first panel session will focus on quality and CDI. The roundtable discussion will cover CDI, and its overlap with quality improvement initiatives and its impact on quality metrics. This session will be moderated by Sheila A. Bullock, BSN, MBA, CCDS, CCS, CAHIMS, CCM. The panelists include Allison Q. Clerval, RN, BSN; Cheryl Ericson, RN, MS, CCDS, CDIP; Dawn R. LaRoque, RN, BSN, CCDS; Michelle McCormack RN, BSN, CCDS, CRCR; Kathleen M. Shindle, RN, BSN, CCDS; and Adele L. Towers, MD, MPH, FACP.
The second panel session will highlight CDI and the revenue cycle, including best practices for CDI integration and positioning. Coding, compliance, and CDI representatives will be on the panel. This sessions will be moderated by Walter Houlihan, MBA, RHIA, CCS. The panelists include Kimberly A. H. Baker, JD, CPC; Donald A. Butler, RN, BSN; Patricia E. Buttner, RHIA, CDIP, CCS; Cheryl Ericson, RN, MS, CCDS, CDIP; and Trey La Charité, MD.
Each session will be followed by an extended Q&A with the audience. Attendees are encouraged to attend the panel sessions and participate in the discussions.
Traditionally, physicians’ responsibilities lie with assessing the patient’s needs, diagnosing the patient’s condition, developing a treatment plan, and caring for the individual until he or she can be safely discharged. All of this care needs to be documented in the medical record by the physician.
Few physicians, however, are taught in medical school how their language and documentation affects various other departments, reimbursement (both their own and their hospital’s), quality data, or other data uses. When their documentation is reviewed, it is typically reviewed by another member of the medical staff to ensure appropriateness of care. Period.
Although CDI professionals can help obtain clarification, it is always the treating physician’s responsibility to diagnosis and accurately document that diagnosis in the medical record and it is always the coders’ responsibility to determine which codes are finally submitted.
In the early days of CDI program development, employment of physician advisors seemed optional. Those facilities that employed a physician advisor often used their acumen minimally to address concerns related to outstanding queries and difficult (noncompliant) physicians. Today, it is widely understood that physician advisors to CDI programs play a far more integral role. Today, physician advisors are frequently called upon to address such concerns and many more—from reviewing claims denials from a documentation perspective to providing trending reports, CDI program analysis, and so forth.
Editor’s Note: Today, at the ACDIS pre-conference events, the authors of the above excerpt from The Physician Advisor’s Guide to Clinical Documentation Improvement, James S. Kennedy, MD, CCS, CDIP, and Trey La Charite, MD, will take to the stage before more nearly 100 attendees looking to learn more about the role of CDI for physician advisors.
Today and tomorrow these attendees will dive deep into all things coding, reimbursement, and documentation. They’ll learn documentation tips by clinical diagnosis and explore support tactics. They will come to understand how documentation improvement can support even physicians’ own practice efforts, and improve overall physician and facility quality scores. Tomorrow, some of these attendees will even explore how to engage physicians in documentation improvement across multiple hospitals.
There’s always something more to learn. Thanks to our wonderful speakers and authors, ACDIS offers a variety of ways for you to learn it. To paraphrase a common saying from Kennedy—“If it walks like a duck and talks like duck… it still isn’t a duck unless you document it.”