The Association of Clinical Documentation Improvement Specialists (ACDIS) honored the nation’s top clinical documentation improvement professionals at its 9th annual conference in Atlanta, GA. On May 23rd ACDIS recognized Candace E. Blankenship, BSN, RN, MedStar Union Memorial Hospital, with the Rookie of the Year award; Susan E. Kohl, MD, Baylor University Medical Center at Dallas, with the Excellence in Provider Engagement award; Jessica M. Vaughn, RN, BSN, CCDS, Wake Forest Baptist Health, with the Recognition of CDI Professional Achievement award, and Karen M. DiMeglio, RN, MS, CCDS, CPC, Lifespan, as its 2016 CDI Professional of the Year.
ACDIS Director Brian Murphy presented the four awards in the general morning session to kick off the 9th annual conference. The awards were presented in front of an audience of more than 1,700 of their peers.
ACDIS recently revised, updated, and expanded its awards for 2016 to reflect the changes occurring in healthcare and the CDI profession in particular. The new Rookie of the Year award recognizes the rapid growth of the CDI profession by awarding an outstanding CDI professional on the job less than two years at the time of nomination. The new Excellence in Provider Engagement award recognizes a professional who has made measurable impacts engaging providers (physicians, nurses, and others) in the need for accurate and complete documentation in the health record. The Recognition of CDI Professional Achievement award recognizes a professional who has made outstanding achievements within his or her facility, and the CDI Professional of the Year award is ACDIS’ top honor, given to a CDI professional who has made significant contributions within his or her organization and on the broader CDI community.
“These four individuals represent the best the CDI profession has to offer,” said Murphy. “Their contributions to the profession in the past year are truly remarkable. All the great work hospitals and providers do cannot be measured without accurate and complete health information in the medical record, including a full accounting of each patients’ diagnoses, procedures, and treatments, and physicians’ medical decision-making and clinical indicators to support diagnosis and treatment. CDI professionals play a critical role in today’s environment of quality and accountability by ensuring that all of these critical data elements are present in the chart.”
To learn more about the ACDIS Achievement Awards, the annual ACDIS conference, or ACDIS membership, please visit www.acdis.org.
The energy coming from the 9th Annual ACDIS Conference could be felt long before entering the convention center. The sense of excitement buzzing amongst the nearly 2,000 attendees was evident as they made the long walk from the hotel to the exhibit hall to kick off this year’s event in Atlanta, GA at a welcome reception on Monday evening.
Upon arriving, the atmosphere could be likened to that of a high school reunion—old friends, who only see each other once in a while, hugging and reminiscing over drinks and light appetizers as if no time has passed. Those new to the group are welcomed with open arms and, within a matter of seconds, are exchanging stories and jovial laughs with their colleagues.
The camaraderie amongst this close-knit community of CDI professionals truly is second to none.
ACDIS Director, Brian Murphy, welcomed the group with a few remarks. “As great as our educational sessions are I’m most looking forward to meeting old friends, making new ones, and learning from them all,” said Murphy. “Networking is at the heart of the ACDIS conference and I’ve never been ashamed to admit that our members learn as much or more from each other as we can bring them with our publications and leadership.”
The well-attended reception was sponsored by platinum sponsor, Elsevier, who also spoke to the group. “The industry is finally understanding the importance of the CDI profession,” said Deborah Neville, Director of Revenue Cycle, Coding, and Compliance at Elsevier. “I applaud each and every [attendee] for taking the time to be at this conference, to increase their knowledge and be able to improve patient care and healthcare overall.”
Murphy later announced that we are officially on the lookout for our 5,000th ACDIS member—we are only 10 away from reaching this exciting milestone! If you are not a part of this organization already, we invite YOU to sign up. Curious about membership benefits? Click here.
The importance of CDI involvement in denial management cannot be stressed enough. Join associate attorney, and returning ACDIS speaker, Sarah Mendiola, Esq., LPN, CPC tomorrow afternoon for her session, “Completing the Circle: The Importance of CDI Specialist Participation in the Denial Management Process.” We spoke with her about her experiences appealing claims that have been denied by CMS contractors, and what she hopes to bring to this year’s event. Join her for her session a 3:15 p.m. on Day 2, room C111.
Q: Tell me a little bit about why CDI specialists should get involved in the denial management process.
A: It is important for CDI specialists to understand what denials their organization is receiving, so that they can implement the appropriate safeguards on the front end to prevent them from reoccurring. Since the CDI team has the opportunity to review the documentation, typically before the claim is even billed, they have the opportunity to implement changes in practice to prevent future denials.
Q: What are three things attendees can expect from your session?
A: (Two) Midnights, Medicare, and Me! We will focus quite a bit on the 2-midnight rule. There was a lot of interest in the application of the rule when I presented at the conference last year, so I kept the format very similar to what we talked about then, and made this more of an updated presentation. Most of the presentation is focused on Medicare rules and documentation requirements, so we will talk about best practices for prevention, and opportunities for appeal if all else fails.
Q: Who should attend your presentation and why?
A: CDI specialists, physicians, nurses, and anyone else involved in chart review and/or patient status determinations.
Q: What do you think is the most important quality for a CDI professional to have?
A: There are so many! It really depends on the role of the CDI department in that facility. However, I think that it is most important for CDI professionals to be detail oriented and good educators. It is important to know your audience, to understand your physicians and practitioners, and be able to convey information in a way that is well received and will lead to practice changes when needed.
Q: What are you most looking forward to about this year’s conference? What is your favorite part of the conference?
A: I’m excited to be presenting! I always look forward to the educational sessions as well. The conference had so many great speakers last year and such a wide variety of topics—there is something of interest in each breakout time slot.
Couldn’t make it to this year’s pre-conference sessions? ACDIS welcomed nearly 250 pre-con attendees who participated in one of our three courses.
Here’s a quick takeaway from Building a Best Practice CDI Team co-presented by Richard Pinson, MD, CCS and Cynthia Tang, RHIA, CCS. The co-creators of the beloved CDI Pocket Guide, created a working session focused on communication and collaboration among CDI specialists, coders, physicians, physician advisors, and other professionals. In fact, Pinson and Tang encouraged facilities to sign up their entire CDI team, and walked them through exercises and case studies.
Throughout the session, Pinson stressed the importance of understanding how your medical staff thinks and learns—and adjusting education methods accordingly. “A successful CDI team is based on engagement of medical staff obtained through effective communication,” said Pinson during the session. “For example, physicians often respond to education using evidence-based literature and consensus guidelines. By collaborating with your team, you will find the methods that work.”
During the Physician Advisor’s Role in CDI Boot Camp pre-conference event, James S. Kennedy, MD, CCS, CCDS, CDIP, president of CDIMD, Physician Champions based in Nashville, explained government payment methods including MS-DRGs, and offered a variety of idioms to help entertain and educate the nearly 100 attendees participating. I’ve known Dr. Kennedy a fairly long time and have come to look forward to hearing some of these. I thought I’d share a few with you.
“If the physician says it quacks, waddles, and flies south for the winter, the coder cannot say it’s a duck,” Kennedy says. “Maybe it’s a goose.
“You all know what MD really stands for, don’t you?” he asks the crowd. “My decision. I’m the doctor and it’s my decision as to how I treat this patient.”
Regarding the lack of provider involvement with establishing coding rules governed by the four cooperating parties: “If you’re not at the table, you’re on the menu. That’s why its important for the physician advisor to stay informed and, where comments are requested, [such as with the inpatient prospective payment system proposed rule and the AHA Coding Clinic for ICD-10-CM/PCS] offer the physician perspective.”
“A good lawyer knows the law. A better lawyer knows the judge and the jury. The best lawyer plays gold with the judge,” Kennedy says. “That’s why as the physician advisor you have to know the roles and be able to interpret them.”
“What’s my favorite radio station?” Kennedy asked. “Here in Atlanta there’s WAOK and WALR-FM in Greensville. But for physicians in your facility regarding the CDI program the only radio station they want to hear is WII-FM–what’s in it for me.”
Looking forward to hearing more from Trey La Charité, MD, medical director for clinical integration and physician advisor for clinical documentation integrity at the University of Tennessee Medical Center in Knoxville and the team from Vidant Health and Franciscan Alliance in North Carolina talk about how their physician advisors advanced the CDI program in innovative ways, tomorrow.
At their most elemental, CDI programs ensure diagnoses and treatments described by treating physicians accurately reflect the patients’ severity of illness using officially sanctioned International Classification of Diseases 10th Revision, Clinical Modification and Procedural Coding System (ICD-10-CM/PCS) terminology, and that such codes are appropriately captured and reported by the treating facility.
Most facilities only focus on this. In fact, most facilities, persuaded by the financial benefits of capturing additional complications or comorbidities (CC) and major complications or comorbidities (MCC) on the CMI of their biggest payer—Medicare—frequently limit the scope of CDI specialists’ reviews to this regard.
The physician advisor should push the facility to expand CDI efforts beyond the scope of CC/MCC capture and fiscal return on investment not only for compliance considerations but also to help earn support from the overall medical staff. Many CDI programs have steered away from the term “improvement” in favor of the term “integrity.” Some suggest that the term “improvement” sets the hospital administration at odds with its physicians implying that physicians’ documentation needs to “improve.” Others imply that for most medical staff, the term evokes a financial connotation—that CDI is about “improving” the facility’s finances over all else.
Whether your program uses the term “improvement,” “integrity,” or some other title, the underlying concern is to address the inherent “value” of CDI efforts in improving a whole host of hospital and patient outcomes. Additionally, the physician advisor needs to assure the medical staff that there is nothing illicit in routine interrogations of the medical record to ensure accuracy. Remember that CMS states:
“We do not believe there is anything inappropriate, unethical, or otherwise wrong with hospitals taking full advantage of coding opportunities to maximize Medicare payment that is supported by documentation in the medical record.”
While many CDI programs start out fiscally focused, the ultimate goal should be to help physicians craft a record that accurately reflects their patients’ illness—to make their patients appear on paper as sick as they are in person. This documentation must be in the medical record because the pendulum in U.S. healthcare is swinging, and in many case has already swung, from a quantity-driven system to a quality-driven one.
If routinely practiced, CDI efforts improve patient outcomes—simply put better documentation improves the dialogue between physicians. Sadly, most physician discussion of a patient’s care, isn’t a face-to-face—it is the information contained in the medical record that allows one physician to quickly determine what care has been provided for what diagnoses thus far and which conditions he/she needs to monitor and care for.
As an example, try to remember the worst “code blue” situation you were ever involved in during your residency training or recent practice experience. When you reviewed the chart at that critical moment, was there anything useful in it that could have helped you address that patient’s immediate needs any better? There is nothing more frustrating or unsettling than to examine the chart of an acutely decompensating patient who has been in your facility for two weeks yet there is no useful information to be found.
Editor’s Note: This excerpt came from the Physician Advisor’s Guide to Clinical Documentation Improvement.
The annual conference begins on Monday. With that, we wanted to leave you with a few quick reminders as you finish up your final preparations. Be sure to keep up with the ACDIS Blog through the next few days, as we offer a series of special tips to help you get the most out of the conference. Just as a reminder, the ACDIS office will be closed for the conference and will reopen Tuesday, May 31. We look forward to seeing you in Atlanta!
As you pack…
Wear comfortable but professional clothing, comfortable shoes you can walk in, and bring extra layers (such as sweaters or jackets). We have no control of the temperature in the convention center and it may fluctuate from room to room.
- Day 1 of the annual conference is always “show your CDI pride day.” We encourage you to wear purple and orange and, new this year, teal. In past, attendees have sported purple ties and orange shirts, fancy hats, and scarves. We’ll be giving out spirit ribbons and special prizes for those who go above and beyond.
- Day 2 is always “state pride day.” We encourage you to wear an item of clothing emblematic of your state. For example, Oregon ACDIS Chapter leader Charlene Shope suggests attendees might want to wear either a Ducks or Beavers blazer!
Bring your business cards! Networking is one of the most important aspects of the conference. Be sure to bring plenty of business cards so you can share your contact information with colleagues, and enter drawings in the Exhibit Hall.
Pen Swap. ACDIS’ CCDS Coordinator Penny Richards participates in a “stationary swap” and had a great time playing this game with attendees last year, too. To join in, pick up a fun pen or two and a small stationary item (like a flower-shaped sticky note pad or flamingo shaped pen) wrapped in a paper bag and drop it off at the ACDIS Registration Desk any time after noon on Day 1. You’ll receive a ticket in exchange and the next day you can pick up your package from the bin. To make your donation to the exchange extra special, consider including a motivational note or CDI tip in your package.
Please remember, we will not be providing printed workbooks. If you wish to have printed materials, you will need to download them and print them off prior to leaving the office for the conference. Please refer to your conference welcome letter for the materials download link. All materials will also be available via the ACDIS Conference App. We appreciate your cooperation and helping us be a bit more sustainable for years to come!
To download our conference App, visit the Google Play Store or Apple App Store and search for ACDIS Conference. (Read more about the App on the Blog.) Login information was sent to attendees via the conference welcome letter. Please contact customer service if you need additional assistance by phone at 800-650-6787 or firstname.lastname@example.org. We will provide a special App-related help desk near the registration area during the conference should you need technical assistance.
Because ACDIS’ mission is to promote CDI education and networking we encourage attendees to use the App to share information learned during the sessions, connect with other CDI specialty areas, post photos of a new acquaintance, snap a shot of your favorite poster presentation, or take a group photo with your team. Please keep posts courteous and professional and be respectful to the speakers, attendees, and exhibitors.
For those arriving on Monday, May 18, we strongly encourage you to pre-register from 4-8 p.m. Pre-registration will be held at West Registration. By pre-registering you will avoid waiting in line Tuesday morning! We also look forward to seeing you at this year’s pre-event cocktail reception on Monday, May 18, 6-8 p.m., in Exhibit Hall A.
The office will officially close at the end of the day today as more than 30 members of our HCPro and BLR teammates make their way to the airport to support the ACDIS community during the largest conference we have ever conducted—with more than 1,500 paid attendees, 40 exhibitors, hundreds of exhibitor attendees, and more than 100 speakers and presenters.
The core ACDIS team is supported by dozens of people with innumerable talents that, when put together, produce the thriving conference we will experience in Atlanta. We hope you’ll join us in thanking our HCPro/BLR staff members who make the conference possible.
While it would be near impossible to name every single person who contributed in some way, we’re going to give it our best shot:
Shannon Storella, Kathy Wilson, Wendy Walsh, Maggie Gagnon, and the entire events team: Shannon is our fearless leader throughout the conference, from the planning stages to the live event. She keeps us all in line and helps the event run as smoothly as possible.
Kathy does an amazing job holding the entire event together working between the various departments as well as with the hotel staff and conference center management to ensure everything stays inline. The conference wouldn’t be as successful (or fun) without her!
Our conference presenters have gotten to know Wendy Walsh (or W2, as she sometimes signs her emails) very well over the past six to eight months. She is our conference producer extraordinaire, helping guide the speakers from the planning stages of their presentations through to execution at the actual conference. She keeps track of speakers’ presentations, makes sure their travel arrangements are set, ensures their presentations met ANCC continuing education requirements, and a host of other tasks required to keep the sessions full of quality information. Not to mention, she helps prepare our room moderators to produce the best session experience possible.
Maggie did a fantastic job both behind the scenes leading up to the conference and throughout the conference to generally ensure that the entire event ran smoothly.
Jess Carbone: Jess is the main person behind our ACDIS conference App, and worked tirelessly with the App developer throughout the year to improve functionality, add messaging, uploading materials, and training the rest of the ACDIS staff on how to use the App. We love seeing the attendees interact through the app and post updates from the sessions, and it would not be possible without all of Jess’s hard work!
Steven Andrews, Sharme Brodie, Katy Rushlau, Amanda Tyler, Laurie Prescott, Delaney Rebernik, and Rebecca Hendren: These amazing folks will be our room moderators for our five session tracks, making sure the sessions ran as smoothly as possible. They’ll let you know where the bathrooms are, ask you to silence your cell phones, and remind you to use the microphones to ask your questions at the close of the session. They will keep the rest of the conference group updated via the App on interesting quotes and tid-bits from each presentation as well. Special shout out to Laurie and Sharme, who will also be teaching our CDI for Quality Pre-Conference Boot Camp.
Sheila McGrath, David Horvath, Melissa Varnavas, Penny Richards, Rachel Dicker, Chris Driscoll, and everyone in the ACDIS booth: These hard-working folks will be available to explain the various books, pocket guides, newsletters, and other products available to help CDI programs train their staff and grow. In between sessions, the booth will be open to attendees wanting to make a purchase or ask a question, and they will be ready and eager to help.
Mary Ann Genovese, Jennifer Hollis, and the rest of our exhibit hall support staff: These folks do a great job working with exhibitors and organizing floor plans, and assisting and directing attendees during the conference.
Melissa Ketelson, Shannon McCall, Dave Garvey, and our registration folks: Thank you for making the registration process run so smoothly, and for answering attendee’s questions, fixing or replacing badges, and providing support throughout the conference.
And, finally, our operations manager and staff Matt Sharpe and Mike Mirabello, who make sure all our shipments arrived on time. You guys do not get enough credit for the incredible work you do—a total of 14 pallets, 378 pieces, and 7,474 pounds left the ACDIS office and it would not have been possible without you!
The list goes on, and surely we’ve still left off a few names! It truly does take a village, and it’s important to recognize the remarkable team behind the faces you know as ACDIS. The conference wouldn’t be what it is without the effort of each and every person on this team.
A query should include the clinical indicators however it should not indicate the outcome of reimbursement or even quality scores. The goal is accurate and compliant documentation. With accuracy as the goal, there are times when the query will generate improved reimbursement and quality scores, and other times when they will lower reimbursement and quality scores. When communicating the reason for a query, the CDI specialist should speak to the accuracy of the record over reimbursement. Thus, CDI specialists do not want to create leading queries or queries that are not supported by the clinical elements in the health record.
Compliant queries should also include patient identifiers, ensuring that the correct patient is being considered. Queries should also include the name and contact information of the person originating the query. This provides the physician an opportunity to contact the CDI specialist to clarify the query or query process.
Here are the components of a compliant query:
- Patient name
- Admit date
- Account number
- Name and contact information of individual initiating the query
- Clinical indicators that support the query
- Statement or question of the issue
An example of a compliant query joint ACDIS/AHIMA query practice brief, Guidelines for Achieving a Compliant Query Practice, is for clarification of specificity of a diagnosis. This type of query would be appropriate for when documentation of the condition has already been provided but greater specificity is needed for accurate code assignment.
Can the etiology of the patient’s pneumonia be further specified? It is noted in the admitting history and physical examination this obtunded patient had a history of nausea and vomiting prior to admission to the hospital and is treated with clindamycin for Right lower lobe pneumonia. Based on the above, can the etiology of the pneumonia be further specified? If so, please document the type/etiology of the pneumonia in the progress notes.
Editor’s Note: This excerpt is from the CCDS Exam Study Guide, Third Edition, written by Fran Jurcak, MSN, RN, CCDS, and reviewed by Laurie L. Prescott, RN, MSN, CCDS, CDIP.
We are just days away from the ACDIS conference, and a few of us at the ACDIS office are feeling a bit nostalgic. Check out these photos from the past nine conferences. We can’t wait for new memories in Atlanta!
ACDIS Through the Years by Slidely Photo Gallery