Q&A: Driving the bus for DRG assignment

Q:If the principle diagnosis ICD-9 code is on the MCC list but there is no other diagnosis for the patient, is the DRG

A photograph of a sculpture created by Christopher Fennell in Athens, GA.

assigned with MCC or without?

For example, patient presents with heart failure but has no other diagnoses. So the ICD-9 code is 428.21, acute systolic heart failure. Would this fall into MS-DRG 291 or 293?

A: If a diagnosis is the principal diagnosis it can’t also be an MCC. It can’t drive the bus and be a passenger at the same time. In your example, if the heart failure is the principal diagnosis (the bus driver), you’d need to find another diagnosis to act as the MCC (a passenger) to group to DRG 291.  For example, any DRG that says “with” in the description (with CC, with MCC with CC/MCC) needs both a bus driver (principal diagnosis) and at least one passenger (CC, MCC, CC/MCC)

However, there is a little quirk about heart failure that is an exception to the rule. If the physician states “heart failure” or “congestive heart failure (CHF)” as the principal diagnosis your beginning ICD-9 code would be 428.0 (heart failure, unspecified as to type).

If the CDI specialist queries the provider to determine whether there is an association between “hypertension” (if appropriate) and “heart failure” (not an assumed relationship) and the provider documents “hypertensive heart disease”   what the coder would assign is a combination code as the principal diagnosis, 402.91 Hypertensive heart disease, unspecified, with heart failure (for example).  The instructional notes (in the code book) instruct the coder to assign an additional code from the 428* series of codes to describe the type of heart failure (e.g., 428.21, acute systolic heart failure).

In this scenario, the coding would include:

• Principal diagnosis (bus driver): 402.91, hypertensive heart disease, unspecified, with heart failure
• Secondary diagnosis (passenger): 428.21, acute systolic heart failure
• MS-DRG: 291, Heart failure with MCC

If the patient also has hypertension (and or chronic kidney disease) it can be very important to query for the association between hypertension (and CKD, if appropriate) and heart disease, and the heart failure so one of these combination codes can be assigned (as the principal diagnosis). Then the patient’s specific type of heart failure may act as the MCC in certain cases.

Editor’s Note: This question was answered by Lynne Spryszak, RN, CCDS, CPC, Chicago-based Independent Healthcare Consultant. Email her at lspryszak@comcast.net.

To obtain physician support simply engage and collaborate

You CAN get physicians to support your CDI program.

By Heidi Hillstrom MS, MBA, RN, CCDS

As a 10-year veteran of a successful CDI program, I am accustomed to being asked, “How did you build your program?”  My response invariably is how vital it is to bring your physicians on board.

Before you respond, “But you don’t know how difficult this is with our physician group!” Or, “Get real Heidi! That isn’t going to happen here!” Let me assure you that obtaining physician support for CDI efforts is definitely achievable.

It all hinges on relationship building. This didn’t happen overnight, for us of course.  Once they understood there was no implied criticism of their documentation ability or attempt to tell them how to practice medicine, a lot of the initial hostility disappeared.

First, be visible to your doctors. Whenever possible, perform your reviews on the units.  Greet them by name.  Don’t be afraid to enter into general conversations that are occurring. It doesn’t have to involve documentation.  The performance of a favorite sports team can be a great conversation starter. During these conversation moments, you will have opportunities to discuss clinical documentation, but keep it brief and to the point.

Second, be respectful of your physicians’ limited time.  I requested to be included on the agenda of their staff meetings.  Personally, I never tell a physician I’m there to provide them with “documentation education.”  They are well educated, and this can be perceived as being condescending. Instead, I tell them that I am here to provide them with the most recent documentation “information” that impacts their practice.

I found formal power point presentations tend to lose their attention fairly quickly.  Rather I present an informative agenda tailored to their particular specialty and encourage open discussion.  I ask them to share their expertise in understanding the clinical indicators for a diagnosis.  This is really where the collaboration begins.

Be prepared to listen to their frustration with the documentation process without becoming defensive.  A little empathy can go a long way. It is crucial to follow up with any questions they may have.  Finally, ask them for their input on how the CDI clinicians can improve their communication process.

Once I became more than a faceless documentation query, building a relationship became much easier.  Now, I am often approached on the units and contacted, by physicians, with additional documentation questions and or concerns. Friendly conversation became natural. My template or note became a message from me.  My queries are more likely to get a response.  In fact, once the physician and clinician relationship grew and clinical documentation is now a collaborative effort, I am often greeted with, “Hey Heidi, is that question for me?” once they saw a query form in my hand.

In closing, I am pleased that I have gone from a physician fiend that they avoided to a friend who physicians seek out.

Editor’s Note: Heidi Hillstrom, MS, MBA, RN, CCDS, is Clinical Documentation Manager at St. Luke’s Hospital in Duluth, MN. Contact her at hhillstrom@slhduluth.com.

ICD-10 for CDI Boot Camp: ‘Put your nickel down’

With apologies to those who were unable to attend the two-day “ICD-10 for CDI Boot Camp” premiere in San Diego May 8

Adelaide La Rosa’s mother, Carmela Costagliola with her dog Joey. La Rossa lovingly used descriptions of occasions regarding her mother and pets as examples for documentation specificity.

and 9, the following is a series of paraphrased quotes from inestimable educator Adelaide M. La Rosa, RN, BSN, CCDS, Director of Clinical Documentation Improvement Program St. Francis Hospital-the Heart Center in Roslyn, NY. La Rosa is an AHIMA-Approved ICD-10-CM/PCS Trainer and Ambassador who currently provides training in ICD-10-CM/PCS to nearly 50 facility staff members and chairs the ICD-10 steering committee at her facility.

La Rosa is from Long Island, NY, so you have to hear (in your mind’s ear) her talking in a sometimes thick Long Island accent. La Rosa’s co-worker Jean Marie Roth, RN, Assistant Director of the St. Francis CDI program helped keep La Rosa on target as she shared tales from her own life. La Rosa frequently turned to her counterpart asking: “Do I have time for one more story, Jean?” as she launched into a tale about an unfortunate health experience and subsequent documentation and coding requirement related to her mother… or her mother’s dog “Joey.”

Roth played the proverbial straight man to La Rosa’s comedic embellishments of her experiences ensuring appropriate documentation, incorporating ICD-10 requirements for additional specificity, and educating physicians about how their documentation affects everything in the healthcare continuum.

Enlivening and enjoyable as the tales were, La Rosa and Roth provided multiple pearls of wisdom for attendees to take away. No doubt you’ll enjoy reading and sharing these tidbits, too.

• “The books must speak to you,”La Rosa told the class, encouraging them to make sure they have solid
  

  La Rosa speaks to more than 120 "ICD-10 for CDI Boot Camp" attendees prior to the start of the ACDIS Annual Conference in San Diego.

  information to support any assertion they make. CDI specialists and coders who query physicians need to know what the Official Guidelines for Coding and Reporting for both ICD-9 and ICD-10 state. They need to know the “letter of the law,” she says and be able to point to the actual guidance in the text.

• “The pen is more powerful than the scalpel.” She uses this phrase with her surgeons to explain the value of their documentation in the process of patient care. The audience responded by letting La Rosa know she needed to update her catch phrase considering the emerging importance of electronic health records and queries.

• “Put your nickel down!” is what La Rosa tells physicians when all they’ve documented is a series of symptoms but neglect to indicate any possible, probable, or likely principal diagnosis. “At some point,” she says, “the physician must place their bet and document their impression of what principal diagnosis they are treating.”

• Depending on your perspective Recovery Auditors (formerly known as Recovery Audit Contractors or RACs) and other governmental and private auditing organizations review medical records and billing statements to ensure they pay only for the treatment provided, or they look for ways to deny a claim to save (and/or collect) money. CDI professionals can be an asset to an organization by proactively ensuring the physician completely documents the care provided to a particular patient during a given stay. Furthermore, facilities need to “RAC them back!” says La Rosa by constantly reviewing Recovery Audit targets, examining Program for Evaluating Payment Patterns Electronic Reports (PEPPER), and targeting CDI record reviews to those areas.

• “It’s not about the DRG; it is about communication of care.” La Rosa constantly reminded her ICD-10 Boot Camp attendees that the CDI specialist’s role is not about capturing additional complications and comorbidities (CC) or major complications and comorbidities (MCC) to shift the reimbursement to a higher-weighted (greater reimbursed) diagnosis related group (DRG). Tracking your CDI program’s return on investment is a necessary part of program advancement and advocacy, La Rosa says. So, yes, CDI managers should track changes in the case-mix index and, yes, they should track how CDI specialists’ efforts affect the Medicare Severity (MS)-DRG or All Payer Refined (APR)-DRG assignment. But remember that as long as CDI specialists focus on capturing the entire clinical picture of that patient’s episode of care, the improvements will follow—and they will be both financial and quality related. “Get the information in the chart and the rest will follow,” she says.

• “We’re here to do it together,” says La Rosa regarding the integrated nature of the documentation improvement effort. Coders, case managers, nurses, and obviously physicians all play a role. “If your CDI program doesn’t meet with these different professionals on a regular basis, start doing so,” she says.

Editor’s Note: Register now for the 6th Annual ACDIS Conference in Nashville, TN, May 21-23! Contact our Member Relations Department at 877-240-6586.

Q&A: Communicating expectations to achieve excellence

Do you know what is expected of you? Do you have clearly communicated goals for how to grow professionally?

Editor’s Note: I recently came across this question and answer in one of our sister publications Nurse Leaders Weekly. In this instance the use of the word “quality” does not refer to a hospital’s quality assurance or quality indicator program but to the overall quality of a given effort. The question regarding how effective communication enables a program or department to advance its effectiveness and implement and achieve new goals for its staff applies not only to “nurse leaders” but leadership in every aspect of healthcare—CDI included.

I am sure that you have all had a particularly influential manager or someone you thought was a really great boss at one time or another. If you had that person in front of you now, what questions would you ask him or her? How did their communication skills help your awareness of your responsibilities?

Q: How does communication factor into the success of my quality improvement plan?

A: Good managers know that quality does not happen by fiat or executive order but is the result of staff members’ comprehensive understanding of what is expected of them, why it is appropriate to expect it, how they will be supported to deliver that performance, and how they will be evaluated according to defined criteria.

Communication is core to:

• Defining the expectations of the organization for each employee’s performance
• Clearly linking those expectations to the mission of the program and the larger organization
• Outlining for employees how their individual and team performances are measured and evaluated, and keeping them informed of the results
• Listening to employees’ thoughts and ideas about potential improvement, born of direct experience in delivering care and service
• Sharing with employees the progress and knowledge developed elsewhere in the organization, and outside it, which may help employees improve individual and team performance

Lost in a sea of electrons…

You may have recently read about the interesting problem of the United Kingdom’s 17,000 pregnant men.  If you

The electronic world won't solve documentation problems.

haven’t, here’s what happened:

Data researchers noticed that about 17,000 British gentlemen who visited their physician were inadvertently coded as having received obstetrical care.  So there were 17,000 pregnant men.

It’s funny, but it’s also sad.  Because, you see, the UK is already using ICD-10.

If anyone thinks that ICD – 10 is the be-all and end-all of clinical documentation, they would be mistaken.

Mistakes are showing up in spite of, or perhaps because of, advancements in technology and systems that are supposed to bring us into the 21^st Century.  I’ve reviewed charts where the physician used an electronic, templated dictation form for ease of use.  Unfortunately, the physicians don’t always edit their templates appropriately.  So I see such gems as, “The patient is in her usual state of health in no apparent distress… Diagnosis:  Acute respiratory failure.”  We have all seen transcription whoppers because the physician signed the dictation without reviewing it for accuracy.  It still happens in an electronic world without medical transcriptionists.

The improvements in data collection and information sharing expected as a result of ICD–10 will only be as good as the information that gets coded.  Garbage in, garbage out, as they say.  These examples only serve to emphasize the importance of getting the information right in the first place, and caring about the quality of the work that we, as CDI specialist, do.

Development of a CDI team should automatically incorporate quality processes for auditing and monitoring, not to degrade or punish, but as a way to lift the team to levels of excellence.  We should be looking at the electronic interface and the electronic requirements of the medical record, including the problem list mandated  by EHR meaningful use, through the eyes of the physician.

We need to formulate recommendations to the IT team that will improve the physician’s ability to document with completeness, accuracy, and clarity.  Computer-assisted coding, while a potentially valuable tool, still requires validation of the documentation against the computerized coding by a human skilled in clinical documentation principles.

I once knew an electrophysiologist who consistently documented, as so many still do, “CHF.”  When I asked for specificity and acuity, he told me to call his office and they would give me the codes.  I told him that I already knew the codes but needed the documentation.  While an electronic world will speed and facilitate our conversion from documentation to codes, at heart, the documentation still matters.  And that’s why we’re here.

Quarterly Conference Call scheduled for May 24

The next Quarterly Conference Call is scheduled for Thursday, May 24, 1-2 p.m., ET. ACDIS members should have

Join us this week for the Quarterly ACDIS Conference Call

already received email instructions regarding how to access the call.
Please note that due to heavy call volume, we recommend that you dial in 10 minutes early.

These calls are offered as a means for ACDIS members to network with one another and to discuss any industry-related issues. We will have a few ACDIS Advisory Board members on the call as well. We encourage your comments, thoughts, and questions during the call.

We want your ideas and questions!
If you have a question to ask or suggestions for discussion on the upcoming call, please e-mail ACDIS Director Brian Murphy at bmurphy@cdiassociation.com. Conference calls are a great way to ask a question, air concerns, or gather input on a policy or procedure at your hospital. While we cannot guarantee your question or discussion point will be addressed on the call, we will try to work in as many as possible.

If you cannot attend the call, a digital recording will be available for members to download on the ACDIS website.

Determining the benefit of flesh-and-blood CDI vs. computer-assisted coding

Don't fear advent of computer assisted coding.

I received an interesting question following the February ACDIS Quarterly Conference Call about the impact of new technology on the CDI profession. It read: “Do you think computer-assisted coding (CAC) will reduce or eliminate CDI jobs?”

Several members of the ACDIS advisory board formulated answers worth sharing (read a few of their comments in the April edition of the CDI Journal.)

Here’s how I feel about CAC. It can be a valuable tool in the box of a CDI specialist, like a hammer or saw, but it does not replace the CDI specialist. At times I too react to new technologies with skepticism and defensiveness, wondering if this or that new gadget will sound the death knell for my own job. But machines will never replace the human element.

In short, summarizing the sentiments of the ACDIS Advisory Board:

• As long as physicians require education as to why accurate, complete, and legible documentation is important, CDI will be here to stay.
• As long as doctors respond to a face instead of an electronic prompt, CDI will be here to stay.
• As long as medicine remains part art and part science, CDI will be here to stay.

In short, CDI is not going anywhere anytime soon. View these new technologies as a new and exciting challenge to master, not as an enemy to fear. What do you think about CAC and the impact it will have on CDI? Send me an e-mail with your thoughts.

Conference Q&A: ‘CDI Career Ladder’

Want to climb the CDI career ladder? Two ACDIS speakers will tell explain how during today's presentations.

Editor’s Note: This post is part of an ongoing series of Q&As with presenters and participants from the 2012 ACDIS Conference in San Diego. The following features Jennifer Love, RN, BA, CCDS, and her  co-presenter Janet Gentle, RN, BSN, MSN, CCDS on the presentation “CDI Career Ladder: Two Perspectives,” which takes place today, Thursday, May 10, 3:15-4:15 p.m.

Q: How long have you been a CDI professional? 

JL: In 2008 I was hired as the manager of CDI for Novant Health.  In 2011, I became the area director of Clinical Documentation Improvement for Kindred Healthcare.

JG: Seven years.

 Q: What inspired you to follow this career path? 

JL: When I was a Surgical Care Improvement Project analyst at Novant, my senior director informed me that the hospital system was considering implementing a CDI program.  In discussions that followed, I was allowed to purchase The Clinical Documentation Improvement Specialist’s Handbook.  I read that book cover-to-cover! I was hooked!  CDI was something fresh; a new challenge which definitely sparked my interest.  I was hired as the manager of Clinical Documentation Improvement and the CDI program was implemented shortly thereafter.

JG: We had consultants who were brought in to redesign our case management (CM) department and establish a CDI program. They encouraged me to interview for the dual CM supervisor/CDI position which, within three years, turned into a full-time CDI position.

Q:  What should someone who is interested in becoming a CDI specialist do to begin their career? 

JL:  I’d recommend they read The Clinical Documentation Improvement Specialist’s Handbook, too, or check out the ACDIS website before making the leap.  I would also encourage them to get approval to shadow current CDI specialists.

To take the CDI career path, the individual should be very attentive to detail, e computer savvy, and possess clinical expertise. To take on this career, the individual will be required to communicate effectively to everyone from coders to physicians.  I’d also tell them to be honest with themselves regarding their weakness and strengths.  If the CDI role plays up your strengths—go for it!  I wish you the best of luck!  Give yourself time to master this role, however.  It will take months before you will feel truly competent.  One more thing, you will make mistakes.  No one in this field is perfect.

JG: Definitely research the CDI role first. And take part in ACDIS/AHIMA educational opportunities. In fact, join ACDIS/AHIMA on either the national or local level for educational and networking opportunities. Attend conferences/educational programs such as Boot Camps and look for an entry level position with a facility that will help train you.

Of course someone looking to advance their CDI career should be able to research best practices to improve current processes, know how to monitor effectiveness via internal audit/productivity measures, understand the importance of developing policies and procedures. There are other ways to advance your career, too. Those on the cutting edge of this profession know how to develop ICD-10 compliant queries or have become involved in their local ACDIS chapter.

Additional opportunities exist down some unexpected avenues such as CDI travel assignments and remote CDI at home, etc.

Q:  If a CDI professional has been working in the field for a few years what steps should they take to advance their role, program, and/or career? 

JL: Don’t let yourself stagnate.  Always be reading something or pursuing something for your professional growth.  Don’t rely solely on your employer to sign you up for conferences, classes, etc.  Take the initiative yourself and your employer will take notice. Also, if you are interested in an opportunity for advancement—speak up! Your boss can’t read your mind. Once you’ve shared your interest, your boss then starts ‘grooming you’ for the next big thing. You never know!

JG:  Develop a CDI team leader/coordinator position and consider yearly salary market adjustments in addition to raises. Look for reimbursement for conference attendance and tie that attendance to team education and CDI program process improvements. There are increasingly opportunities in collaborative environment and autonomous practice

Q: What steps can a CDI manager take to help staff members feel there are opportunities for advancement at their own facility? 

JL: One thought is to implement a CDI career ladder program.  Another thought is to encourage the employees to build relationships with quality, HIM, case management, and other related departments within the facility as opportunities for advancement may exist and/or open up in one of them.  The specialized experience of a CDI professional along with the other skills one possesses would make for an appropriate transition during a needed time of new projects, etc.

 JG: As mentioned earlier managers need to provide different educational opportunities and tie those opportunities to overall process improvements within the program. Empowering staff to take ownership of their own career is also important.

Q: What are you looking forward to most at this year’s ACDIS conference? 

JL: I look forward to seeing the beautiful city of San Diego, those familiar smiling faces, and taking away at least one pearl of wisdom that will take me to the next level of CDI expertise.

JG:  Presenting about career ladders! I am also looking forward to all the networking opportunities the great educational opportunities. Our local chapter the Michigan ACDIS is having dinner together on Wednesday night and then Friday I’m looking forward to the great Local Chapter Networking Lunch and Event. Of course, I’m looking forward to the sunshine and visiting the Pacific Ocean.

Q: What inspired you to become an ACDIS conference speaker? 

JL: I felt compelled to share valuable insight from my recent CDI career change with my ACDIS colleagues.  I wanted others who may be considering a CDI job change to be even more equipped and informed than I was during my job search.

JG: I am very passionate about creating a career ladder for nurses in alternative practices, such as CDI.  Historically, clinical ladders have been developed for bedside nurses.  The development of the specialty ladder at Northern Michigan Regional Hospital was innovative and based on original literature search, and it has afforded all NMRH nurses equity and opportunity for professional advancement.

Visit the poster presentation at ACDIS in San Diego

ACDIS attendees take in the information at the 2011 conference poster presentation. This year nearly 24 presentations are being offered.

If asked, could you describe your CDI challenges and successes on a 36 X 48-inch poster? Some of your peers have done just that and will boast their programs at the 5^th Annual ACDIS Conference 2012 ACDIS Poster Presentation in San Diego.

The posters are a visual snapshot of program successes and offer you the opportunity to take tried-and-tested ideas back to your facility. Along with their posters, each presenter will provide a one-page description of the poster and the program it showcases.

Posters will be on display in the Elizabeth Foyer, outside the main conference and exhibit halls. We will be setting up later today, Wednesday, May 9, at 4 p.m., and a few will be installed early Thursday morning.

If you are attending this year’s conference, please make time to stop and view the posters, talk to the presenters, and ask questions. Your peers walk the same path you do and they can be an invaluable source of guidance.

If you cannot attend, don’t worry, we will be taking photos of the presentations and compiling a special report after the program so you can see all their hard work.

This year there are nearly 24 different presentations! Here is a list of what you can expect to see:

CDI program history and growth

• Analyn Dolopo, University of California San Diego Health, CDI Program Success
• Lisa Romanello, CJW Medical Center, The GPS of CDI
• AnnMarie Wells, CMC Main, CDI Growth in Evolving Health Care Industry
• Lynette Whitley, CMC Northeast, Program History
• Margaret Scott, Baylor Health, Inpatient Documentation Improvement Program
• Valerie Bica, Nemours-Alfred Dupont Hospital for Children, Pedi CDI, not a Medicare Program

Educational/promotional lessons

• Joi Freeman, Kindred Healthcare, Monthly Newsletter to Clinical Staff
• Cynthia Ziblis, St. Alphonsus RMC, CDI Newsletters and Educational Flyers
• Tim Weister, Mayo Clinic Rochester, CDI Education for Providers and Medical Students
• Diane Clement, Maine Medical Center, Advertise Your CDI Program

Multi-disciplinary enterprises

• Donna McIvor, KP Northern California, Remote RNs in CDI
• Wendy Platt, Baxter Regional Med Center, Using your Physician Champion to Captain Rough Seas
• Ellen Mitchell, Lutheran Medical Center,  Multi-disciplinary Effort to Improve Documentation
• Kara Masucci, Morristown Memorial/Atlantic Health, It Takes a Village to Reinvigorate the Program

Quality and mortality measures

• Michelle Johnson, Quality Metrics
• Alicia Gordon, Fletcher Allen, Mortality Scores and CDI Nurses
• Pam Florence, U Kentucky HealthCare and UHC, What Drives Mortality?
• Dawn LaRoque, Riverside Health, CDI Impact on Morality Scores
• Mary Shaughnessy, Northwestern Memorial, Mortality Metrics Improvement

Additional efforts

• Sylvia Hoffman, Hoffman Consulting, Avoid Leading Queries
• Tara Kreiling, St. Mary Medical Center, Solve the Documentation Puzzle
• Susan Tiffany, Robert Packer Hospital/Gurthie, Regional Network in Rural Community

And don’t forget to vote for your favorite poster on Thursday! You’ll get a ballot in your conference bag. The winner will receive a fabulous blue ribbon to hang on their poster and then take home as a forever reminder of the 2012 Poster Presentations.

Pre-Conference Q&A: ‘The Physician Advisor’s Role in CDI’

ACDIS Advisory Board member Trey La Charite, MD, co-presents a two-day preconference event regarding the role of the physician advisor in CDI efforts

Editor’s Note: This post is part of an ongoing series of Q&As with presenters and participants from the 2012 ACDIS Conference in San Diego. Today’s post features Trey La Charite, MD, ACDIS Advisory Board member and physician advisor for the University of Tennessee Medical Center who is co-presenting the ACDIS pre-conference session titled “The Physician Advisor’s Role in CDI: A collaborative approach for success.” The two-day session began today.

Q: How much time should a physician advisor dedicate to CDI efforts every week?

A: I hate to sound like I am deflecting but it truly depends on the size of the facility and the depth of the problem.  If you have a big hospital and nobody ever writes anything in the chart, you have a lifetime’s worth of work ahead.  If your facility only has 100 beds and most people already write reasonable notes, then you may only need just two to three hours a week.

In general, however, I would think that around 25 to 30 hours a month is a reasonable starting estimate with the understanding that this will likely grow as the wide-reaching effects of a CDI advisor are realized in the utilization review, quality improvement, compliance, and denial/appeal worlds.

Q: What are the top three reasons to employ a physician advisor who is specifically dedicated to documentation improvement?

1. Although this paints physicians in a negative light, most physicians simply take education, direction, and suggestion better from other physicians.  Unfortunately, many physicians will just not listen to a nurse, HIM personnel, or an administrator.
2. CDI programs need a constant, positive, and visible example of someone “walking the walk” as opposed to just “talking the talk.”
3. The need for tying a program to a face.  The medical staff may take a new endeavor more seriously if they know this is “Dr. So-And-So’s program.”

Q: What are three of the CDI physician advisor’s primary tasks?

1. Medical staff education
2. Being a visible example of following all CDI principles (definition usage, creating excellent notes, etc.)
3. Establishing program direction and providing guidance

Q: What is the greatest obstacle to hiring/employing a physician advisor?

A: The fear of being seen as someone who has been seduced by the dark side of the force (i.e. – administration in the C-suite).

Q: What are you looking forward to most about this year’s ACDIS Conference?

A: Learning from other CDI professionals how they achieve CDI success in their facilities.