Author Archive for Melissa Varnavas

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:”

1. If it is a complication of surgery, it is either a complication or surgery
2. If it is a manifestation of a disease unrelated to the surgery it is not a complication of the surgery
3. If it is not treated it may not be codable—but it may

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.

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.

2010 ACDIS Conference agenda set

It’s been a real pleasure to be a part of the 2010 ACDIS Conference Committee, the 12-member volunteer group planning the annual conference behind the scenes, especially since we’ve completed most of the hard work and can move on to some of the more fun planning items.

The 2009 ACDIS Conference Committee did a great job. I'm looking forward to Chicago so I can capture a photo of my new 2010 committee friends.

ACDIS sent out the call for presentations shortly after the 2009 conference concluded. A record number of respondents offered a true plethora of programs to choose from so the group had some due diligence and research to do. From the list of nearly 40 speakers, each committee member picked his or her top 15 choices.  ACDIS Director Brian Murphy compiled their responses and when the group reconvened everyone discussed the results.

The 2010 conference June 3-4 at the Hyatt Regency in Chicago will follow a similar format to previous years. It features two general sessions, a closing session question and answer panel, and 18 breakout programs for a total of 21 sessions. Highlights include programs on physician advisor strategies, risk adjustment for Medicare’s mortality and readmission indicators/AHRQ patient safety and inpatient quality indicators, performing CDI in outpatient ED setting, data mining, and tips to enhance the CDI program, among other topics.

The committee’s work continues, however. In the next few months we will explore opportunities for a poster session and develop ideas for some extracurricular fun. Sure a day of intensive learning is it’s own reward, and we will be in the beautiful Windy City, but you know what they say about all work and no play… so, stay tuned for more details on the way.

Northern Illinois CDI Network meets Nov. 5

Our friends in Northern Illinois have been gathering regularly for more than two years now, and

St. Alexius Medical Center is the site of tomorrow's IL meeting.

were a tremendous influence in the organization of the larger Association of Clinical Documentation Improvement Specialists.

I would be remiss if I didn’t give them a “shout out” about their meeting tomorrow. I am sure that the gathering at St. Alexius Medical Center in Hoffman Estates, IL, will be just as successful as all the earlier Prairie State meetings.

Here’s a copy of the agenda:

• Donna Kennedy- Compliance issues affecting CDI process
• Jonathan Becker- Monitor/measuring CDMP program
• EHR- Electronic Health Record- Impact on CDI
• RAC- discovery of clinical documentation queries
• Linnea Thennes and Colleen Stukenberg-ACDIS local chapter
• Working process between CDS and Coders working from home
• Misc

Three New York groups gather in December

My alma mater. I used to study on this lawn in the spring.

I went to school in Westchester County,  New York, a 20-minute train ride from New York City, at the College of New Rochelle, in New Rochelle, NY. (The city most famously known as home to the Dick Van Dyke Show.)

So I was particularly pleased when Ann-Marie Carducci, RN, MPA, CPHQ, CPUR, CPC, CCS, director of utilization management at Montefiore Medical Center in the Bronx offered to get a local group going in the area.

But it’s been a bit of a bumpy ride and sadly with workload increases and additional responsibilities, Ann-Marie needed to pass the baton over to Deanna Holowczak, BSN, RN, Clinical Documentation Specialist, at Riverside Healthcare System in Yonkers. Deanna’s currently studying to earn her master degree in nursing administration while she juggles a number of other responsbilities. So thank heavens for the addition of  Luanne Jennex, RN, clinical documentation specialist over at Westchester Medical Center, in Valhalla, who met with Deanna and agreed to help launch the first meeting of the Westchester County NY ACDIS group.

Luanne is also in school, finishing up her final courses on her way to earning her BSN, with a master degree potential. “Imagine that after 34 years of nursing?” she jokes.  It just goes to show, she says, “you can teach an old dog new tricks.”

So, after some months of diligent grassroots networking efforts the Westchester group is ready to go, looking forward to hosting its first meeting in December. Anyone intersted should contact either Deanna or Luanna at their e-mail addresses above.

In a blog post yesterday, I talked a little bit about the geographical difficulties in getting a local networking group going. Like California, New York defies easy categorization. According to the state Web site, New York contains nearly 50 counties and more than 1,000 cities, towns, and “villages.”  From New York City to Albany is 159 miles. The drive takes, according to Google maps, a mere 2.5 hours; roughly the same amount of time it takes to drive from the end of Long Island into the Big Apple. From Buffalo to Yonkers its a 408 mile commute.

When I went to school in New Rochelle I could make it out to Long Island for visit in about an hour, but I was a crazy college kid back then. Most seasoned residents know enough not to undertake such a drive.

So I appreciate the importance of Adelaide M. La Rosa’s efforts in Roslyn, NY. A registered

Long Island ACDIS promises to go the distance for networking needs.

nurse and director of the Clinical Documentation Improvement Program over at St Francis Hospital, she’s been gathering the names and contact information of interested CDI specialists for a few months now and is also ready to host the Long Island NY ACDIS Chapter’s first group meeting.

What I particularly appreciate about both these groups is their flexibility. Not only are they willing to volunteer to help their CDI peers but they’ve also expressed a willingness to include any CDI professional into the meeting that wants to come. So while there is currently no ACDIS groups in Queens or Manhattan for example, those who would like to make the trek off the big island and over to the long one are more than welcome, Adelaide says. The same holds true for our Westchester County hosts.

A great view of the Albany skyline. Join CDI specialists there for the December meeting.

There’s a similar story to tell about our third New York group being fashioned by Lois Rubin RN,  BSN, CPUR, CCDS, Lead Clinical Documentation Specialist at St. Peters Hospital, up in Albany. Lois received a great response to initial inquiries about an ACDIS meeting in northern New York. Such a good response, in fact, she worried about the logistics of gathering such a diverse group of people. Nevertheless, she’s courageously forging ahead and plans to host the first meeting during the third week of December.

Such wonderful efforts on behalf of the profession are just another reason we are so energized by local chapter growth in general and in New York in particular.

If you are interested in getting a networking group going in your community please contact me at mvarnavas@cdiassociation.com.

California ACDIS meetings underway

California encompases more than 150,000 square miles.

California (163,696 square miles) contains nearly 60 counties and no less than 12 “regions,” according to the state park Web site, whose motto is “Discover the many states of California.”

It’s wise advice. For the past few months a number of ACDIS members worked diligently behind the scenes to organize local CDI gatherings in what Gov. Arnold Schwarzenegger calls “The Great State of California.” Initially, some said the state was just “too big” geographically for networking to work. After all, San Bernadeno County alone contains three million acres. The city of Los Angeles has the fourth largest economy in the United States.

This is a big state.

Fortunately, CDI professionals are not easily deterred. On Wednesday, October 23 the Central California ACDIS Chapter held its first meeting. Next week, on Tuesday, November 10, at 1 p.m., the Northern California ACDIS Chapter will meet.  Plans for a Southern California ACDIS Chapter meeting are underway.

Sure, it’s true some states are more geographically challenging than others. But we’re seeing groups in Washington (71,342 square miles), New York (54,556 square miles), and yes, Texas (268,820 square miles) too. In New York City it can take more than an hour to drive from one borough to the next. But a drive from the tip of Long Island to the center of Manhattan takes just under two and a half hours (I’ll post more about developments in the Big Apple tomorrow). In California, too, they throw away the mileage measure in favor of the traffic report and the hour count.

Just as each geographic area presents unique meeting challenges, each area also presents unique clinical documentation improvement challenges.  Payment methodologies and intensity of government scrutiny is not the same in Oregon as it is in Kansas. Such difficulties are one of the primary reasons we believe local networking is so important.

Even if a first meeting starts with five CDI specialists sitting  in a restaurant talking about the difficulties of their day it helps! The primary intention of ACDIS chapters is to foster networking opportunities for CDI professionals, to establish a community of peers a CDI specialist can turn to, to talk about fears and concerns.

Ultimately, California CDI specialists decided to start with a single overarching California ACDIS group that will provide regular “virtual” meetings and three so-called “local” groups for the aforementioned areas. We expect and quite honestly hope that other, even more local, groups will soon grow to meet the diverse needs of CDI in the state.

We are so proud to be able to announce the formation of the California ACDIS Chapter.

For information contact:

Adriana van der Graaf, MBA, RHIA, CCS, CHP, National Director, Healthcare Reform Services at Integrated Revenue Management, who hosted the first Central CA ACDIS Chapter and will help organize the state-wide meetings. Contact her by phone at 760/448-1063 or by e-mail at avandergraaf@irminconline.com.

SheRee P. Garcia , RHIA, CHP, director, Health Information Management Services at UCSF Medical Center, who volunteered to host the first Northern CA ACDIS meeting. Contact her by phone at 415/353-2885 or by e-mail at sheree.garcia@ucsfmedctr.org.

Gloria S. Noell, RN, CCM, HCQM, CPUM, director of care management at Providence Little Company of Mary joins Wendy De Vreugd, RN, BSN, PHN, FNP, CCDS, senior director case management at Kindred Healthcare Hospital Division, West Region to gather CDI for a Southern CA ACDIS session. Contact Noell by phone at 310/500-6272 or by e-mail at Gloria.Noell@providence.org. Contact De Vreugd by phone at 714/899-5020 or by e-mail at wendy.devreugd@kindredhealthcare.com.