All Entries in the "Advisory Board" Category
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.
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?
- 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.
- CDI programs need a constant, positive, and visible example of someone “walking the walk” as opposed to just “talking the talk.”
- 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?
- Medical staff education
- Being a visible example of following all CDI principles (definition usage, creating excellent notes, etc.)
- 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.
Pre-Conference Q&A: ‘The Physician Advisor’s Role in CDI’
James S. Kennedy, MD, will present a two-day pre-conference regarding the role and responsibilities of physician advisors for CDI.
Editor’s Note: Over the coming days and weeks, we will post a series of Q&As with presenters and participants from the 2012 ACDIS Conference in San Diego. Today’s post features James S. Kennedy, MD, CCS, ACDIS Advisory Board member and a director at FTI Healthcare in Brentwood, Tenn. Kennedy will co-present the ACDIS pre-conference event titled “The Physician Advisor’s Role in CDI: A collaborative approach for success.” The two-day session takes place Tuesday and Wednesday, May 8-9, 8 a.m. to 4 p.m.
Q: What role should CDI physician advisors play in audit review and data analysis?
A: Clinical Documentation Improvement (CDI) physician advisors are critical to the entire process of ensuring the integrity of coded administrative data (ICD-9-CM and CPT) and its application to physician and hospital quality and cost efficiency measurement.
CDI is the process of preventing and reconciling inconsistent, incomplete, imprecise, conflicting, or illegible documentation to bridge the gap between treating physicians and coders. Physician advisors must be able to analyze data derived from these codes to target their efforts and should review the results from documentation audits as to hone their message.
Examples of these activities include:
- Data Analysis: ICD-9-CM coded administrative data is primarily used to determine, measure, and report severity and risk adjusted outcomes and cost data for various metrics. These include cost, length of stay, complications, mortality, readmissions, and the like.
Risk and severity adjustment means that the actual metric being measured (observed) is compared to the likelihood of that metric occurring (expected). CDI ensures the integrity of the expected metric, usually increasing it since many clinical descriptions are incomplete or imprecise, thus reducing the risk-adjusted metric.
Take for example the Colorado Hospital Report Card. Note that Colorado reports an actual mortality rate and a “risk-adjusted” mortality rate. There are instances when the risk-adjusted mortality is less than the actual mortality since the death rate is less than expected. There are others, however, where the risk-adjusted mortality rate is higher than the actual.
Another aspect is measuring complications of care. Some facilities code incidental serosal tears as “accidental lacerations.” Physician advisors would want to analyze Patient Safety Indicator data at their hospitals (e.g. from Thomson-Reuters, the Delta Group, and the like) to determine if the data driving these metrics is accurate.
For example, look at the website “CareChex,” a division of the Delta Group, to see how it ranks overall surgical care in Chattanooga, Tenn.
Physician advisors should partner with their chief quality officer to learn how these risk-adjustment methodologies work and how the definition, diagnosis, documentation, and coding of these conditions factor into them.
Armed with this information, the physician advisor can help develop systems that work with providers to accurately capture these metrics.
- Chart Audit: Physician advisors are integral to the chart review, given that they recognize the clinical scenarios that are often not documented completely and precisely. Imagine a patient admitted with a pH of 7.02, pCO2 of 100 and a pO2 of 40 and stupor requiring mechanical ventilation but only described as respiratory insufficiency with CO2 narcosis. This patient has acute hypercapnic respiratory failure and could potentially be labeled as having a metabolic encephalopathy. The physician advisor recognizes these scenarios and can help concurrent reviewer and coders recognize the circumstances whereby query would be prudent.
AHIMA published a nice summary of the role of the physician advisor, and you read more about the role in the January edition of the CDI Journal.
Q: How can a physician advisor help achieve buy-in from the medical staff for CDI efforts?
A: The best ways I know to achieve buy-in from the medical staff are to:
- Make CDI an academic exercise, emphasizing the definitions of clinical conditions. These can include:
- Transient ischemic attack versus stroke. Note that the 24-hour time frame is completely eliminated.
- Acute myocardial infarction vs. accelerated angina. Note the critical role of properly calibrating troponins and equating elevated levels with “symptoms of ischemia.”
- Acute kidney injury. Note that it is only a rise of the serum creatinine of only 0.3 mg/dl
- Ask the quality officers of your hospitals to generate individual physician reports regarding their own cost efficiency and outcomes, outlining the actual and the expected outcomes. Should a physician see that their expected mortality rates is higher than expected and that CDI is a strong solution addressing the “expected” component, his or her participation and interest is likely to increase!
Q: How involved should the physician advisor be in the day-to-day operations of the CDI program?
A: Given that most physician advisors have their own private practices, they do not need to be involved with the direct day-to-day operations of initiating queries. They should, however, be available at designated times to support concurrent reviewers and coders regarding the clinical circumstances assessments of clinical situations requiring query and to aid in their construction.
If at times a physician does not respond, the physician advisor may potentially have a collegial conversation about a query. One must be cautious, however, to frame this conversation about defining a patient’s condition without putting the physician on the defensive.
One of the fun things a physician advisor can do is support the development of the electronic medical record as to make the capture of complete and precise documentation less onerous to the practicing physician.
Q: What are you looking forward to most about this year’s ACDIS Conference?
A: Wow….what’s not to look forward to? ACDIS is everything a CDI professional, coder, or physician advisor would want—clinical conversations, problem solving, medical informatics, and collegial interaction with like-minded individuals working to solve the challenges we all share.
It’ll be great to be with old friends and make new ones! Not to mention that all this occurs in downtown San Diego, in a phenomenal setting (this is a beautiful hotel), right next to Balboa Park (let’s rent a bicycle and ride!) and close to Sea World, the ocean, and all that makes southern California great!
I must say, however, that the most anticipated event for me is the Physician Advisor pre-conference where Dr. Trey LaCharité and I spend two days training physicians from all over the nation to understand and embrace CDI principles.
I feel that this contributes to the professional practice of medicine and empowers physicians to successfully negotiate healthcare reform. Needless to say, I’m very excited about the conference!
ACDIS advises members to ‘stay the course’ despite potential ICD-10 delay
ACDIS Advisory Board recommend facilities continue with ICD-10 preparations.
As I’m sure most of you are aware, The Department of Health and Human Services (HHS) has proposed a one-year delay of ICD-10-CM and ICD-10-PCS. You can read the complete release here http://www.gpo.gov/fdsys/pkg/FR-2012-04-17/pdf/2012-8718.pdf. The go-live date for which most of us were preparing—October 1, 2013—is now extended to October 1, 2014, barring any last-moment changes.
According to CMS, many provider groups had expressed serious concerns about their ability to meet the initial Oct. 1, 2013 compliance date. The proposed change in the compliance date for ICD-10 will give providers and other covered entities more time to prepare and fully test their systems to ensure a smooth and coordinated transition to these new code sets.
ACDIS would like to offer the following guidance for our members:
Stay the course with ICD-9 and ICD-10 documentation education. Hospitals continue to struggle with documentation and coding requirements under ICD-9; the best way to prepare for ICD-10 is to perform ICD-9 correctly and negotiate the differences between it and the new coding system. Regarding the best time to begin ICD-10 training: We’ve heard anecdotal evidence of hospitals moving out their ICD-10 training dates for their coding staff, which is understandable. However, an industry-wide recommended first step is ensuring that additional required physician documentation is in place for HIM/coding staff. Getting the additional specificity necessary under ICD-10 now is a good way to ensure a seamless transition to October 1, 2014. CDI specialists should use this time to improve their core competencies and knowledge base of ICD-10.
Provide commentary to CMS. Commentary on the proposed rule is open for 30 days starting on Tuesday, April 17. If you feel strongly that the one-year delay should not be implemented, or if you believe that the one-year delay will benefit your hospital, let CMS know by providing your comments at regulations.gov. CMS reviews all provider comments, and who better to hear from than CDI specialists, for whom the change to ICD-10 will be of the greatest impact. To comment on the proposed delay to ICD-10, click the following link to the Federal Register http://www.regulations.gov/#!documentDetail;D=CMS-2012-0043-0001 and click the “Submit a Comment” button. Comments are due on May 17, 2012 by 11:59 p.m. ET.
The clash of clinical vs. coverage/payment concerns
by Trey La Charité, MD
Auditors are increasingly looking at medical necessity denials but shouldn't the physician make the decision about whether the patient needs to be admitted?
In the aggressive post-discharge auditing environment where I now find myself practicing medicine, I and my colleagues are subject to heavy scrutiny by CMS and private insurers. Observation versus inpatient status review is the new focus of these non-clinician auditors and has become the reason for the vast majority of my facility’s denials. This new auditing pressure we all face stems from the completely noble idea that reductions in fraud, abuse, and improper payments will preserve resources for those who truly need medical care. Sadly, as with many commendable aspirations, the execution is poor and often produces a dismal result.
As the physician advisor for CDI, I have been diligently educating every physician at my institution about ensuring the medical necessity of our inpatient admissions. But while CMS asserts that the admitting physician is solely responsible for status selection (i.e., inpatient, outpatient, or observation status), admission status for the physician has no clinical relevance. Physicians do not recognize “conditional” or “partial” admissions, which observation status implies. As far as physicians are concerned, their patients either medically need something or they don’t.
The rules concerning inpatient versus observation status selection are not newly created; CMS’ vague guidelines for
appropriate status selection have been around for years. The difference is that CMS and other payers suddenly discovered that they can extend their existing financial resources by “enforcing” those rules. Payers and their related auditing agents have traditionally avoided the question of whether a patient actually needed the medical care that was provided. Instead, they simply point to inappropriate status selection and deny the associated claim. The issue is whether physicians should be contemplating a patient’s admission status at all.
Editor’s Note: This article is an excerpt from the quarterly publication for ACDIS members the CDI Journal. La Charité is a hospitalist and physician advisor for CDI and coding at the University of Tennessee at Knoxville, and an ACDIS Advisory Board member. Contact him at Clachari@UTMCK.EDU.
Introducing new CDI Education Director
Hello everyone,
I’d like to take a moment to introduce Cheryl Ericson to the ACDIS membership as our new CDI Education Director.
Cheryl Ericson
Cheryl is an MS, RN, and CDIP (and soon to be CCDS). She is a former CDI manager and oversaw utilization review and CMS quality measures at The Medical University of South Carolina (MUSC), a large academic medical center. She has an extensive background that includes adult education, data analysis, knowledge of the healthcare revenue cycle and CMS guidelines, as well as certification as an InterQual instructor. She also has experience with RAC audits and denials.
Cheryl is a member of the ACDIS advisory board and has served on many ACDIS work groups. She served on the American Health Information Management Association (AHIMA) ICD-10 work group and was a contributor to the new AHIMA exam for CDI. She also contributed to the development of the CDI toolkit and coauthored the 2010 AHIMA CDI practice brief.
As our new CDI Education Director, Cheryl will be responsible for teaching our four-day CDI Boot Camp and our upcoming two-day ICD-10 for CDI Boot Camp in addition to answering your CDI questions and helping us improve our association overall. Her broad range of experiences makes Cheryl an invaluable asset to our ACDIS team and we look forward to sharing her vast knowledge and experience with you in the future. Contact her at cericson@hcpro.com. Please feel free to leave her a welcome message in the comments section below.
Thanks,
Brian
CDI ‘Roadmap’ committee charts program priorities
Don't get lost on the road to success. The CDI Roadmap Committee will offer direction for new programs.
Although you might not have heard of it before, ACDIS has formed a group called the CDI Roadmap Committee to help develop and define some of the core structures that the CDI profession has been lacking. These include the broad goals and objectives of CDI, staffing and productivity considerations, setting new goals for mature programs, and a realistic structured outline to help map out the way.
The CDI Roadmap Committee has been meeting since September 2011. The committee currently consists of the following members:
- Glenn Krauss, RHIA, CCS, CCS-P, CPUR, FCS, PCS, CCDS, C-CDI, ACDIS Advisory Board Member, Independent Revenue Cycle Consultant in Madison, WI.
- Lynne Spryszak, RN, CCDS, CPC-A, ACDIS Advisory Board Member and independent HIM consultant in Roselle, IL.
- Donna D. Wilson, RHIA, CCS, CCDS, ACDIS Advisory Board Member and Senior Director of Compliance Concepts, Inc. in Wexford, PA.
- Cheryl Ericson, MS, RN, ACDIS Advisory Board Member and CDI manager for Medical University of South in Charleston, SC.
- Gail B. Marini, RN, MM, CCS, LNC, ACDIS Advisory Board Member and CDI manager for South Shore Hospital in Weymouth, MA.
- Beth Kennedy, RN, BS, CCS, CCDS, Associate Director, Documentation Improvement Program CMO, The Care Management Company, LLC., Montefiore Medical Center in Bronx, NY.
The majority of the group’s first meeting was spent discussing the purpose and intent of the group and defining both short and long-term objectives. The committee determined that its objective is to create a phased approach to CDI success. The team decided to develop a pre-implementation timeline/checklist, then took a deeper delve into the goals/objectives of a basic CDI program and requirements and expectations for staff.
At subsequent meetings members offered drafts of a pre- implementation checklist with items such as assembling a steering committee and an outline for developing a project plan. The group also discussed sample orientation checklists, collected job descriptions for physician advisors, CDI supervisors, and CDI specialists, and discussed potential CDI evaluation criteria and assessment of CDI staff coding and clinical skills.
The CDI Roadmap Committee will likely break after it completes the “pre-implementation” and “implementation” phases of the timeline, and continue work on “ongoing maintenance” and “advanced level CDI” phases at a later date.
The committee plans to send its work to the ACDIS advisory board for approval and compile its findings in a series of White Papers available as free resources to the ACDIS membership.
Editor’s Note: This article first appeared in the March 15 edition of CDI Strategies.
New Advisory Board members chosen
Susan Belley
Susan Belley, M.Ed., RHIA, CPHQ
Project Manager
3M HIS Consulting Services
Atlanta, GA
sebelley@mmm.com
A project manager within 3M HIS, Belley has more than 30 years experience in HIM performing a variety of roles in academic medical centers, multi-hospital systems, and teaching institutes ranging from 200 to 1,300 beds. She has direct experience in managing coding and data abstraction, auditing, accounts receivable (A/R), case mix index management, clinical documentation improvement, corporate compliance, quality management, converting computer systems (transcription, coding, and master patient index), and electronic medical record implementation.
Belley is responsible for development of new service offerings and content development for educational programs and software for 3M HIS Consulting. These include the ICD-10 Claims Impact Analysis, ICD-10 Modeling and Translation Services, ICD-10 Comprehensive Assessment and Roadmap Service, ICD-10 Documentation Assessment Service, and Clinical Documentation Improvement System software and data monitoring tools. These tools provide comprehensive case mix index and profiling analysis to assist hospitals in improving quality outcomes, ensuring the accuracy of performance reports, and achieving appropriate reimbursement.
Belley has taught coding for 20 years (ICD-9-CM, CPT-4 in an accredited HIM program) and is an experienced coding auditor for inpatient services. She holds a post-graduate certificate in Healthcare Corporate Compliance from George Washington University in Washington, DC.
Timothy Brundage, MD
Timothy N. Brundage, MD
Physician Champion
Kindred Hospital North Florida District
St. Petersburg, FL
DrBrundage@gmail.com
Brundage has served as the medical director for case management and CDI departments for Kindred Hospital Central Tampa since 2004 and became the physician champion for its north and central districts in 2008.
At Kindred, he acts as a liaison between the case management department and the attending physician and helps to render opinions regarding admission status based on Interqual criteria and sound medical judgment. In addition, Brundage reviews patient charts selected for Medicare audits and prepares for admission audits and RAC record reviews.
Brundage is in active practice as a hospitalist at St. Petersburg (FL) General Hospital where he teaches resident physicians through daily hospital rounds, reviews their documentation, proofs their dictated history and physicals, discharge summaries, and progress notes. He is also a Diplomat of the American Board of Internal Medicine.
Fran Jurcak
Fran Jurcak, RN, MSN, CCDS
Director, CDI Practice
Huron Healthcare
Chicago, IL
fjurcak@huronconsultinggroup.com
Jurcak has more than 25 years of experience as a nurse, nursing professor, and consultant, with clinical experience in critical care and emergency medicine. Currently a director in the CDI Practice at Huron Healthcare, Jurcak has helped implement CDI programs in more than 50 hospitals in the past five years. Prior to joining Huron Healthcare, Jurcak was a project manager for J. A. Thomas & Associates providing clients with assessment of CDI opportunities, implementation of CDI programs, and ongoing CDI education and program support.
Her expertise encompasses utilizing outcome data to mentor and train staff in providing strategic direction and application. Jurcak taught as an assistant professor of nursing at Madonna University in Livonia, MI, for more than 15 years, and earned recognition as “Faculty Advisor of the Year” in 2006.
Jurcak obtained her CCDS in 2009. She is the author of The CCDS Exam Study Guide, serves on the CCDS Exam Advisory Board, and is a member of the Michigan chapters of ACDIS and HFMA.
Dee Schad
Dee Schad, RN, BSN, CCDS
Director Care Coordination and CDI
Clark Memorial Hospital
Jeffersonville, IN
dee.schad@clarkmemorial.org
With more than 17 years nursing experience and more than 12 years specializing in CDI, Schad currently serves as the director of care coordination and CDI at Clark Memorial Hospital in Jeffersonville, IN. She is actively involved in the hospital’s ICD-10 assessment and preparation, integrating physician education and CDI efforts into the process. She also is a member of her facility’s RAC and utilization review committees.
Schad’s CDI experience includes the implementation of new CDI programs, managing a multi-facility program, and CDI software implementation. Her area of focus is staff and physician education with an emphasis on engagement.
Schad earned a certificate in coding technology from Indiana University in 2009 and a Bachelor of nursing degree from Indiana University in 1995. An ACDIS member since 2008, she is the founder and current president of the Kentucky/Southern Indiana ACDIS chapter growing its membership to more than 60 professionals in under two years. She also served on the 2011 ACDIS National Conference Planning Committee.
ACDIS Advisory Board final nominees: Cast your vote
If you are an ACDIS member please vote for four new volunteers to represent you on the Advisory Board.
Voting is now open for four ACDIS advisory board positions, for terms of service starting in 2012 through the end of 2014. Log on to the ACDIS website to select the four candidates you believe are the best fit for the association, and then cast your vote.
The results of the election will be announced in early February.
ACDIS advisors are important, volunteer positions that help shape the direction of the association and provide leadership, expertise, and representation for the membership. The term of service is a maximum of three years.
The voting page includes the nominees’ background in CDI and information on why they are seeking election. The vote will close end of business day on Tuesday, January 31.
If you have any questions, please e-mail ACDIS Director Brian Murphy at bmurphy@cdiassociation.com.
Brian Murphy, CPC
Director
Association of Clinical Documentation Improvement Specialists (ACDIS)
200 Hoods Lane
Marblehead, MA 01945
781-639-1872, ext. 3216
bmurphy@cdiassociation.com
