All Entries in the "Boot Camp" Category

CDI specialist orientation (more CDI Talk inspiration)

One of the repeated conversation themes on CDI Talk is how to orient a new staff member (within an existing program), or how a small program can start its own CDI efforts and train its own staff. Parallel to those conversation threads are participants’ real hunger for more avenues and sources of education.

Let’s look at some of ACDIS’ online poll data to set the stage:

• July 2011: How many total years of professional experience do you have in healthcare (CDI, plus other)?
• 20 years or more, 60%
• November 2009: How long did it take you to get up to speed as a new CDI specialist?
• 3 to 6 months, 32%
• 6 to 12 months, 34%
• June 2011: How long do you think it takes to achieve an “expert” level of proficiency as a CDI specialist?
• 2 years, 35%
• 3 years, 22%.

And here’s one  final on-line poll data point to help me answer the question as to whether CDI managers are actually providing enough training to new staff members:

• January 2011: How long is your training period for new CDI specialists?
• 12%, 2 weeks
• 22%, 30 days
• 30%, 31 to 60 days
• 20%, 61 to 120 days
• 12%, approximately 6 months
• 3%, less than 6 months

It seems to me that those who indicated that it takes six months or more to get up to speed need more training than what I commonly consider necessary as part of orientation.  This data suggests that what is these new CDI specialists need is more of a mini-college training program.

Obviously there is a rather significant challenge—how to provide the level of knowledge and training along with the

(Image via Homeclick) It is a sink that is made so fish swim in it. Get it? Sink or swim.

appropriate mentoring to actively promote and support the new CDI specialists so they can succeed. Of course, there is always the consultant option which proves to be relatively expensive. Plus, a ‘mature’ program should not need to rely on such an expensive option for new staff orientations. At the opposite end of the spectrum is the ‘sink or swim’ method.

Thankfully, home grown and self-supported possibilities exist to constitute a middle ground between these two options. At the very least, facilities should implement an orientation or mentoring process where the experienced individual’s guidance can make a huge impact.

I believe the biggest challenge facing those hoping to implement a CDI orientation program comes from a lack of targeted, written learning resources. I consider one of the largest draws for ACDIS membership stems from the need for learning, resources, and accessibility to a community of knowledgeable and supportive peers. ACDIS provides such a community, with a quickly growing resource base. (If you’re a member, you ought to know. If not, go look at every part of the ACDIS home page).

In addition, ACDIS offers a few helpful handbooks and guides that can be re-purposed for orientation, such as:

• The 2012 CDI Pocket Guide
• The CCDS Exam Study Guide
• The CDI Specialists Handbook, second edition
• The Physician Queries Handbook

Furthermore, the only independent (i.e., not part of a consulting package) seminar I’ve found is HCPro’s CDI Boot Camp. While the total cost (fee, travel, hotel) may be prohibitive for many there is also the online version as an option. Again, a mature CDI program ought to be able to handle at least some of the orientation process internally.

Even with the valuable resources of ACDIS, some holes in new staff orientation remain. AHIMA and AHA’s Coding Clinic for ICD-9-CM provide further guidance, but even those resources do not cover everything. Several major elements of an orientation program are not addressed by the resources mentioned.  Just to get started, how about:

• Creating a tool that outlines in detail basic competency and knowledge expectations for the novice CDI specialist. This tool should also list areas for mid-level and advanced achievements to give new CDI staff a set of expectations for continued professional growth. There are some examples in the Forms & Tools Library, in the policies and procedures section (search for “staff orientation checklist), but not at the detail I envision.
• Curating a collection of vital subject articles and references. (Review the CDI Journal archives, the ACDIS Blog, and the Helpful Resources links just to get started on this collection. Add in other professional organizations and their publications such as the National Institutes of Health, AHIMA, AMA, and others and this would be a one-stop database of useful CDI knowledge.)
• Creating an outline of topics that the new CDI specialist needs to master before achieving their initial competency. Further, this outline ought to provide enough detail and referenced sources to serve as a complete training program guide.
• Sources would likely include the books and articles mentioned immediately above, along with sections of widely accepted texts such as coding guidelines, Faye Brown, and medicine texts like the Merck Manual.

Before starting to collect all those articles and tools, though, I should probably determine the basic elements of an orientation program! Below I’ve listed a few resources online which discuss this, including:

• The five key elements of a good orientation program
• The Community Tool Box: Developing Staff Orientation Programs
• Making New Employee Orientation a Success

After reviewing these, I must confess that my definition of orientation varies from those discussed above.  Still, several points are important to keep in mind to successfully bring a new staff member up to speed in the CDI world:

• Provide structured, purposeful training
• Offer a straightforward sequence of topics or activities to enable learning
• Give new staff members a written agenda complete with goals and measurable objectives
• Provide ongoing, two-way feedback and evaluation
• Supply appropriate resources and support
• Actively integrate the new person into the team
• Celebrate and welcome the individual and his/her accomplishments as they gain proficiency in their new role
• Pair new staff with an experienced mentor and provide oversight of their engagement
• Offer engaging, interactive, as well as some self-directed education

However, as mature and professional learners, CDI specialists must be responsible and accountable for their education and success.

Honestly, for a new or developing program that has to add or replace staff, the right consultant is worth the money.

At some point CDI programs need to be able to hire new staff and train them in-house. Creating a comprehensive training program does require a lot of effort and maybe it is work that some of you have already done?  If so, why duplicate work? Let’s see if we can compile a  “best of” list of what program components others have found successful and create a tool that we can share. Post your information here to the blog, e-mail me, or contact Associate Director Melissa Varnavas mvarnavas@cdiassociation.com

Q&A: How to resolve DRG confusion

Q: Confession. I am very frustrated. I am fairly new to CDI. I have a nursing background. I’m trying to understand how

Learning how to navigate the coding and DRG landscape can be daunting. Don't worry. Others have had to learn this too. Ask for help and know you are in good company.

the coding and DRG system works. But when I look up a diagnosis in the DRG Expert in the alphabetic index to diseases it is not listed as I would expect it to be.

Take for example, bradycardia. It is not listed under that term or arrhythmia.  Yet, it is listed under cardiac arrhythmia. For another example, how about anorexia? The only listing is anorexia nervosa—not unspecified.

I also find it ironic that I cannot infer what a physician is stating (it has to be documented precisely) but when I have to look up a term I have to guess its meaning.

Do you have any advice for me?

A: Your frustration is very common among new clinical documentation improvement (CDI) specialists.  The publishers of the DRG Expert did not include the same type of Index to Diseases that you would find in Volume I of an ICD-9 code book—probably to save space. The Index to Diseases alone in my code book is 380+ pages.

This is one reason that during the CDI BootCamp I mention so many diagnoses as we review Medicare Severity Diagnosis-related groups (MS-DRGs) in a major diagnostic category (MDC) and either have you highlight them or write them in, because I, too, had exactly the same issues you are having.

Every CDI team should also have a coding book in their department to use as a reference (ask your facility HIM department if they have an old one you can have), especially if you do not have access to the encoder (coding and reimbursement software), which would let you look up whatever you wanted—however, even that has limitations, because search terms often use “coding language” rather than the everyday language of clinicians.

As far as your comment regarding the irony of the situation, all I can say is “Right on, girl!”  It is the reason we have taken on this role. We were hired to become the “translators” or “interpreters” to ensure that the clinical language matches the language needed by the coders. Acquiring the skills to understand both of these languages, along with the ability to translate from one to the other, is what makes us, as CDI professionals, unique.

As a final note, I just want to share that my very first DRG Expert was COVERED from end to end with handwritten notes, stickies, and slips of paper. I used this book for three years, copying my info into each new edition until I was granted encoder access. Every time I asked a coder where to find something I wrote it in the book—especially those diagnoses that had really strange “code” descriptions.

I hope that I can assure you, that by this time next year, you will have many of these coding terms memorized.

I tell all my CDI BootCamp students that there is a long learning curve to this position, so don’t worry. While some people catch on quickly, for most it may take up to six months before that proverbial light bulb finally goes on and frequently it takes up to a year to feel confident in the role.

Don’t get discouraged. Most CDI specialists will tell you the same thing! Before you know it, you will find yourself sitting in traffic, converting license plate numbers into DRGs or diagnosis codes.

Tales from the Classroom: Abandoning the CC/MCC emphasis

Look for complete documentation in the medical record not just for diagnoses and conditions that improve DRG assignment and increase reimbursement.

As the lead instructor of HCPro’s CDI Boot Camp I have the opportunity to teach new and old (or, rather, experienced) CDI specialists in a live classroom setting. I primarily teach what we call our “open-reg” (that’s shop-talk for open registration) classes which are offered at various dates and locations around the country. However, I am also frequently asked to teach the CDI Boot Camp for a specific facility or a local group of hospitals or hospital system. (In shop-talk, we call this an “onsite” class.) Sometimes the students are all from one facility and other times three (or more) local hospitals band together to bring the CDI Boot Camp to their area.

For those of you who haven’t met me or heard me teach, I am a huge advocate for CDI specialists, whether they are coders, nurses, physicians or mid-level providers (nurse practitioners, physician assistants). I have had all of these types of students in class and I like to think that everyone who comes to my classes takes away at least one thing they can use to improve their program or do their job better.

As someone who has done the job (I was previously the CDI reviewer/manager for a 400-bed acute care facility) I think I am able to address the reality (and the frustrations) of working in the CDI role on a daily basis. And I should say that I see the CDI role as one which affects long-lasting changes in provider behavior and documentation patterns.

On CDI Talk recently Melissa Varnavas, the Assistant Director of ACDIS, posed the question: “What is on your wish list for 2012?” Some suggested they’d wish to change the opinions of those who view the CDI as a revenue enhancement tool. The discussion there reminded me of a experience I once had during a Boot Camp. The individual who introduced me on the first day told the group that their facility was providing the classroom training because “[CDI staff] have to focus on getting the highest DRG, increase the CMI, and really hone in on getting those MCCs and CCs!”

Students in my classes won’t hear me (ever) tell them to query a provider just solely to capture a MCC or CC. And Boot Camp attendees will never hear me tell them to query because one diagnosis results in a higher-paying DRG than another. Of course I teach the concepts of DRG assignment and the difference between an MCC and a CC—that is the world we live in. Medicare is not going to stop using the MS-DRG system just because we don’t like it.

I do not focus on queries for increased reimbursement because I know from experience that when CDI programs stop focusing on the almighty DRG and adjust their efforts to querying whenever greater specificity is required for accurate, specific code assignment, the Case Mix Index improves, facilities start to report complications accurately, quality measures look better and yes, programs also receive what they deserve under the IPPS.

In the above mentioned scenario, that individual’s introduction did not deter me from teaching what I ethically believe are CDI program best practices. I think the students in this particular class, many of whom had been CDI specialists for several years, were relieved to hear me say that: If you do the right thing for the right reason, you’ll do fine in the long run. I believe most of them knew the essence of this all along.

As a member of the ACDIS Advisory Board since its inception as well as the lead CDI Boot Camp instructor I am aware that I do not solely represent myself when I talk to students. I know that I must also present a positive image of the CDI profession and ACDIS and what we are all working so hard to achieve: A complete, accurate written representation of the care provided to patients in our facilities. Nothing more. Nothing less.

There may be people who don’t want to hear that message, but if I’m teaching your CDI team that’s what you’re going to hear.

You’ve got questions, she’s got answers

CDI Boot Camp instructor Lynne Spryszak (center) with her daughters and granddaughter.

Recently, an online CDI Boot Camp attendee wrote to Lynne Spryszak, RN, CCDS, CPC-A, CDI Education Director, wondering how she could ask questions after her online sessions ended. Since I receive most of the e-mailed exchanges of questions and answers back and forth between Lynne and her online students, I thought this particular exchange presented a poignant example of why Lynne is such a terrific teacher.

Online participants have six weeks to access the materials and ask questions of the instructor. After that time the participants do not have access to the “ask a question” link. So, as Lynne told the student, she always replies to questions via her own e-mail account, so students can add her name to their address book and contact her any time.

If this were the only question asked by this particular student, I probably wouldn’t have pulled this exchange to praise Lynne here. But this individual also asked several other questions all of which Lynne promptly, kindly, responded to. Although the CDI Boot Camps deal specifically with inpatient hospital documentation, one of the student’s questions was about outpatient chemo IV therapy. Rather than dismiss the issue, Lynne did a little digging and found an article from Medicare Audit Contractor Palmetto which addressed the topic in question and provided the student a platform from which she could conduct her own further research on the matter.

Finally, the student also requested additional help with learning how to “navigate” the DRG Expert and Lynne was ready with some kindly after-school advice.

“With time, you will learn how the codes are named and it will get easier. This is also why I have students highlight certain DRGs as we go over them in class because I had trouble in the beginning, too. I suggest that every time you have to ask where something is, write it in your book so that you can find it again. My initial DRG book was FILLED with sticky notes, highlights, and tabs. Eventually (really!) you will have most of the stuff you see regularly memorized,” she wrote.

My point (and I hope I’m not belaboring it) is that the information Lynne provides during class is invaluable but the additional information and support she offers is even more so.

Physician Queries Boot Camp:Tales from the classroom

The new Physician Queries Boot Camp held its first session last month.

Last month I had the pleasure of teaching the first Physician Queries Boot Camp.  No kidding – it really was a pleasure! First of all, I didn’t have to get on a plane to get to the class site (yay!); and second, I got to see some previous students from the CDI Boot Camp – that was really fun!

I was looking forward to teaching this particular class because it’s so different from the CDI Boot Camp. What makes this class so different  is that it is only two days long and class size is limited to 16 students so  the classroom gets to be very hands-on and interactive.  There are individual activities and small group activities and opportunities for students to interact with, and learn from, each other.

The syllabus was based on feedback I received from the CDI Boot Camp students about topics they wanted to cover in more depth, such as:

• Practice writing queries
• Role-playing verbal queries
• Drafting queries and program policies and procedures
• Preparing for RAC audits
• Determining how to query for those high-volume, high-risk situations such as:
  • altered mental status
  • renal and respiratory failure
  • encephalopathy
  • and our good friend, malnutrition

We even have actual medical records to review – poor handwriting and all!  I heard lots of “how in the world do they expect a coder to read this?!” while attendees at that first session were doing their individual and group chart reviews.  Talk about real-life simulation!

Although the Physician Queries Boot Camp is designed for those newbie CDI specialists (generally those in the job for less than a year) I had one very experienced CDI specialist tell me that she learned a few new things, which I thought was terrific.  When I attend a seminar I feel that if I take away one new idea or concept that my time was well-spent.

Besides the actual didactic learning that takes place students go home with an draft outline for their own policies or procedures, some individualized query templates, as well as several sample policies and procedures they can modify for their own use.

For me, the highlight of the class was when I used a deck of playing cards to determine who would be a physician or a CDI specialist for the final activity that brings everything they’ve learned together.  Those who received red cards became CDI specialists and black card recipients were instantly promoted to physicians!  Each “CDI specialist” had to choose a physician and the duo practiced verbal queries.  The physician/student decided what “type” of physician he/she would be and the CDI specialist/student had to approach their physician, introduce themselves using their pre-developed 60-second elevator speech and then verbally query for one of the situations they identified during earlier classroom chart reviews.

I have to say – people can be VERY creative!  One of my “physicians” even used props: an iPhone, a pager,

Let's hope not all your physician/CDI staff interactions end up this way.

pencil, and chart.  This “physician” engaged in a spirited phone conversation when the CDI specialist approached, yelled out instructions to an invisible nurse, and more or less ignored the CDI specialist who stood waiting patiently for an opportunity to deliver her query.  Everyone got to have a turn being the physician and the CDI specialist, so those who enjoyed being the “uncooperative provider” had the tables turned when they had to be the one approaching the physician. They never knew just how the situation would unfold, sometimes to riotous effect!

It was beyond funny to see a CDI specialist deliver her well-thought out introduction and query, only to have the “physician” give her a hard time – again, and again, and again.  The “physicians” handed out the whole gamut of responses that you would typically hear: “So – do we get more money for this”? or “Yes, I get that, but how does this affect me personally?”

Lest you think that all of our “providers” were surly, some of the “physicians’ were congenial and receptive – which also turned out to be humorous since we could tell that the CDI specialist was “ready for bear.”  The varying “skits” demonstrated the value of being able to think on your feet when you verbally query a provider and showed examples of how you would respond in varying situations.

I can’t wait to do this again!

Tip: Use free resources to help you start your ICD-10 preparation efforts

The more I learn about ICD-10, the more worried I get. At this point my worries are more related to knowing enough to be dangerous but not knowing nearly enough to truly understand or feel confident about our CDI program’s preparation efforts. Two recent ACDIS polls touched on feelings about ICD-10 (What are your initial impressions of ICD-10? and What is your planned primary method/vehicle for ICD-10 training?).

The conversion to ICD-10 is going to happen on October 1, 2013.  There seems to be two opposing trains of thought about this implementation deadline:

1. We have plenty of time.
2. We are directly on top of this deadline and had better get our plans together.

In one sense, education of CDI specialists during the first six months of 2013 would (or should) be enough to prepare for individuals to complete their daily jobs. If CDI staff receive training on ICD-10 codes too far in advance then they will require an intensive refresher shortly before the conversion. However, if we wait too long we take a risk that all of the best training resources are fully committed and are unable to meet our facility needs.

A number of other potential problems need to be considered also. Where will your facility find the additional funds for training its CDI staff, for example? You’d need to know when training budgets are proposed and align the various learning objectives to your training expectations. And, of course, you’ll have to get that ICD-10 training budget approved. If you ask for funds too early, you risk being denied by your CFO.

Consider whether or not you’ll use in-house expertise for additional staff training. If so, expect to extend your training schedule further. It will take additional time to train a single individual on the various important aspects of ICD-10 and still more time for that individual to focus their training to your facility and various staffing needs.

Planning for your CDI program’s ICD-10 training needs really does need to start now but don’t worry, there are a number of resources I’ve found that seem exceedingly helpful. These include the following:

1. 3M. As a significant vendor of all things related to inpatient coding, 3M also offers a number of free ICD-10 preparation tools including:
   1. A nice 14 page PowerPoint pdf
   2. An ICD-10 Blog
   3. A free coder forum webinar series
2. AHIMA. Of course one would expect that AHIMA would be a premiere resource for all things related to this important transformation. The Association offers an e-newsletter, a resources page, and it even offers suggested tasks for inpatient coders.
3. AMA. The American Medical Association offers a crash course of basics that CDI professionals might look to for help with training their own physicians. This site contains a number of links to helpful information also.
4. Becker’s Hospital Review. Offers an article on 10 steps to prepare for ICD-10.
5. CDC. This is where you can find the most direct information regarding changes to the proposed ICD-10 coding guidelines and updates to the codes themselves.
6. CMS. CMS offers its overview of ICD-10 including detailed information on the procedural coding system, otherwise known as PCS.
7. HCPro’s ICD-10 Trainer Blog. This includes several posts by Christina Benjamin regarding low-cost resources for ICD-10 education and a roundup of additional ICD-10 resources.
8. The Milestone Group. Offers a white paper “5 Steps for a successful transition.”

There are a number of additional training options which range from more formal classroom programs to individualized educational offerings from consulting services, but I wanted to highlight some starting points that are free and easily available.

Editor’s Note: This article first appeared in this week’s issue of CDI Strategies. Subscribe to the free e-newsletter. Butler earned the 2011 CDI Professional of the Year Award. He is the Clinical Documentation Improvement Manager at Pitt County Memorial Hospital, in Greenville, NC. Contact him at dbutler@PCMH.COM.

ICD-10 White Paper available

Remember last week when I was talking about all the great White Papers available to ACDIS members? I neglected to mention another great White Paper resource—the Revenue Cycle Institute.

• Inpatient or Outpatient Only: Why Observation Has Lost Its Status
• Present on Admission: Accurate reporting to ensure appropriate reimbursement
• Sepsis and Septicemia: Clear up coding and documentation confusion.

The latest addition to this library is ICD-10-CM and ICD-10-PCS: Are YOU Getting Ready?, written by ACDIS Advisory Board member Shannon E. McCall, RHIA, CCS, CCS-P, CPC, CEMC, CPC-I, CCDS, director of HIM and coding and instructor of the new HCPro I CD-10 Basics Boot Camp™.

CDI will play an important role in the effective transition from ICD-9 to ICD-10. Just as your HIM counterparts are gearing up, the CDI team needs to raise specialists’ and physician awareness about the documentation changes  on the way. The White Paper offers proprietary data about what facilities across the country are doing to prepare for the stages of implementation and offers  recommendations about how to plan effectively for the shift.

Does your CDI team involved on the ICD-10 planning committee? Have you started examining the ICD-10 coding guidelines? Let us know how you think your facility will fare when the 2013 changes come.

Adventures in online learning: CDI Boot Camp goes virtual

CDI Boot Camp Online version holds its first session beginning September 20.

It was about 90 degrees that first day of filming back in July. And that was the temperature outside. Inside the Greeley Conference room where the production team set up a temporary studio for the filming of the new CDI Boot Camp Online it had to be closer to 100.

Air conditioning. Forget about it. The simple hum of the AC could have caused audio recording disaster. And for that matter, no fans either. I don’t know how Lynne Spr yszak, RN, CCDS, CPC-A, CDI Education director for HCPro, Inc., didn’t end up like the Wicked Witch of the West— in a puddle on the floor. But that first day, and every consecutively inferno-like day that week, Lynne emerged from the cool confines of the Salem Waterfront Hotel and hopped into my little maroon Saturn for the drive to Marblehead all smiles. Calm. Cool. And collected.

But that’s Lynne. Even under the bright lights and soaring temperatures she kept her focus on the task at hand, providing thorough coverage of what CDI professionals need to know to do their jobs. Did she suffer from lack of movie-star experience? Not a whit in my opinion. I sat in on the filming for many of the Boot Camp sessions and then, roughly two weeks later, had the pleasure of sitting in on a live version of the CDI Boot Camp that took place in Woburn, MA.

The primary difference between the two programs comes from the classroom-like interaction of the students in the live Boot Camp setting, in my opinion. For example, by the end of the second day of lessons the Woburn students (who hailed from as far away as Texas) were making plans to catch the train into Boston for some sightseeing. By the end of the week, they were exchanging e-mails and phone numbers and talking about the implementation of best practices as well as how to incorporate the lessons learned from their Boot Camp experiences into their day-to-day facility activities.

Now I don’t think there will be many tourist excursions stemming from the new online version of the Boot Camp. But I do expect there will still be a sense of comerardie among participants. For one, that’s just the personality type of the CDI specialist–they’re friendly, helpful, and kind. But understanding the vital role that such interaction with the classroom teacher plays, the CDI online version of the Boot Camp includes regular “office hours” where participants dial in to a conference line for an hour Q&A session and review with either Lynne or her fellow Boot Camp instructor Margi Brown, RHIA, CCS, CCS-P, CPC, CCDS.

For those who may not know how virtual education sessions work let me offer a brief explaination. As indicated, Lynne and Margi came to Marblehead back in July and presented the CDI Boot Camp before a film crew and small audience. The film was then edited into segments and formatted for online viewing. Participants may sign up for one of the sessions starting later this month with additional sessions scheduled throughout the year. The course runs for two weeks with an office hour each week. Participants have access to session recordings for an additional six weeks. We have had a number of volunteer participants give the Online Boot Camp a test run for us and so far the results have been phenominal.

Oh, I almost forgot the other added benefit of the online version… You get to keep your AC on.  The next session starts September 20.

Kansas, Oregon, Pennsylvania, Massachusetts make the list of upcoming CDI Boot Camps sites

I really wanted to come up with some good joke here that involves the cities of Philadelphia, Kansas City, KS, Portland, and Boston but, heck, I just can’t come up with anything.

Don't pick on our accents, Boston's a beautiful city... even if you do need a translator to understand us.

I’d have to make fun of my beantown-base but I love it here too much to pick on our Bowstown axscents or wonder where the CDI specialists who sign up for the Boot Camp will end up paahking (prolly somewheres down by the Norf End, I magine).

So, jokes aside, I thought I’d let you know that ACDIS recently released its schedule for the summer series of CDI Boot Camps.

The Boot Camps continue to quickly sell out so I encourage you to register early if you are interested, especially since class sizes are limited to guarantee individual instruction and a low student-teacher ratio. Without further jesting on diction the schedule is:

• Philadelphia, PA, May 3-6
• Kansas City, KS, June 21-24
• Portland, OR, July 26-29
• Boston, MA, August 2-5

The four-day educational session covers:

• Medical record review and physician query techniques
• MS-DRGs and reimbursement under the IPPS
• ICD-9-CM coding rules and regulations
• CDI program benchmarking and compliance initiatives
• Problematic diagnoses, including congestive heart failure, sepsis, and renal disease

In addition to our open registration classes, the CDI Boot Camp is also offered as an on-site program for organizations that have a number of employees who need training. To explore the possibility of hosting a CDI Boot Camp or to discuss other training programs, call 877/233-8828 or e-mail bootcamps@hcpro.com.