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Guest Post: Marketing your CDI program

Kelli Estes

Kelli Estes

by Kelli Estes, RN, CCDS

Maintaining an organizational presence through the continued marketing of your CDI program is one of the most valuable steps you can take towards leveraging long-term success. Hospitals cannot afford to have their CDI program become an “out of sight, out of mind” idea six months to a year after launching.It is very important to maintain a level of CDI enthusiasm among providers throughout the year. In reality, the CDI initiative must become part of the cultural norm in order to attain the longevity of its effects everyone desires to see.

Too often, CDI programs kick-off with quite a buzz in the air. There is typically an organizational presence from the intentional promotion carried out for weeks or months leading up to the implementation date. Unfortunately, after six months to a year, the CDI team loses steam and finds themselves without much fizz among providers. Following are a few ideas to effectively market CDI programs:

  1. Mark your calendar for the week-long celebration of CDI Week which just took place the third week in September. Use this time to:
    • Provide snacks in the doctor’s lounge throughout the week
    • Attach CDI tips to candy as a fun giveaway and to educate providers
      • Attaching a CDI tip to Smarties candy is always cute
      • Dum-Dum suckers will get a nice laugh too
    • Host CDI week giveaways as your budget allows
      • Starbucks or Dunkin Donuts coupons
      • Restaurant gift cards
      • Nook, Kindle, or iPad for a Grand Prize giveaway
    • Provide special recognition for star documenters
    • Host a special “lunch and learn” education session to be led by the CDI physician advisor or the star documenter of the year!
  1. Feature CDI news on a centrally located bulletin board for everyone to see.  Be sure to update the board at least monthly by providing CDI tips to include new ICD-10 information and also showcase the top documenters for the month. You can get really creative because I’ve never met a physician who didn’t like a bit of friendly competition.
  1. Contribute short articles or quick tips in any physician newsletters that go out regularly. Make it personal, feature various CDI staff at different times to allow the providers to get to know the CDI team members better.
  1. Work with your IT department to implement CDI tips as computer monitor screen savers to promote CDI awareness.
  1. Develop a CDI intranet site to allow the CDI team to provide access to electronic tip sheets, slide presentations, video teaching, etc. This is a convenient way for providing access to CDI information at the leisure of providers.
  1. Throughout the year, develop a poster series with CDI tips to be placed in various locations commonly used by providers.

As you can see, there are many ways to market your CDI program, but nothing will trump relationship building between your CDI team and the providers.  The more time the CDI staff can spend on the patient care units, the more credibility the team will earn. Becoming a trustworthy resource to providers in their environment will only stand to have an invaluable benefit to the overall success of your CDI program!

Editor’s Note: Estes has spent more than a decade as a CDI specialist and consultant, presently with DCBA Inc., in Atlanta. She is highly skilled in the overall process of CDI program start-up and enjoys guiding the decision-making required to implement and sustain longevity in any viable program. Estes has also been involved in CDI program follow-up assessments and has written several articles for DCBA’s monthly newsletter, CDI Monthly, where this article was originally published. Contact her at kestes@dcbainc.com.

TBT: CDI input helps EHR implementation succeed

Learn how new technologies will affect CDI efforts in this week's free webinar.

CDI involvement in EHR implementation is key.

Editor’s Note: In social media memes Throw-back Thursday generally means sharing an old high school photo, something you wish had been left unpublished–like your 80s bouffant or 70s bell bottoms. We thought we’d pick up on the theme and occasionally go back into our CDI archives to highlight some salient CDI tid-bit. This week’s installment comes from the April 2012 edition of the CDI Journal.

“We saw the EHR train as it was whisking by. We were shouting ‘Wait! Wait! What about CDI?’ ” says one CDI specialist. “They didn’t know CDI existed. The [implementation team] hadn’t thought about us and how we interact with the record or what we might need from an electronic system. So now we’re trying to play catch-up and do the best we can with what we’ve got.”
CDI specialists probably think phrases like “interoperability” and “meaningful use” need not cross their minds—EHR implementation belongs in the hands of the IT or HIM department, right? The answer to that question is yes and no, says Barbara Hinkle-Azzara, RHIA, (formerly) Vice President of Operations for Meta Health Technology in New York City. The individual end-user (i.e., the CDI specialist reviewing medical records on the hospital floor) “may not need to be involved in ‘checking off the boxes’ to certify meaningful use is met, but certainly adapting to an EHR and adhering to meaningful use requirements affects the information CDI professionals review and how they will ultimately perform their jobs.
“EHR systems will change the CDI specialists’ experience,” she says.
A CDI program director or physician champion can play a pivotal role in the implementation of initial and ongoing assessment efforts for EHRs and their components, says John Pettine, MD, FACP, CCDS, CDI director at Lehigh (PA) Valley Health Network.
“CDI staff should get involved and do it now before it is too late. Otherwise, CDI professionals are at the mercy of decisions made without their input, which can be tragic to the success of the program going forward into ICD-10,” he says.

Guest Post: Have you had a CDI check-up lately?

Kelli Estes

Kelli Estes

By Kelli Estes, RN, CCDS

A large number of hospitals across the country have some version of a CDI program in place. With ICD-10 implementation on our heels, it is recommended by AHIMA that all hospitals have a “mature” CDI program in place by October 1, 2014.

In October 2013, I attended the AHIMA pre-conference coding meeting in Atlanta. An informal polling of the audience led to some interesting revelations regarding CDI program maintenance and growth through audits. Most everyone in the room professed to having an internal and external audit process in place for coding, but only a few hands went up when asked about having a CDI-specific audit process. Additionally, recommendations were made to have outside auditors assess CDI programs currently operating under ICD-9 to leverage their stability during the transition to ICD-10.

A thorough, CDI-specific audit can illustrate how viable any CDI program will be come ICD-10, particularly considering projections of a 25% decrease in productivity as a result of ICD-10. Let’s face it!  If you have CDI problems with ICD-9, you will have those same problems with ICD-10. So don’t delay  developing policies and procedures for CDI audit processes including conducting your own internal audits and hiring an external audit team.

What should should you audit for? Good question. Here are some of the items we recommend:

  • CDI specialists’ query writing skill/compliance
  • Missed opportunities to capture MCCs/CCs as well as further severity of illness and risk of mortality
  • Query trends to identify educational opportunities for physicians
  • Productivity when reviewing patient records

Most models of CDI look similar on the surface, but when assessing the detail in the various moving parts you will find differences that could cost your organization big in the long run. You want to make sure you are working smarter, not harder. You also need to identify process improvement needs such as collaboration with other healthcare team members involved in the care of the patient  (i.e., nutrition, wound care, care management, core measures). The only way to capture this type of information best is by reviewing a random selection of CDI cases and overall processes.

Editor’s Note: Estes has spent more than a decade as a clinical documentation specialist and consultant, presently with DCBA Inc., in Atlanta. She holds the CCDS certification through ACDIS and was in the first group of participants to sit for the exam. Since joining DCBA in 2005, Kelli has assisted with project management in dozens of CDI program implementations. She is highly skilled in the overall process of CDI program start-up and enjoys guiding the decision-making required to implement and sustain longevity in any viable program. Estes has also been involved in CDI program follow-up assessments and has written several articles for DCBA’s monthly newsletter, CDI Monthly, where this article was originally published. To subscribe to CDI Monthly, click here.

For additional information on performing program audits read these related articles from ACDIS:

TBT: Four tips to tackle multi-facility CDI management

What lesson learned do you have to share? Your peers are waiting to hear your insight. Submit your ideas for the 2014 ACDIS National Conference now.

Are you a multi-facility CDI manager? What advice would you give to someone expanding their CDI program to other network hospitals?

Editor’s Note: In social media memes Throw-back Thursday generally means sharing an old high school photo, something you wish had been left unpublished–like your 80s bouffant or 70s bell bottoms. We thought we’d pick up on the theme and occasionally go back into our CDI archives to highlight some salient CDI tid-bit.  Today, we’ve chosen this July 2012 article.

It’s Tuesday. For some CDI program managers that means jumping in the car and driving an hour or more to another hospital in their system to make rounds with CDI specialists there. For some, it’s a routine that happens at least once a week; for others, once a month. Although the requirements of managing CDI programs and their staff at multi-facility hospital systems differ depending on a variety of factors, try the following four best practices for success:

  1. Standardize policies and procedures; then fine-tune for differences
  2. Communicate consistently across hospitals
  3. Know your staff
  4. Use available resources

Meg McGill, RHIA, corporate director for HIM at Methodist Le Bonheur Healthcare in Memphis, Tenn., manages 19 CDI specialists across seven hospitals. In the beginning, McGill’s primary role related to governing the overall direction of the healthcare system’s CDI efforts.

Each specialist reports directly to either the chief medical officer or performance improvement director at their facility and secondarily to McGill, whose primary job is to communicate CDI program data and effectiveness to facility and system management, she says. After little more than a year, Methodist Healthcare was ready to “take the program to the next level,” says McGill.

“We had to take a step back and take a deep breath to see where we wanted this program to go and how to get there.” So they hired a CDI director, whose No. 1 task,“will be to make sure all the processes are done consistently across all the sites,” McGill says.

Although absence may make the heart grow fonder, lack of communication can quickly turn fondness into indifference.

“You need to get to know your staff so they feel comfortable with you and you feel comfortable with them,” McGill says. But long distances make face-to-face meetings difficult. “It really took me about a year to get to that point because I never really get a chance to see them,” she says.

To keep CDI staff on the same page, McGill holds monthly meetings for all CDI staff with the coding director and two lead coders who also attend. CDI specialists also meet monthly by facility with their immediate directors to discuss productivity, statistics, and facility concerns.

“Communication is definitely one of the big challenges,” says McGill. “You need to be sure you say the same thing individually that you say to the entire group. You have to have open communication and you have to get to know your staff. When concerns come up, they can talk to you one-on-one, pick up the phone and call you, schedule an appointment, or send you an email. Be sure to make time for that. But otherwise I really rely on email.”

Tip: Readmissions an emerging CDI focus area

Have you begun reviewing records with an eye toward readmission reduction? Let us know!

Have you begun reviewing records with an eye toward readmission reduction? Let us know!

As more facilities face the specter of reimbursement losses related to the Readmission Reduction Program, CDI programs may be asked to take a second look at records to help ensure documentation is adequate to fully support the patient’s diagnoses, says Susan Wallace, MEd, RHIA, CCS, CCDS, CDIP, director of compliance and inpatient consultant at Administrative Consultant Service, LLC, in Shawnee, Okla.

While it may seem like “just one more thing” added to the CDI review plate, Wallace says it needn’t be an onerous project.

First, make sure CDI focuses on more than CC/MCC capture and problem-focused reviews.  The readmission reduction targets currently include acute myocardial infarction, congestive heart failure, pneumonia, COPD (also COPD secondary to respiratory failure), stroke and elective hip / knee replacements.  Beyond the current readmission reduction program, inpatient quality reporting measures also target hospital-wide readmissions, so appropriate risk-adjustment is important for all admissions. p>Second, reach out to other departments such as case management and quality to discuss how they are evaluating readmissions and brainstorm ways CDI can help.

Thirdly, says Wallace, stay informed. Review your facility’s Quality Net data and be familiar with the codes, diagnoses, and documentation requirements for those conditions.

“The Quality Net report to hospitals includes an appendix with factors used for risk adjustment; facilities can look at that data to compare their own facilities to other state and national statistics,” says Wallace. “That’s information that isn’t typically shared or reviewed, so CDI can look for opportunities there. Simply asking for the report can be a way to open the door and begin communications with the quality department.

Editor’s Note: This article originally published in the June 19 edition of CDI Strategies. If your CDI program is reviewing records with readmission reduction in mind, ACDIS would like to hear from and share your lessons learned in an upcoming CDI Journal article. Send your program description to Associate Director Melissa Varnavas at mvarnavas@cdiassociation.com.

Primer for new CDI staff: Take it easy on yourself

Enterprising CDI specialist should consider working across facilities to develop standard policies and procedures.

Five tips for new CDI–but the number one lesson is to take your time and don’t be too hard on yourself about what you may not know yet.

As one who at times has been responsible for the care and feeding of new CDI specialists, I think it’s time for me to share my views on newbies.

Those of us who’ve come from the nursing ranks, especially those of us who’ve been nurses a long time, are well-familiar with the concept, nurses eat their young. It derives from the tendency of some older nurses to grind the heart and soul out of younger nurses. Greater awareness of the practice has, I think, led to kinder, gentler orientation processes, but many older nurses who go into CDI still have the mindset that they have to be perfect or someone’s going to tear into them. So here’s a few words of advice for new CDI specialists:

1.  Nobody dies in this job. I have to admit in the spirit of transparency, that having once shared this concept with a certain new CDI specialist, I received a phone call one day shortly thereafter. “You lied to me.”  Now, talk about putting my heart in my throat! What could I have possibly lied about? “You said nobody dies in this job. I went out to review this patient and she died.” Okay, well, yes, patients do die every day despite our hospital’s and our physicians’ best efforts. But they do not die because of anything the CDI specialist did or did not do. Unlike bedside nursing (and ICU nursing, where I came from)–where a wrong medication or forgotten procedure could actually be a life-or-death event–mistakes in CDI don’t actually impact lives. “Nobody dies in this job” is meant simply to take the pressure off those of us who come from the nursing perfection. Did I say perfection? Of course I meant profession.

2.  Orientation never ends. Yes, your manager is going to give you an orientation schedule that has a start date and an end date, because they have to.  But it’s really not like the orientation I experienced when I was a new nurse where I showed up for work one night and saw my name no longer attached to my preceptor. When I asked, I was told, “You’ve been here eight weeks. You’re off orientation.” As a new CDI specialist you have a right to expect regular bidirectional feedback so that the transition to independent practice is seamless and appropriate. Orientation is a fluid process, and while it’s not unreasonable or unexpected to have goals and target dates, every CDI specialist is unique and orientation needs will differ. If you feel like you’re not getting what you need, speak up. I tell new CDI specialists and prospective CDI professionals that regardless of their previous healthcare background, this will be the toughest learning curve they’ve ever encountered. And that’s not something that can be overcome on a fixed schedule.

3.  Speed kills. This is one of those “do as I say, not as I do” moments. My work pace is extremely fast, but I do on occasion miss things because I work so quickly. In the beginning, you are probably going to panic about your productivity. You may have been told you must complete X number of initial reviews and X number of followups daily. I’m not here to tell you to ignore your manager, but if you are working methodically and paying attention to how you approach cases, you will get faster. You will learn what to look for and what information probably won’t make a difference. If you frequently find yourself spending an hour on one case, consider whether you’re getting a return on that investment of your time, or whether you might have the same results if you’d cut it down to 15 minutes. If you just can’t seem to tear yourself away and your manager is imploding, then take your little smartphone and set your timer for 15 minutes at the start of each case. When the timer goes off, walk away. By not getting to the next case, you may be missing an opportunity on another chart that didn’t get opened.

4.  It’s okay not to know it all. You may finish your formal orientation process as a whiz in cardiovascular CDI, because you come from a cardiovascular background, you had a cardiovascular CDI whiz for a preceptor, and you saw a wide variety of cardiovascular conditions and complications as part of your orientation process. But the vacancy in the department for which you were hired was on the gynecology floor, where you have zero experience. Fear not. You can still function. Honest. You have learned basic principles that apply no matter where you are assigned, and you will learn, exponentially, as you gain experience. You will learn by making mistakes, and that’s okay. (See #1 above.) The hallmark of a good CDI is recognition that you don’t know everything, having a willingness to learn, and inquisitiveness–you don’t wait for someone to teach you, but go seek out information yourself. As I used to say when I precepted staff nurses at the bedside, the day you think you know it all is the day you need to hang it up. So hang in there, and eventually you will feel more comfortable. The day will soon come when you will likely be a CDI resource, a person your colleagues seek out when they have questions.

5.  Seek the next level. You can go to Boot Camp or have a good orientation or take a coding class, and you can learn to function at a basic level, but if you want to advance beyond querying for acute systolic heart failure, you’re going to have to take the initiative and learn. Read, read, read. Network, network, network. Talk to your colleagues. Read and post on ACDIS’s CDI Talk.  Somehow, realizing that there’s always new information out there makes the knowledge that you don’t have all that information easier to accept.

So take it easy on yourself!  You worked hard to get into CDI and you deserve to give yourself a break.