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Consider CDI time management techniques

“E-mail eats the day away.” Sounds like a play on the ‘ole “apple a day” routine, doesn’t it? It’s actually an PR piece touting a new software that sorts and prioritizes your e-mail. Imagine if  automatic e-mail management saved you hours every day. I’ve seen some pretty disorganized e-mail in my day. One co-worker had more than 600 messages in her inbox at one time. She wondered why her e-mail wouldn’t work.

That press release got me thinking about how clinical documentation improvement (CDI) specialists manage to juggle their responsibilities and how they can effectively make the case for CDI to physicians whose time management techniques are already being tested.

Physicians often say their biggest concern about providing high quality documentation in the patient record is the amount of additional time they think it will take, according to Ruthann Russo, PHd, JD, MPH, RHIT, partner in the law firm Russo and Russo, LLP, in Bethleham, PA.

Time flies so try to make the most of it.

Time flies so try to make the most of it.

In her handbook Time Management for Clinical Documentation, Russo pools a variety of sources to show how various stakeholders’ demands affect a physician’s time management capabilities. For example, insurance companys frequently assume that a primary care visit takes a physician a mere 16 minutes. When micro-management of that caliber can affect your fiscal well being, imagine the time management stress that must result.

“Supporting your physicians in the time management process can result in better clinical documentation practices,” Russo writes.

Here are some time management tips you can either share with your physicians or keep to use yourself:

  • Prioritize
  • Plan your day
  • Plan for breaks and take them
  • Handle each piece of paper (or e-mail) only once
  • Make decisions, don’t procrastinate
  • Block out specific time to respond to phone calls
  • If there’s a task you dread, do it right away and get it out of the way

Physician support for CDI programs suffers when they worry about how additional documentation requirements could encroach on their already limited available time, Russo says. So, be open and honest with physicians. Talk about their time concerns and be realistic about how much time your additional interactions may take. Initial physician training sessions are a perfect time to raise these concerns and share some of your own time management techniques.

Appropriate investment in CDI helps programs bloom

Changes in the IPPS (Inpatient Prospective Payment System) led hospitals to develop clinical documentation departments to assist with these changes. Some hospitals hire consultants to initiate their novice CDI staff. They provide generous budgets to facilitate education and growth.

In many cases, the documentation departments outgrow the consultant firms hired to teach them as its  staff members become more savvy about the ins and outs of their particular hospitals. As these departments expand, the hospital case mix index grows.

CDI programs need to be nurtured in order to bloom.

CDI programs need to be nurtured in order to bloom.

Some hospitals hire CDI staff members and provide only minimal education. They keep a tight budget and provide minimal flexibility. These programs grow with the help of available audio conferences and through networking. The staff struggle and grow slowly.

Other hospitals are reluctant to start clinical documentation programs. They hired one or two nurses or add new responsibilities onto their already busy coders. These hospitals provide little in the form of incentives or budget. The CDI staff members are simply told to go out and find MCC’s. These hospitals are often disappointed with the results.

Hospitals must realize that in every successful business, you get what you pay for. A successful clinical documentation improvement program can potentially bring in a great deal of otherwise lost revenue, as well as increase the case mix index.

While appropriate documentation for appropriate documentation’s sake is the clinical documentation improvment team’s mantra, hospitals must do more than plant a seed for documentation improvement results to grow. Similar to a garden, they must water and fertilize their programs in order to see them bloom.

CDI professionals of the year nominated

 I’m no spoiler, so I’m not going to tell you who has been nominated by whom for the 2009 CDI Professional of the Year award. . . 
Who'll win the big one this year?

Who'll win the big one this year?

yet. Here’s a sneak peek at what healthcare professionals say about their nominees:

  • “In the past 18 months I feel that we have had breakthrough in physician acceptance of documentation improvement, both in its importance to the organization and to their own practice.”
  • This CDI professional “skillfully extracts ‘real’ medical record entries, poses appropriate queries to small groups of physicians, and ultimately convinces the physicians that further specifying a patient’s diagnosis or better explaining a procedure best explains what has occurred with a patient.”
  •  This CDI professional “worked with our executive management staff to demonstrate a 5.1% opportunity to increase severity of illness and 32.4% opportunity to increase risk of mortality, and a 4.0% opportunity to increase the case mix index. “
  • “We all know improved documentation improves revenue, but now we are able to show hard evidence that documentation improves the length of stay, the severity of illness, the mortality ratings, and overall patient care quality. [This CDI speicalist’s] creative thinking has influenced many hospital changes and probably many more to come.”

If you know a CDI specialist in your organization worthy of being named “CDI Professional of the Year” fill out the form and e-mail ACDIS Director Brian Murphy at

Tip: Adapt policies and procedures for physician queries

One policy fits all.

One policy fits all.

When AHIMA released its “Managing an Effective Query Process” brief in September 2008, it raised a number of concerns among them the responsibility of a CDI program to draft consistent policies and procedures for conducting physician queries.  In a recent ACDIS poll, 29% of respondents said they did not have a query policy in place and 43% said their facility allows CDI staff a “flexible” query system.

Be careful about developing multiple rules for your facility query process, says Garri Garrison, RN, CPUR, CPC, CMC, director of consulting services for 3M Health Information Services in Atlanta.  The Department of Justice and the Office of the Inspector General “don’t care who asked the question”—either the HIM professionals in the coding department or a registered nurse in the CDI program—if the query leads the physician to document in an inappropriate way. So make sure when you develop your policy that you establish one approach and that everyone involved in the CDI program—coder, nurse, physician advisor—follows that approach.

Hear what Gloryanne Bryant, RHIA, CCS, senior director corporate coding HIM compliance department at Catholic Healthcare West in San Francisco had to say during the ACDIS quarterly conference call:

Get the Flash Player to see the wordTube Media Player.

The quarterly conference calls allows ACDIS members to speak with each other and industry experts as an informal networking opportunity. Those who are unable to listen to the call “live” may access the MP3 recording of the call on the ACDIS Web site.

ACDIS has a number of sample policies and procedures available in the Forms & Tools section of the Web site. Download a sample inpatient physician query policy that you can adapt to your facility’s needs.

CDI Professional of Year nomination forms due April 1–send them in!

Hi everyone,  I just wanted to send out a final reminder that nomination forms for our CDI Professional of the Year award are due in next Wednesday, April 1.

What makes a CDI Professional of the Year ? Well, there are no hard-and-fast guidelines. Here’s a few suggestions:

  • A manager who helped implement a successful program
  • A colleague who works hard at their job and is passionate about what they do
  • A persistent CDI specialist who got a difficult physician to finally break down, buy into a program, and document in the record
  • A CDI specialist working on their own in a small hospital on a shoestring budget, doing all that he or she can to get their program off the ground (if this matches a description of someone you know, nominate them!)

This is your chance to help a colleague recieve the recognition he or she deserves. We will be handing out our second CDI Professional of Year award at our upcoming conference in Las Vegas on May 14-15. The winner will receive a trophy and free admission. We also plan to hand out two awards for Recognition of CDI Achievement to two other deserving professionals. All three winners will recieve their awards and be recognized at our networking luncheon.

ACDIS members can read the story of last year’s winner, Randi Ferrare, published in CDI Journal.

Submitting a nomination is simple. Just go to to our awards page, fill out the form, and e-mail it to myself at

Finally, you can expect a sneak preview of some current nominees later this week.

Thanks, and best of luck!


Reminder: Florida ACDIS Chapter meeting Friday

I can’t tell you how thrilled I was to see the Florida ACDIS Chapter’s new logo! floridalogo1It even earned a “groovy” from our chief operating officer.

As a reminder the group holds its  its first meeting Friday, March 27, 2-4:40 p.m. The agenda includes  a review of the history of CDI and an analysis of the role of the physician advisor in the CDI program.

If you plan to attend please fill out the survey form and send an email to

No blarney, you’ve got the luck of the Irish

Feeling lucky?

Feeling lucky?

There’s not much time left in the good old Irish holiday of four leaf clovers and other Celtic mythologies. So before all your luck runs out, we here at ACDIS wanted to offer our own sort of celebration in the form of a quick contest.

It’s simple. We’ll  pick one random winner from those who leave a comment on this post to receive a free copy of “Coding and You: What every healthcare professional should know.” The handbook comes in packs of 10 so you can hand them out to finicky physicians or stubborn (not like the Irish) healthcare workers who don’t seem to understand the importance of coding and appropriate documentation yet.

We know sometimes the RSS feed doesn’t always post to your inbox right away so we’ll give you until noon Wednesday, March 18.

Good luck!

Birds of feather: ACDIS chapters start to soar

Let's get every state with the cardinal as its chosen mascott to start a CDI Chapter!

Let's get every state with the cardinal as its chosen mascot to start a CDI Chapter!

There’s been a number of additions to the roll of local ACDIS chapters. Most notably, we’ve received interest from Ohio and Virginia to meet with fellow members.

Imagine my surprise to find that both these states’ also call the cardinal their state bird. Look out North Carolina! As it turns out, seven states have the bright-hued aviator as the soaring emblem of their respective aviary prowess (and that’s not including state affinity for the bird associated with the names of sports teams St. Louis Cardinals nor the Arizona Cardinals).

Okay, so here’s a challenge. I put the call out to any clinical documentation improvement specialists from Indiana, Kentucky, and West Virginia (which all say the cardinal is their state bird, too) to start local ACDIS chapters in their neck of the woods. After all as the saying goes. . . birds of a feather. . . right?

Download this document for some tips for how to get a CDI chapter started including advice from state organizations which have been gathering for a few years now.

Click on this link to download a list of current local groups, meetings, and contact information.

CMS cheat sheet on IPPS basics available

Page three and four of CMS’ revised Acute Inpatient Prospective Payment System Fact Sheet (January 2009) contains a number of pastel looking charts outlining what seems to be mathematical equations. These graphical details show how IPPS payments are derived through a series of adjustments applied to separate operating and capital base payment rates.

Although I don’t recommend it for bedtime reading, the Medicare Learning Network Payment System Fact Sheet should be on your CDI required reading list.

Maybe you’ve read it before, maybe you’re already well-versed in the IPPS process and know all about how DRGs became MS-DRGs and how the wage-index fits into the final cost analysis, but maybe all this sounds like you need an accounting degree or a master’s in business healthcare administration. Either way, it’s always good to keep an eye on what CMS says about its own systems.

Maybe make it your lunch-time reading instead.

KISS method applies to CDI physician education too

One really great way to get the message about your clinical documentation improvement program out to the medical staff members is through the use of group presentations.

The presentation is a challenge in itself-trying to teach that proverbial old dogs new tricks-but, it turns out that organizing and scheduling those presentations can be just as challenging. Physicians have a small amount of time to get a great deal accomplished. Getting physician to give you five minutes of their time is fantastic but getting them to commit to half-an-hour or a whole hour is downright miraculous. That is, if you aren’t routed by way of the overprotective secretary.

The CDI specialist must not get disheartened. Persistence is the key (and a hearty supply of bribes, I hear they love chocolate). Once the presentation is finally set, remember to remain respectful of the physicians’ limited availability. They are used to moving fast and juggling multiple tasks at once.

Your presentation must be on the point and have enough visual interest to pack a punch. You must grasp their attention and hold it. Do not talk about DRG’s MCC’s and CMI’s. Keep it simple and let them know what is in it for them. In this world of increasing quality data reporting the physician needs to understand the impact of their documentation on their physician scores. Tell them what they need to know.

Oh, in the forms and tools library on the ACDIS Web site there’s a few sample presentations and physician education e-mails available for members to download.