2010 ACDIS Conference agenda set

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

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

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

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

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

Northern Illinois CDI Network meets Nov. 5

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

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

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

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

Here’s a copy of the agenda:

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

Three New York groups gather in December

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Next ACDIS quarterly conference call Nov. 19

Hi ACDIS members,

Our next quarterly conference call is scheduled for Thursday, November 19, from 2-3 p.m. ET. This is a members-only call and dial-in instructions were e-mailed out to our membership list yesterday and today.

Please note: If you did not recieve an e-mail notification, and you are an ACDIS member, please e-mail ACDIS member relations specialist Sue Calabro at customerservice@cdiassociation.com. Sue will provide you with the dial-in number and passcode.

These calls are offered as a means for ACDIS members to network with one another, and to discuss any clinical documentation improvement related issues. We will have a few ACDIS Advisory Board members on the call as well. We encourage your comments, thoughts, and questions during the call. Additionally, if you have any suggestions for discussion that you would like to forward along to our advisory board, please e-mail me at the address below.

If you cannot attend the call, we will provide a digital recording for download on our Web site.

Thanks, and I hope you can dial in on the 19th.

Brian Murphy

bmurphy@cdiassociation.com

California ACDIS meetings underway

California encompases more than 150,000 square miles.

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

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

This is a big state.

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

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

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

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

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

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

For information contact:

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

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

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

Florida ACDIS sets football themed meeting for November

Go Florida ACDIS!

The quarterly ACDIS Florida Chapter meeting will be held on November 13th, 2009 at Shands Hospital at the University of Florida, home of the 2008 NCAA Football National Champion Florida Gators. The team at Shands has put forth a great regional meeting. So, thanks for all the hard work and dedication. Go Gators!

Here’s the agenda:

• Kick Off: 8:40-9:15  a.m., PreGame Registration/Breakfast
• 1st Down: 9:15-9:30 a.m., A word from our sponsors, greetings from George, Sylvia, and Susie
• 2nd Down: 9:30-10 a.m., Defensive Coordinator “This Isn’t a Complication: Bridging the Communication Gap” Francesca Kayser Enneking, MD, professor and chairman, department of anesthesiology University of Florida College of Medicine
• 3rd Down: 10:00-10:30 a.m., Offensive Coordinator “Public Quality Measures and Mortality Risk Adjustment” Millie Russin, RN, MSN, director of clinical process improvement Shands at the University of Florida
• Halftime: 10:30-10:50 a.m., Bathroom break/calisthenics
• Time Out: 10:50-11 a.m., Pictures
• 4th Down: 11-11:30 a.m., Team Physician “CDI – Keys for Success” Mihaela Dragut, MD, CCS physician advisor, Clinical Documentation Improvement UF & Shands Jacksonville
• Tail Gate Luncheon with 3M: 11:30-12:30 a.m., Computer-Assisted Coding Demonstration Clinical Documentation Improvement Software Demonstration
• Touchdown: Recap/Highlights/Next Game

The art of communication: Getting back to basics

Communication is defined in the Merriman-Webster dictionary as a verbal or written message,

Face-to-face verbal interactions offer CDI specialists unique physician education opportunities.

exchange of information, or a process by which information is exchanged between individuals through a common system of symbols, signs, or behavior. Consider the evolution of communication within the last century, beginning with the carrying of mail by horse and buggy, then the introduction of the telegraph, telephone, fax machine, and now the internet.

Now consider the evolution of communication as pertains to coding and clinical documentation improvement (CDI). Before the advent and growth of CDI programs, documentation improvement consisted of a retrospective coding query to the physician. The query sought clarification of principal and secondary diagnoses consisting of complications and comorbidities (CCs).

Today, CDI programs shine a light need to educate physicians about complete and accurate clinical documentation. CDI programs highlight that need in the face of increased coding and billing regulatory scrutiny as well as a sound, prudent business strategy to meet the business financial challenges faced by physicians. Savvy CDI specialists therefor have incorporated educational tools into their programs including monthly newsletters, tip sheets, and pocket guides.

The execution of effective communication strategies dictates the successes and failures of a given CDI program. As I have the opportunity to “observe” programs in action, one component of communication often seems to be lacking. This component includes old fashioned verbal communication with physicians about the clinical facts of the case, existing documentation, and possible clinical documentation that may be missing from the health record.

Verbal communication allows the CDI specialist to provide education and reinforce teaching principles, a key point missing from the use of written clinical queries. The use of verbal communication allows the CDI specialist to read the physician’s body language and other cues to determine whether the physician understands the principles being discussed.

Appreciation and understanding of these documentation principles by the physician serves as the basis for educational reinforcement of other tools used in physician clinical documentation improvement efforts, the likes of newsletters, tip sheets, handouts, etc. No clinical documentation improvement program can be successful in the long run without going beyond episodic education of continuous, repetitive clinical queries. Eventually, physicians have a tendency to grow weary of the same day in, day out queries. They become numb to the content.

Physician clinical behavior modification by necessity requires more than leaving queries in the record for the physician to review at a later time. If one thinks about the use of clinical queries, an argument can be made for the evolution of clinical clarification to merely have changed from retrospective to concurrent. The physician is reading the clinical query on the hospital floor as opposed to reading it, culling information post-discharge, from the medical records.

Consider varying and adjusting CDI specialists’ work schedule to improve likelihood of reaching out to physician’s individual patient rounding practices. Reaching out to physicians for provisions of providing education is best served through learning of these practice patterns and adjusting one’s schedule accordingly. Generally speaking, making clinical documentation rounds routinely from 8 a.m. to 5 p.m., with a predetermined lunch break misses out on the opportunity to effectively and efficiently fulfill the roles, goals, and objectives of any program, that is true clinical documentation improvement.

Good Luck.

Add analysis of severity adjusted data to your CDI activities

Catapult your CDI program with SOI/ROM assessments.

The days of capturing a patient’s condition solely through complications and comorbidities (CC) and major CCs (MCC) are slowly fading. There is a new focus on capturing severity of illness (SOI) and risk of mortality (ROM), and clinical documentation improvement (CDI) programs are taking notice.

And why shouldn’t they? SOI and ROM programs provide a higher level of detail about a patient’s condition and the care provided. They also strengthen hospitals’ quality data and physician report cards, which in turn improve revenue and reduce compliance risk.

During a September 18 HCPro audio conference, “Severity of Illness and Risk of Mortality: Sharpen Your CDI Focus with New Measures of Success,” speaker Garri L. Garrison, RN, CPC, CMC, CPUR, defined SOI as “the extent of physiological decomposition or organ system loss of function experienced by the patient.” Or in simpler terms, “how sick is the patient?” In self-explanatory terms, ROM is meant to indicate the patient’s likelihood of dying.

These two terms should catapult your CDI program to new heights of clinical specificity. A severity adjusted program is an ideal method to carry out your new and improved CDI efforts. A severity adjustment program allows hospitals, consumers, payers, and regulators to understand the patients being treated, the costs incurred and, within reasonable limits, the services and outcomes expected.

New e-learning courses open to ACDIS members

In my spare time, I am a creative writing student at a low residency program. Essentially, that

Not an actual sample.

means I’m taking a correspondence course on how to be a better writer. Every month I mail off a packet of papers. My adviser takes out her colored pens, marks them up, and sends them back. It is a little intimidating. I trust you share my “red pen” fears. But I graduate in January (hooray), and hopefully these writing lessons have made the Blog, e-newsletter, and other publications more enjoyable for you.

Sometimes, however, I catch myself wishing for a simpler way, something more akin to our own ACDIS online learning library. As far as I know though there are no writing CEUs for assistant association directors. But if you happen to be in the market for a convenient way to collect CEUs for coding, case management, or CCDS certifications, ACDIS can help.

Just last week we posted two new e-learning courses: one on hospital acquired conditions and another on present on admission. These new programs join sessions on 2009 IPPS MS-DRG update, understanding and applying the 2009 ICD-9-CM codes, inpatient coding: physician queries, and major complications/comorbidities.

Since I won’t be earning CEUs for writing this blog post, I’ll be jumping online in the coming weeks to tackle the ACDIS e-learning offerings myself. I promise to post my progress to all of you here. Feel free to place your bets now on how I’ll do.

If you’ve taken any of our courses please let us know what you think. ACDIS plans to add roughly four new courses every year and we’d love your feedback about what to concentrate on in 2010.

CDI takes center stage at forum in Chicago

Two ACDIS board members discuss CDI in Chicago this week.

Today and tomorrow the World Research Group holds its fourth annual Clinical Documentation Improvement & Coding Expo at the Hilton Suites in Chicago. We are extremely happy that ACDIS members will be well represented. The roster of presenters includes ACDIS Board Members Colleen Stukenberg, MSN, RN, CMSRN, CCDS, Clinical Documentation Management Professional at FHN Memorial Hospital in Freeport, IL, and Garri L. Garrison, RN, CPC, CMC, CPUR, director of Acute Care Services at 3M health information systems in Atlanta, GA.

Stukenberg will present “A CDI Orientation Process: A Checklist to Get Started.” Even when a healthcare organization hires consultants to start the CDI program staffing turnover and program growth requires ongoing training, she says. Her presentation later today explores the scope of a CDI orientation process. Tomorrow, Stukenberg moderates a panel discussion “How to Bridge the Gap Between Physicians, CDI Specialists, and Coders.” The discussion will have equal representation from each profession, naturally. Topics on the agenda include problematic terminology, evidence-based principles, common pitfalls in physician documentation, and clinical indicators in the medical record, among other items.

Before I stop touting Stukenberg’s expertise I want to just take a moment to laud her new book “Successful Collaboration in Healthcare: A Guide for Physicians, Nurses & Clinical Documentation Specialists,” which ties in quite nicely to her prestation tomorrow. The book describes ways in which nurses and physicians can collaborate to enhance patient safety and quality, and how this collaboration can have a positive effect on the financial aspects of an organization, Stukenberg says.

Garrison moderates a panel of professionals tomorrow afternoon to discuss “The Metrics for Evaluating a CDI Program.” Many ACDIS members say that once their CDI programs have been in place for a while, they need to ramp up their benchmarking and data collection. Garrison’s presentation explores how three different facilities tracked their CDI outcomes based on financial, quality, and other ratios.

We are so proud to have such talented board members and know that many ACDIS members also do their part to demonstrate the importance of clinical documentation improvement in their own communities. If you are an ACDIS member and have an upcoming speaking engagement we’d like to hear about it. Let us know by posting a comment here on the ACDIS Blog, on our LinkedIn or Facebook pages, or by shooting us an e-mail.