Local CDI schedule December/January meetings

California

California ACDIS Chapter meets via telephone/web conference line on Wednesday, December 8, 9-10 a.m. This month’s agenda includes a discussion/presentation regarding the impact of ICD-10 on CDI, with Donna Kent, RN, BSN, CCDS, manager of Clinical Documentation Integrity Program at Torrance Memorial Medical Center. Participation is free and registration is not required. For information, contact Dexter D’Costa, MD, manager, clinical documentation, quality improvement, and patient safety, by phone at 650/723-5343, or by e-mail at dr_dexterdcosta@yahoo.com.

Minnesota

The next Minnesota CDI meeting will be held Wednesday, December 22, 1-2:30 p.m. via telephone conference line. For information, contact Mark LeBlanc, RN, MBA, CCDS, by phone at 952/993-5692 or by e-mail at Mark.LeBlanc@ParkNicollet.com

January

Indiana

The Central Indiana ACDIS Chapter meeting is scheduled for January 12, 10 a.m. to noon, at Riverview Hospital in Noblesville, IN.  The agenda includes:

• Review and discussion of local member survey
  • Meeting topic and speakers suggestions for 2011
  • Vendor participation
  • Chapter dues
  • Chapter leadership
  • Term service of executive team
  • Nominations for leadership positions/officers
• ICD-10 Education, with Indiana Health Information Management Association Task Force leader Danita Forgey

For information, contact Susan Bradford, RN, BSN, Clinical Documentation Specialist at Riverview Hospital  by phone at 317/776-7285 or by e-mail at sbradford@riverview.org.

Michigan

Michigan ACDIS Chapter meets quarterly, the first session for the 2011 schedule will be Thursday, January 20, noon to 1 p.m. With a presentation by Denyatta Henry, MBA, RN, CCS, CDMP Coordinator at McLaren Regional Medical Center in Flint. For information, contact Janet Gentle, MSN, CCDS, by phone at 231/487-3564 or e-mail at jgentle@northernhealth.org.

Maryland

Maryland CDI gathers again on Friday, January 21. For information, contact Christine Mobley, RN, director of clinical documentation at Prince George’s Hospital Center by phone at 301/618-6507 or by e-mail at christine.Mobley@dimensionshealth.org.

Ethics brief offers CDI reminders for appropriate practices

The American Health Information Management Association (AHIMA) released its Ethical Standards for Clinical

AHIMA ethics guidance offers CDI reminders

Documentation Improvement (CDI) Professionals paper earlier this year.  Hopefully, the majority of CDI professionals have taken the time to read the document in its entirety and have assimilated the material to your business practice of CDI. If you have not had the opportunity to read AHIMA’s CDI ethics  brief, now is the time to clear off your desk and begin the task.

The AHIMA paper highlights key provisions of ethical standards governing the practice of CDI that serves as an underlying foundation of our profession. These ethical standards are based on the AHIMA’s Code of Ethics, its Standards for Ethical Coding, as well as the Association of Clinical Documentation Improvement Specialists’ (ACDIS) Code of Ethics.

Basic points

Common sense points governing the roles, duties, and responsibilities of a CDI specialists are presented within the paper. While the information provided is certainly logical and congruent with the philosophy that we ascribe to as CDI professionals, it is worth mentioning several items that may need reiteration from a practical application standpoint. Consider the following:

• CDI specialists shall use queries as a communication tool to improve the quality of health record documentation, not to inappropriately increase reimbursement or misrepresent quality of care
• CDI professionals shall not query the provider when there is no clinical information in the health record prompting the need for a query
• CDI professionals shall facilitate documentation that supports reporting of diagnoses and procedures such that the organization receives the optimal payment to which the facility is legally entitled, remembering that it is unethical and illegal to increase payment by means that contradict regulatory guidelines
• CDI professionals shall not misrepresent the patient’s clinical picture through intentional incorrect documentation or omission of diagnoses or procedures, or the addition of supported diagnoses or procedures to inappropriately increase reimbursement, justify medical necessity, improve publicly reported data, or qualify for insurance policy coverage benefits.

These points on face value appear to represent a philosophy that we consistently ascribe to in carrying out CDI efforts. However, in our quest to secure specific, accurate, and detailed clinical documentation in support of a “complete” record, we may be circumventing the clinically accurate and clinically relevant aspect of CDI.

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Watch for substance abuse, emotional distress in documentation around the holidays

The Thanksgiving holidays are often filled with excesses. There is the obvious food and drink extravaganza; the all day football watching; the exhausting shopping on black Friday; the unsolicited parental advice, the crying children and of course the many pounds gained.

The holidays also account for a greater incidence of depression, stress, substance abuse and suicide. The numbers of people choosing to take their own lives is increasing. By some estimates a person tries to take their life every 39 seconds. Suicide is not limited to a single age group, racial group, or socioeconomic class. Currently, among the 15- to 19-year olds, suicide is the second leading cause of death (following accidents). The suicide rate has tripled over the last 30 years in this age group. The elderly (often following the death of their spouse, or favorite pet) are another large group very much at risk. (Kirsti A. Dyer, MD)

There are conflicting reports as to whether the suicide rate increases during the holiday, or afterwards. Whether or not there is an increased incidence of suicide, we know there is an increased incidence of depression, mental health visits and the blues, both during the holiday and up to three weeks after the holidays.

Clinical documentation specialists need to be aware of the specialized documentation needs when dealing with substance abuse and the rules that govern the admission of a patient with an overdose.

Physicians historically document “history of drug use” when a patient is admitted, regardless of whether the patient has a current positive drug screen. The physician must be educated on the benefit of documenting drug use/abuse ongoing. The capture of this diagnosis is a comorbidity and therefore, reflects the extra resource consumption and increased severity of illness that these patients possess.

Drug overdoses or the admission for affects of drugs taken with alcohol, are coded to DRG 917-918-Poisoning and toxic affect of drugs.

Similar comorbidities include ETOH withdrawl delirium, ETOH or drug withdrawl, ETOH induced persisting dementia, ETOH induced psychotic disorder with hallucinations, and ETOH mania, psychosis, or mood disorder.

May your holidays be blessed and may you have a wonderful Thanksgiving holiday .

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.

National CDI specialists estimate

I was recently wondering about an  estimate of the number of CDI specialists across the country.  After some Google searching and a couple of conversations I did not find any publicly available estimates.  So,  I’ll try to come up with a ballpark one on my own.

The data (some from memory; other specific sources cited):

• When ACDIS launched, the press release cited 50% of acute care hospitals had a CDI program.  That was (wow, time flies!) back in October 2007.  I will use an estimate of 60% (a conservative number I believe because I generally suspect the number may now be actually closer to 75%).
• The CMS current Final Rule impact file provides information about beds, discharges, etc.
• Based on a couple of ACDIS surveys, I am estimating 1 FTE for every 100 beds in a facility.  Alternatively, around 1 FTE for every 2,000 annual discharges.

The CMS impact file data is based on the MedPAR fiscal year 2009 data:

• 651,289 beds
• Total annual discharges:  10,620,161

Now for some math:

• 621,289 beds divided by 100 beds per FTE, then 60% = 3,728 CDI FTE’s
• 10,620,161 discharges divided by 2,000 discharges per FTE, then 60% = 3,186 CDI FTE’s

So, my estimate for full time CDI specialists currently employed throughout the nation is NOT LESS than 3,200 and may actually be as high as 4,660 (if 75% of all acute inpatient hospitals have a CDI program).

FYI, there is a lot of potential fun in the CMS files, especially the impact file.

• CMS estimates FY 2010 and FY 2011 CMI for each facility (based on FY 2009 coded data)
• Compare  similarly sized hospitals average daily census, CMI, annual discharges, etc.
• DRG Distribution data (Tables 7A and 7 B)

Sure there are some flaws in my analysis:

• Smaller hospitals may skew this data since they are less likely to have a CDI program and may be less likely to fully or over staff to ensure coverage.
• Larger hospitals may actually be better staffed and more likely to have a CDI program.
• I did not attempt to include other settings such as LTAC’s, ED, ambulatory, etc.
• Of course, there are additional areas of CDI interest and activity, such as the professional coding community.

After running through the numbers above, my instinct suggests the estimate is low but I cannot see how I might come up with anything better. Any suggestions?

Protect your ACDIS membership information

We’ve had a few recent instances where an ACDIS member has given his or her username and login information to a coworker. Generally, these instances are innocent enough. A CDI manager asks a staff member to login and download some forms or maybe a CDI specialist sees a good article in the CDI Journal and gives their login information to a friend so they can read the article, too. While such acts seem innocent enough we urge ACDIS members to remember that memberships are individual and should not be shared by multiple users.

Multiple use becomes a particular problem when a professional logs into the site to fill out a job posting using another person’s information. It also becomes problematic when participating in CDI Talk and various other aspects of the ACDIS community.

If your facility has a multiple-member team we do offer group membership rates, just call 877/240-6586 for details.

Nearly 250 attend fourth-quarter members’ conference call

During last Thursday’s (November 18) quarterly ACDIS member conference garnered nearly 250 participants. While we

Quarterly Conference Call recording available online.

regret that due to the high volume of callers some late comers may have had difficultly dialing into the conference line, our teleconference hosts did expand the line and members should have been able to get through if they dialed in again. If you happened to miss the live call, the recording is now posted on the ACDIS website under the last navigation bar on the left side of the screen titled “Quarterly Conference Calls.”

The call began with a discussion of plans for the 2011 ACDIS Annual Conference slated for April 7-8, in Orlando. ACDIS Director Brian Murphy listed some of this years’ hot topics, thanked the conference committee for their efforts, and reminded listeners that ACDIS is now accepting applications for the poster session.

There was also some preliminary discussion of the CDI Work Group’s efforts to establish a CDI recognition/awareness week which may be come a reality in 2011.

Additional discussion included:

• MLN Matters article SE1028
• Acute renal failure and other 584-series codes
• ICD-10 conversion
• AHRQ patient safety indicators

ACDIS members have access to White Papers galore

Our 'White Papers' offer valuable information about the latest CDI trends.

Ever wonder why we call a “White Paper” a “White Paper”? According to the website Word-Detective.com, the phrase originated in England. When large-scale official policy or legislative reports were delivered by government officials to members of Parliament, they were dubbed “Blue Papers” due to the color of their covers. However, summary statements or pieces too short to warrant a “blue” cover received a white one instead and thus earned the name “White Paper.”

Back home in America we adopted the term after World War II, Word-Detective.com suggests, “to represent anything in business or government that offers a succinct analysis of a larger issue of importance. “

ACDIS has no shortage of these informative works available on its website. From discussions of altered mental status, to developing a quality-focused agenda for CDI, to good E/M documentation. You can find each White Paper under the CDI Journal/Quarterly Newsletter button. White Papers appear as a link under the Journal issue closest to its publication date.

• White Paper: What Every CDI Program Needs to Succeed is Structure, Staff, Process
• White paper: Good E/M Documentation a Win-Win for Physicians and CDI Specialists
• White Paper: Cut through the confusion of altered mental status
• White paper: Roll out an engaging CDI program
• White paper: Instill a culture of quality to ensure CDI success

‘Care transitions’ conference slated for December 3

I enjoying parsing a phrase as much as next linguistically entertained individual but the following “definition” from CMS certainly takes some effort to decipher.

According to CMS, “community-based organizations provide care transition services across a continuum of care through arrangements with subsection (d) hospitals (as defined in section 1886(d)(1)(B) of the Social Security Act) and whose governing body includes sufficient representation of multiple health care stakeholders, including consumers.”

Now maybe I am over-simplifying (if so, I certainly hope that my friends in case/care management will offer us all some additional insight) but from what I understand CMS is about embark on a new initiative called the “Community-based Care Transitions Program (CCTP). Essentially this initiative aims to bring together hospitals with assisted living facilities, nursing homes, and other community extended care programs to make the transition from the acute care easier for patients. Of course, ideally, this will also keep patients healthier and thereby reduce healthcare costs.

While I’m sure there is a complicated additional set of Medicare reimbursement initiatives that go along with CCTP, I’m not going to try to parse those. (I’ll surely get myself into more hot water if I try.) But if you’re interested in learning more about the CCTP, CMS will hold a National Care Transitions Conference December 3 to provide guidance for hospitals and other healthcare providers.

The conference will cover several topic including:

• An overview of the CCTP
• Evidence-based care transition models
• Lessons learned from participation in the Quality Improvement Organizations’ (QIOs) 9th scope of work care transitions sub-national theme
• Hospital-based interventions to reduce readmissions
• Positive financial implications of successfully reducing readmissions

Those interested in attending the CMS National Care Transitions Conference can do so either in person or via a webinar. To register for the event visit CMS website.

Poster presenters for 2011 annual conference sought

The fourth annual ACDIS conference, to be held April 7-8, 2011 at the Hilton in Walt Disney World® Resort in Orlando, FL, will include a poster session as part of its conference offerings. It’s an informal way for hospitals to share their CDI-related successes with each other, foster increased networking, and exchange ideas and information.

ACDIS has a room reserved for the poster session and there will be dedicated viewing time on Day 2 of the conference (April 8, noon-1:30 EST). Space is limited to approximately 18 presenters and the posters will be placed on display for the duration of the conference. All final decisions on posters will be made by the 2011 ACDIS Conference Committee.

If you would like to submit a poster (please, no larger than 4 feet in width), and are available to present your poster on day two at the time specified above, please e-mail a description of your idea to ACDIS Director Brian Murphy at bmurphy@cdiassociation.com. Accepted poster presenters will receive a 50% discount off the price of conference admission.

Any and all ideas are welcome. Some poster topics to consider include the following:

• An overview of your CDI program—staffing, processes, etc.
• Successful physician training/educational methods
• CDI program data mining and reporting techniques
• Query forms, physician newsletters, etc. that you’ve developed and would like to share

For more ideas, you can view a complete listing of last year’s poster presenters right here on the ACDIS blog.

Thanks, and I look forward to hearing from you,

Brian