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Website Tips: How to register for ACDIS Radio and never miss an episode again

According to the 2017 ACDIS Membership Survey, 73.68% of members find ACDIS Radio a beneficial piece of their membership experience. The bi-weekly talk show hosted by ACDIS Director Brian Murphy covers a wide-range of CDI-related news and topics through conversations with industry leaders, ACDIS Advisory Board members, physicians, CDI specialists, and managers. The show airs every other Wednesday at 11:30 a.m. eastern.

But, how do you access this free resource? While you can head over to the ACDIS website and listen to all the past episodes as soon as a day after they originally air, registering for the program makes things even easier. Plus, when you listen live, you can weigh in on the weekly poll and participate in the Q&A segment.

Simply follow the two step process below and you’ll get a weekly reminder when the show will air and instructions on how to tune in.

1. First, go to the ACDIS main page and select “ACDIS Radio” under the “Network & Events” tab (it’s the third option).

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2. Then, click the “register” button underneath the ACDIS Radio logo. The registration page will automatically open in a new window.

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3. Fill in the necessary information on the registration page and click “register” at the bottom of the page.

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4. Once you’ve clicked “register,” you’ll see a confirmation page with an option to add the program directly to your Outlook email calendar. All the instructions for listening to the call will be in the reminder emails for each episode.

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Editor’s note: To listen back to previous episodes of ACDIS Radio, click here. To read a recent Radio Recap about a session at the ACDIS Symposium: Outpatient CDI, click here.

Website Tips: Join in on the discussion on ACDIS articles

ACDIS members can join in on the discussion with any articles on the website they find intriguing by using the Discus feature. Just like the ACDIS Forum, this feature allows members to connect, discuss interesting articles, and weigh in on the issues presented.

But, how do members do this? Simply follow the following step-by-step guide for joining the conversation below.

  1. Scroll to the end of the article you want to comment on, past the “More Like This” section, to the section titled “Discussion”

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  1. Write your comment in the chat pod where it says “start the discussion”

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  1. Enter in your name and email address, ensuring your comment is signed and you receive notifications when someone responds to the comment

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  1. Either create a Disqus account using the prompts, log in with Facebook, Twitter, or Google, or simply check the box that says “I’d rather post as a guest”

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  1. Click the gray arrow below the sign-in information to post your comment

After posting a comment, the commenter will receive an email when someone responds or posts a comment of their own on the same article.

If you have any questions regarding commenting on ACDIS articles or anything else, please contact ACDIS Editor Linnea Archibald at larchibald@acdis.org.

Website Tips: How to participate actively in the ACDIS Forum

One of the things ACDIS members appreciate most about membership is connecting with other CDI specialists. One of the best ways to do so is through the ACDIS Forum.

ACDIS members can follow all their favorite Forum threads by updating their subscription preferences. Simply follow the following steps:

  1. Log on to the ACDIS website
  2. Go to the Forums page (under the “Network & Events” tab)
  3. Click on “My Profile” under the person icon on the right

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  1. Click the blue “preferences” link at the top of the profile page

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  1. Select “notification preferences” on the right

 

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  1. Check off the categories you want to receive notifications from for both discussions and comments and then click “save preferences”

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To become a member of the ACDIS Forum, click here. Only ACDIS members can actively participate in Forum discussions.

Editor’s note: If you have any questions regarding joining the forum, email ACDIS Editor Linnea Archibald at larchibald@acdis.org.

 

Last Week on CDI Talk: Assigning queries to residents

How do you assign queries to residents, PAs, and NPs?

How do you assign queries to residents, PAs, and NPs?

Editor’s Note: CDI Talk is a networking forum for ACDIS members, in which members ask pressing questions and garner the opinion and expertise of their peers. Join by clicking on the CDI Talk tab on the ACDIS website.

Academic medical centers face a whole different set of challenges when it comes to CDI. In one recent discussion on CDI Talk, users discussed how academic medical centers assign queries, specifically if they should address the query to the treating resident or the attending physician. Users also debated whether or not they should require a co-signature for resident’s answers from the attending, and if the same policies apply to nurse practitioners (NPs) and physician assistants (PAs).

Query processes should be outlined in hospital by-laws, says Angelisa Romanello, RN, BSN, FNS, CCDS, CDI Manager at the CJW Medical Center in Richmond, Virginia. For example, per her facility’s by-laws, CDI specialists only query residents, NPs, and PAs who work for their hospitalist group. For any the service line, the attending has to be queried. This helps hold the attending responsible for their students, she says.

Clinicians are licensed to “establish a diagnosis independently,” Sutter West Bay in San Francisco, California doesn’t require a countersignature for NPs and PAs, says Paul Evans, RHIA, CCS, CCS-P, CCDS, manager of the CDI program there.  Residents, however, are required to have any and all notes, including a query response, counter-signed by the attending, as per their hospital’s by-laws.

“If a resident is working with an attending, we send the query to the attending,” says Evans. “Often, the attending will expect the resident to answer our query, and that query must then be signed by the attending.”

State laws are important to consider when speaking to the responsibility of the attending physicians in terms of resident oversight and medical records, according to Robert Billerbeck, MC, CPC, owner of Meditco LLC in Colorado. Colorado law considers NPs a “Licensed Independent Practitioner” (LIP) for primary care, and therefore require no co-signature. However, the state law does require a PA to obtain a co-signature and other oversight. Facilities, he says, may have their own rules that meet state regulations, but some facilities’ in-house rules go further than others. For example, a facility can require an MD co-signature for NPs, even though the state does not require it, and other facilities may not have the same requirement. And rules differ from state to state.

“The bottom line is we need to know both state and facility rules when determining signature requirements for any given location,” says Billerbeck.

Residents are often more open to CDI efforts than seasoned physicians, says Deborah Dallen, RN, CCDS, CDI Supervisor at Einstein Medical Center in Philadelphia, Pennsylvania. Her team queries residents, PAs, and NPs on any service. Queries are usually assigned to the primary team with the exception of debridement and OR report clarifications, which are usually assigned to the surgical resident or attending physician. Dallen and her staff have an excellent response rate with residents and, despite the required 24-hour turnaround requirement, they usually meet their deadlines both concurrently and post-discharge.

Queries are not always formally mentioned in hospital bylaws, however, says Katy Good, RN, BSN, CCDS, CCS, CDI Program Coordinator, and AHIMA Approved ICD-10CM/PCS Trainer at Flagstaff Medical Center in Arizona. Many facilities treat queries like progress notes, and maintain them as a permanent part of the medical record. The guidelines for progress notes indicate who can independently sign a progress note. If query guidelines are not explicitly outlined in a facility’s by-laws, the guidelines for progress notes can be used when figuring out who can sign queries.

For example, at Good’s facility, by following the guidelines for progress notes and applying them to queries, residents require a co-signature. Further, queries are sent to the attending, and they are responsible for assigning the query to the resident. Similarly, PAs require a co-signature for progress notes at her facility, and therefore CDI specialists do not send queries directly to them. NPs do not require a signature for progress notes, so CDI specialists do send queries directly to them. Check with physician groups about their preferences for handling queries—some who employ NPs will want the queries sent directly to the NP, rather than the surgeons or physicians themselves.

Membership Update: The Pediatric CDI Talk is up and running!

Join the new CDI Pediatric Talk group and share your facility's practices and concerns.

Join the new CDI Pediatric Talk group and share your facility’s practices and concerns.

The new pediatric listserv message board was finished this week. It works just like CDI Talk and can be accessed on the CDI Talk page. For those of you unfamiliar with CDI Talk, simply subscribe using the button on the page.

Once approved, you can visit the Talk group and adjust your settings via the “my account” tab. You can chose to receive messages in your email as they are submitted or pick a different option that works for you, such as a daily or weekly digest of messages.

A lot of work went into the creation of this service and we appreciate the help of our technology and design team here at ACDIS for bringing this wonderful idea to fruition. We hope you all get a lot out of the ability to network with each other on a more continuous basis via this great new membership benefit.

Reminder: Now through August 31, current ACDIS members are encouraged to refer a colleague to ACDIS and receive 25% off your next membership renewal fee. Should your colleague join, they receive a discount, too. Look for additional details coming soon to your inbox.

Calculating the worth of CDI staff

Here is a "what if" scenario to help illustrate CDI specialists' return on investment.

Here is a “what if” scenario to help illustrate CDI specialists’ return on investment.

By Mark N. Dominesey, RN, BSN, MBA, CCDS, CDIP

What follows below is applicable to a program or organizational perspective, not all who read the ACDIS Blog are interested in this type of program management discussion.

Hospitals that base CDI pay on nursing or HIM pay scales may not be taking into account the value of CDI to the bottom line. We, as CDI professionals, have to continually advocate for the value we bring to the organization.  CDI Staff are “value-add,” not “net-loss” employees.  It is understandable for a hospital to offer a lower salary for a person new to CDI, but within 1-2 years, that employee becomes very valuable in the CDI world.

Let’s make this easy for the accountants and the chief financial officers in our hospitals to understand (let’s talk quality afterwards, the numbers guys and gals want “hard financial numbers” to justify their investment in CDI).

Think about it this way….  The Advisory Board Company (a Washington, D.C., based global research company) states that a high performing CDI specialist (someone with roughly 2 years’ experience) brings about $1.4 million in revenue to a 250-bed hospital.  An “average” CDI specialist brings about $700,000 in revenue, according to a 2012 webinar titled “Creating Top Tier CDI Capabilities.”

Let’s do some math.  (All salary numbers are assumptions, not based on mine or any other numbers.)

Costs: Let’s assume 30% overhead on salary for benefits, space, utilities, education costs etc. and build this in to the salary equation. Let’s assume three employees working at a given facility all earn the same salary and the manager earn about 20% more in additional salary. It appears that the national “going rate” (advertised salaries) for a CDI specialist is $75,000; and roughly $90,000 for a CDI manager.  (For additional rates review the ACDIS “2012 CDI specialist Salary Survey,” published in the CDI Journal.) So far, for costs we have:

  • $315,000 for personnel
  • $94,500 for overhead
  • $60,000 for software/hardware
  • $40,000 for part-time physician advisor salary (This assumes a hospitalist who makes roughly $200,000-$250,000 salary would be paid about a 1/4th or 1/5th of their time).
  • $509,500

Revenue: Again these are assumptions, but let’s say that a high performing team (which includes our staff of three and their manager) can earn the facility roughly $1.4 million each with the manager who reviews records part-time earning roughly $700,000 for a total of about $4.9 million. If we consider this in reference to the previous mentioned webinar and within context of anecdotal earning from consulting firms, this looks about right (other organizations say a 250-bed hospital can make as much as $5 million/year with a great CDI program). Let’s say that an average performing team of the same make up earns about $2.45 million.

Return on investment (ROI): Let’s calculate the return-on-investment using the following equation: ROI equals payback after investment divided by that investment or ROI=(payback – investment/investment). So for our high-performing team in the above example the equation would be ($4.9M-$509.5k)/$509.5k=8.62

Some financial people like to see and present ROI in percentages.  So multiply the number by 100 and add the percent unit, or 862%, and be described this way: “The potential return on investment for a high performing CDI team is 862%.”

Assuming we have an average performing team ROI = 3.8.  In percentage form: 380%

So, don’t you think we easily justify our existence from a financial standpoint? A CDI team represents at minimum a 4 to 1 ROI with the potential being much greater!

Let’s give our staff members’ raises of about 10% to make our team have better standing in competitiveness and retention.

Costs: Specialists $83k x 3 + Manager $100k = $349k + 30% (overhead) = $454k; add $60k (software) + $40k (adviser) = $554k. ROI=  7.84 or 784% for a high-performing staff and 3.42 or 342% for an average performing staff.

How many other departments in the hospital show an ROI as good as this?

The main point of this exercise is to show that most of us CDI practitioners have advanced training and we are in a very competitive and fast-growing career field.  Thus, by presenting the value we bring in financial terms, we should be able to justify to administration our higher pay in relation to our nurse and HIM colleagues.

Editor’s Note: Mark N. Dominesey, RN, BSN, MBA, CCDS, CDIP, is the manager of Clinical Documentation Excellence at Sibley Memorial Hospital in Washington, D.C., and a frequent contributor to CDI Talk, where this post originated. Contact him at mdomine2@jhmi.edu.

Networking support: Dancing with the blinds closed

The value of your good work is inherent in the good work itself. If you are the only one that recognizes it, you can nevertheless close those blinds and find joy in a job well done.

During CDI Week (September 17-21) one of our CDI Talk members wrote in to vent some frustration. She’d spent 50 minutes being berated by a physician. He told her that CDI specialists do not represent the government and that her questions were keeping him from caring for his patients, among other things.

If he’d simply answered her questions, he would have been done in two minutes instead of the 50 he’d spent berating her.

After taking herself to the stairwell for a good cry, she took her concerns to the chief medical officer (CMO) and the vice president (VP) of quality who both supported her efforts, treated her professionally, and eased her frustration. She took to the CDI Talk message board for further support from her fellow CDI professionals.

Here are some examples of the advice and support they provided, further proving that the ACDIS networking community is a valuable resource:

  • I [try] not to let physicians get me riled up (though many certainly get under my skin particularly if they insult me or the reason I am here). When a confrontational situation arises, I tell them that I have an appointment to make, and will get back to them.  I then usually go see their chair and get a meeting set up or get my physician advisor to intervene. I try to remind myself and others that physicians are like everybody else; they eat, sleep, die, cry, love, blink, grow hair, and have failings like the rest of us.
  • I have a motto that gets me through those moments: ‘It’s nice to be important, but more important to be nice.’ It evens the playing field for me.
  • Hang in there… it happens to all of us at one time or another.  If your facility has a code of values which includes mutual respect, you can issue a complaint about the providers conduct. I’ve done that in the past and it worked wonders. We actually got the surgeon to apologize.
  • I have had to go into the stairwell to cry as well, don’t worry. In some ways, CDI does represent the government.  We are the buffer for physicians so that the government does not come down on their incomplete documentation with payment denials and low quality scores. We have all been there, haven’t we?
  • After those types of interactions, I try to remember why our profession is important. I know that he will change his tune once he receives a Recovery Auditor denial.  If his services are an outlier, he will be touched by the Medicare Angels.  Then, all of a sudden, he will want you on his team. I’ve had that experience—been there, done that—and then danced in my office when the blinds were closed.

There’s a lot of great advice here: reminders to reach out to appropriate staff for assistance when dealing with a colleague who is, for whatever reason, being uncooperative; and that words of encouragement for the individual as well words of support for all CDI specialists’ professional skills and abilities go a long way toward improving confidence and make for a more productive and cooperative work environment.

The physician, while arguably the most important member of the healthcare team, also relies on the skills of the CDI professional. Each brings a different set of skills to the table and it’s only when working together that the patients’ needs will be best served and the reimbursement for services appropriately paid.

Perhaps the best advice she received is that, while it’s okay to find a quiet place and cry out your frustration, there’s a lot more joy in dancing with the blinds drawn.

Find a place for peer input in CDI internal reviews

Back when I worked in newspapers we called it “editing by committee.” When a reporter finished an article he or she would ask a peer to read it over and offer suggestions before passing the revised piece on to the editors. Through the process the reporter may discover a new approach or see the need for additional research to enrich the article. It was a good learning process all around. I learned to be a more careful reader and writer, a conscientious critic, and delicate manager.

So I was interested to read a recent post on the Medical Records Briefing talk group

How does your CDI program scrutinize its own work?

regarding coding peer review process. A Norwich, CT, coding manager explained that while her facility audits for coding accuracy with an external group, those efforts don’t help facilitate an ongoing dialogue with the staff members themselves.

She wrote: “If someone can help me on this, I would appreciate it.  I want to open up a dialogue with the coding staff with a peer review.”

In response, someone suggested holding informal weekly coding meetings in addition to external audits. During the meetings staff members to bring their most challenging case or chart from their week’s work to share and discuss other issues staff members may  struggle with.

The dialogue made me wonder how CDI professionals face similar concerns.

On our own CDI Talk Group , one ACDIS member reported that a coder from her department would follow-up in the afternoon on the charts reviewed earlier in the day. Others suggested CDI managers implement a self-auditing program that pulls a random sampling of queries on a monthly or quarterly basis and cross-references them against the final coding assignments. And others echoed the Medical Records Briefing post suggestion. These recommended weekly or monthly collaborative meetings with a core group of CDI stakeholders to discuss problematic areas, particularly difficult charts, changes in coding or documentation rules, and any systematic problem areas that may arise.

Whether your facility employs a formal external auditing process for your CDI program or not it’s always a good idea to check your work. Let us know what process works for your facility.

Talk the CDI Talk

Join the CDI discussion

Join the CDI discussion

I don’t know how many of you subscribe to CDI Talk, but I think you’re missing out if you’re not subscribed. CDI Talk is an active talk group of ACDIS members and generates a lot of great discussion. It’s a good way to keep updated on the issues affecting CDI programs around the nation, and I would love to have you weigh in on the conversations. Signing up is easy (and free with ACDIS membership):

  • Sign in to the ACDIS Web site (www.cdiassociation.com) with your password and username
  • Go to our CDI Talk page, here: http://www.hcpro.com/acdis/cdi_talk.cfm
  • Click the gray “subscribe button”
  • Post messages by using the “create new message” button, or by sending a message to cdi_talk@hcprotalk.com.

CDI Talk tip: Archives offer topic search option

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CDI Talk offers another way to network.

Many of you are familiar with how talk groups operate. In general, if you are a member of an organization you can subscribe to its talk group. This allows you to pose a question to the other subscribers or members of the group. If a member knows the answer or wants to respond to the conversation at hand they can do so.

So, if you are confused about a new regulatory requirement, wondering how others are improving physician relationships and communication at their facilities, want to bounce some ideas off of a peer, or have a shared conversation about professional development, CDI Talk is a helpful place.

When you sign up for the talk group you can chose to receive messages individually, as submitted by members, or you can chose to receive a summary of the daily discussions (a “daily digest”). While both of these options are useful they both have their drawbacks—individual messages can clog up your e-mail inbox and a daily digest can be difficult to read if there are multiple discussion threads.

If you’re signed up for CDI Talk, however, you also have access to the Talk Group Archives. The best thing about the archives is that they are fully searchable by keyword. But you can also browse the message list and sort by the author of the post, the number of responses the post generated, the topic, and/or the date.  Personally, I find this the most useful method to stay connected and informed. Usually, on Friday mornings I carve out about 15-20 minutes of my day to scroll through the list from the week.  If there’s a topic I’m interested in, I click on the subject line and open the string of responses to learn more and join the conversation.

New and seasoned CDI specialists benefit from the opportunity to talk regularly via e-mail with their peers on CDI Talk.  Over the years, generous professionals have shared tips and tricks, best practices and benchmarking data through this forum.

It’s just one more way ACDIS helps you stay connected. If you’re not a member, what are you waiting for? The $129 membership more than pays for itself in product discounts, useful tools, quarterly conference calls with the advisory board, the newsletter. . . okay, I’ll stop bragging. . . If you’re interested, contact ACDIS member relations at 800/650-6787 or e-mail customerservice@cdiassociation.com, or visit HCMarketplace.com.