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Q&A: Physician advisor collaboration with CDI

Huth

Thomas W. Huth, MD, MBA, FACP,

Editor’s Note: As part of the fifth annual Clinical Documentation Improvement Week, ACDIS has conducted a series of interviews with CDI professionals on a variety of emerging industry topics. Thomas W. Huth, MD, MBA, FACP, Vice President of Medical Affairs at Reid Hospital & Health Care Services in Richmond, Indiana, answered the following questions regarding physician advisor’s role in CDI. With more than 20 years of clinical practice experience and a Master of Business Administration degree, Huth has served in a variety of medical staff, organized medicine, and community leadership roles. Contact him at Thomas.Huth@reidhospital.org.

Q: Can you describe your role as a physician advisor to CDI?

A: I give expert guidance to the CDI specialists when they have questions about what to query, and how to do it, and how to approach the doctors in an effective manner.

Q: Can you describe the engagement and collaboration of your medical staff in CDI?

A: We work to establish a cultural expectation of engagement and collaboration of the medical staff with the CDI specialists. We provide constant feedback to the doctors and to the medical staff leaders about performance. We also ask the medical staff leaders to send the message to the individual doctors about the importance of CDI to the quality of care for patients and the objective performance of the organization on severity adjusted metrics.

 

Q: What has been your most successful approach for obtaining physician buy-in?

A: We have had good success by providing physician-specific feedback on the impact of complete and thorough documentation to measures of quality and efficiency. When doctors are shown their own data they usually become much more engaged in the process.

 

Q: Does your medical executive committee have an escalation policy or other policy requiring physicians to respond to queries/CDI clarifications in a set timeframe? Can you describe its effectiveness?

A: We have an analytics team which gathers in-depth data on physician response rates and we provide that to doctors on a weekly basis. Consequently, our response rates have improved to above 90% in most weeks. There is a comparable rate of agreement with the CDI specialist’s assessment. We don’t emphasize agreement rates to the doctors and we don’t report the rates to them individually. Instead, we use agreement rates as a measure of the quality and appropriateness of the CDI specialists’ queries.

 

Q: What are your biggest challenges with getting physician buy-in?

A: Keeping doctors engaged in improving the processes and quality of documentation since they have a lot of other priorities.

 

Q: What do you think the role of the CDI physician advisor is/should be in terms of program advancement and analysis?

A:  It’s very important to have a physician advisor with advanced training in CDI available to the CDI team. The advisor should be an effective liaison to, and teacher of, the medical staff. The physician advisor can provide many useful insights into the data and help plan improvement projects.

Q&A: The Role of the Physician Advisor in CDI

Hernandez

Rebecca Hernandez, RN, BSN

Fainman

Zachary Fainman, MD

 Editor’s Note: As part of the fifth annual Clinical Documentation Improvement Week, ACDIS has conducted a series of interviews with CDI professionals on a variety of emerging industry topics. Zachary Fainman, MD, co-medical director and physician advisor of care management at Advocate Luther an General Hospital in Park Ridge, Illinois, offered his insight into the role of the physician advisor in CDI. Fainman provides oversight over care management, social work, utilization management, government audit and CDI, a position he has held since 2011. Fainman is also the founder of the physician advisor committee at Advocate System. Contact him at zachary.fainman@advocatehealth.com. Rebecca Hernandez, RN, BSN, CDI program supervisor works with and educates CDI specialists, nurses, physicians, and other healthcare practitioners to ensure accuracy and timely clinical documentation in the medical record. Contact her at rebecca-l.hernandez@advocatehealth.com.

Q: Can you describe your role as a physician advisor to CDI?

A: As physician advisor to CDI, I act as an interface with physicians and CDI specialists. I also give my input on issues where CDI and coding may approach clinical situations from different perspectives.

I work hand in hand with Rebecca Hernandez, our CDI supervisor, in reviewing CDI department and physician metrics, and troubleshooting physician/CDI dynamics. In addition, Rebecca and I provide individualized physician education using their real time clinical cases and translating the case into quality data metrics to explain why CDI is critical to their practices as well as to the institution.

Q: Can you describe the engagement and collaboration of your medical staff in CDI?

A: The issues of trust, respect, and credibility are paramount in achieving engagement and collaboration.  My 20-plus years of clinical experience, as well as my knowledge of regulatory requirements from both governmental and private payors, has been helpful in gaining credibility.

Rebecca’s experience as a critical care nurse, as well as her exposure to multiple healthcare systems as a travel nurse, has gained her respect along with credibility. Thanks to the hard work of our CDI specialists, coders, and leadership, I believe our medical staff is extremely well engaged and collaborative.

Q: What has been your most successful approach for obtaining physician buy-in?

A: I sincerely believe our most successful approach has been individualized and data-driven education.  Rebecca, in collaboration with our medical directors and coding manager, has put together succinct straightforward clinical case studies which provide a clear and relevant picture of how CDI impacts not only revenue, but quality metrics as well.

As in any CDI program, one of the challenges is to get the physician to attend an educational meeting to gain buy-in. One way we get physicians to attend is by respecting their time constraints. So, we remain flexible with our meeting times and venues. Once we get the physicians to attend, they are grateful for the explanation and will actually seek out CDI specialists for their input.

Q: Does your medical executive committee have an escalation policy or other policy requiring physicians to respond to queries/CDI clarification in a set time?  Can you describe its effectiveness?

A: Yes, queries are expected to be answered within 24 hours. If not, the physician receives follow up communication (method of their choosing) from CDI specialists. If there is still no response, within an additional 24 hours, the physician advisor will contact physician and he is unable to obtain response, will escalate the situation to the chief medical officer. So far, this process has been very effective. With a medical staff of about 1,400 physicians, only a few have been escalated to the chief medical officer level.

Q:  What are your biggest challenges with getting physician buy-in?

A: Again, trust is a big issue. At first, physicians believe only the institution will benefit from CDI by realizing an increase in revenue. Once the CDI/physician advisor staff establishes credibility with the medical staff, this issue is abated.

Fear of litigation or government audit is also a barrier. Once the physician is convinced that accurate documentation may in fact positively impact these issues, these barriers are also mitigated. Physicians must be shown that staff and leadership of the institution really do care about them and demonstrating that CDI can aid in presenting an accurate picture of physician performance is one way to prove this.

Q: What do you think the role of the CDI physician advisor is/should be in terms of program advancement and analysis?

A: This again is a dual role between physician advisor and CDI leadership. Data must be available as to the impact on metrics such as length of stay, risk of mortality, severity of illness, case mix index, and complications among other measures. Also, this is a continuous process and does not involve a “one time” meeting. The accuracy of the data is crucial, if not accurate, credibility is at risk.

Q&A: Expanding into quality reviews

Mary Kay Brooks, RN, MSN, CPHQ

Mary Kay Brooks, RN, MSN, CPHQ

Editor’s Note: As part of the fifth annual Clinical Documentation Improvement Week, ACDIS has conducted a series of interviews with CDI professionals on a variety of emerging industry topics. Mary Kay Brooks, RN, MSN, CPHQ, the director of CDI at the University of Iowa Hospitals & Clinics, in Iowa City, answered the following questions regarding CDI expansion into quality reviews specifically regarding the improvement of her facility’s capture of patient safety indicators. Contact her at mary-brooks@uiowa.edu.

Q: What was the impetuous for shifting your CDI program alignment under the chief medical officer (CMO)?

A: Shifting the program helped to signify the importance of CDI to our physicians and physician extenders. CDI-related metrics are included in our provider performance evaluation data.

Q: Is there any dotted line alignment of the CDI program with quality or HIM?

A: Not officially. I ran the quality/safety department for eight years, so I was already very familiar with the publicly reported quality/safety metrics, and had a solid working relationship with HIM. We definitely closely team with HIM.

Q: Can you provide a brief scenario/description of what PSIs are and why documentation failures might affect this reporting?

A: PSIs are a set of risk‐adjusted metrics for adult and pediatric patients that identify potential hospital complications or adverse events after surgery, procedures, and childbirth. They’re used to evaluate and/or reward hospital or physician performance.

Q: Why did you focus on PSI 15 and 90?

A: We focused on the metrics that had the biggest impact (particularly related to Medicare’s value based purchasing initiative) and opportunity for improvement. PSI 15 is for accidental puncture and laceration (APL) rate.

We realized that there was no consensus between physician documentation and coding guidelines for certain types of injuries and that those situations where the condition was inherent, intended, or routinely expected were being coded as APL, which in turn led to a complication report. So we focused on educating physicians about APL to increase their awareness of the metric and how it is being used.

Then we asked the physicians for assistance and cooperation during reviews. Additionally, we establish a feedback mechanism so we can show them when their data improved and they share with us any problems or difficulties they have.

The PSI 90 is a composite metric and includes:

  • PSI 03 – Pressure Ulcer Rate
  • PSI 06 – Iatrogenic Pneumothorax
  • PSI 07 – CVC‐Related Bloodstream Infection
  • PSI 08 – Postoperative Hip Fracture
  • PSI 09 – Postoperative Hemorrhage or Hematoma
  • PSI 10 – Postoperative Physiological and Metabolic Derangement
  • PSI 11 – Postoperative Respiratory Failure
  • PSI 12 – Postoperative Pulmonary Embolism or Deep Vein Thrombosis
  • PSI 13 – Postoperative Sepsis Rate
  • PSI 14 – Postoperative Wound Dehiscence
  • PSI 15 – Accidental Puncture or Laceration Rate

Q: What was the biggest challenge you faced as you expanded your CDI program’s focus?

A: Educating the CDI nurses on the quality metrics specifications and finding the balance of accurately identifying and coding true complications.

Q: What “ah-ha” moments did the CDI team realized as they began their record reviews?

A: I would say learning to look beyond what simply impacts the quality scores versus what should truly be considered a complication.

Q: What tracking/monitoring data did you use and how often did you review that information?

A: We have an audit set up with HIM to target cases of interest. We look at information retrospectively/comparatively through Hospital Compare and University HealthSystem Consortium data.

Q: What other quality measures/areas might your facility look at investigating?

A: We are primarily targeting hospital acquired conditions and PSIs for adult and pediatrics.

Q: Is there a danger that CDI programs focus on a topic, switch focus and then lose ground they previously gained? (So, if you made progress on PSI 15/90 and move onto HAC focus will physicians go back to their previous poor documentation ways?)

A: Not so far. We routinely monitor or performance, and conduct mini reviews to identify failures.

Q: What staffing considerations should CDI programs evaluate prior to expanding review efforts?

A: Well, certainly your program should be fully staffed. You should also identify some early physician CDI adopters to enlist as “helpers” and “educators” for your physicians and targeted staff.

Q: What advice would you offer to CDI programs/staff looking to possibly expand their reviews?

A: Pick one or two metrics to start with. Don’t go overboard.

 

CDI Week kicks off with caption contests, surveys, QAs, and your events

We think the fifth annual Clinical Documentation Improvement Week is a big deal. It seems like clinical documentation efforts have never been more important than they are right now on the eve of ICD-10-CM/PCS implementation, as the sun begins to set on pay-for-service reimbursement models. As the role of CDI specialists expands, coders, nurses, physician champions, chief executive officers, nurses, all need a broader awareness of the important role this unique profession plays.

That’s what CDI Week is all about. It’s an entire week where CDI programs can spread the word about their value and bring in various healthcare disciplines to discuss how CDI efforts affect them.

By now, you’ve heard that this year’s theme is “Branching out into Healthcare.” Our poster, a word tree with all the various ways CDI efforts are expanding. Today, members received a welcome letter, our industry survey, and two Q&As. Each day, we’ll post a new Q&A on a different topic both here on the blog and on the ACDIS website. Join us on our Facebook page for a “caption content” to win a prize, send us your team photos, and tell us what you’ve got planned to spread the CDI gospel this week. Below are a few photos we’ve already received. Happy CDI Week!

 

Anthelio Healthcare CDI team in at the Alamo in San Antonio!  From L-R Wendy Vanderlaan, Shawn MacPhee, Ann Millis, Susan Fantin, Donna Huth.  We are all ACDIS members and RN, CCDS

Anthelio Healthcare CDI team in at the Alamo in San Antonio, Wendy Vanderlaan, Shawn MacPhee, Ann Millis, Susan Fantin, Donna Huth!

William Woloszyn, Ana Colbert, Angela Maxfield, Ann Norwood, Diane Schubert, Connie Ryan, Michele Phelan, Jennifer Horton, Audrey Drake, Kim Bond, Heather Shideler.

The CDI team at Hillcrest Medical Center in Tulsa, Oklahoma, too this great shot with a selfie-stick! The team includes: William Woloszyn, Ana Colbert, Angela Maxfield, Ann Norwood, Diane Schubert, Connie Ryan, Michele Phelan, Jennifer Horton, Audrey Drake, Kim Bond, Heather Shideler.

Shelia Bullock, CDI Director at The University of Mississippi Medical Center started CDI Week off right with an amazing breakfast for her staff!

Shelia Bullock, CDI Director at The University of Mississippi Medical Center started CDI Week off right with an amazing breakfast for her staff!

New ACDIS swag for CDI Week

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If you follow ACDIS on social media, you may have already heard the news: we’ve got a few new ACDIS goodies on our marketplace. We’re really excited to share these items with you.

First up, try our new ACDIS lunch bag. Carry your midday meal in ACDIS style with this purple lunch tote. Measures 8” high, 7.5” wide and 5.5” deep. Features include two handles, silver foil insulating liner, plastic slot on top for your business card or identification, and side front pockets to hold your cell phone, keys, or luncheon utensils and napkin.

Second, our new ACDIS badge reels. Show your ACDIS and CDI pride on your identification badge reel.

Clips securely to your belt, lapel, pocket or handbag. Extends 30 inches for fast and easy access to security entry points, then retracts back into the white case. Sold in package of five badges so you can share with your team.

For more information about these and other ACDIS products, visit the CDI Marketplace or contact customer service 800-650-6787 or customerservice@hcpro.com.

CDI Week Cartoon Caption Contest

It is time for the CDI Week Photo/Cartoon Caption Contest. Post your (tasteful and respectful please) suggested captions for the following cartoon in the comments section and ACDIS Members Services Specialist Penny Richards will chose a favorite to win a prize.

Cartoon 6

CDI Week Photo Caption Contest

Here’s the next CDI Week Photo/Cartoon Caption Contest. Post your (tasteful and respectful please) suggested captions for the following photograph in the comments section and ACDIS Members Services Specialist Penny Richards will chose a favorite to win a prize.

 

Pic 6

CDI Week Photo Caption Contest

Here’s the next CDI Week Photo/Cartoon Caption Contest. Post your (tasteful and respectful please) suggested captions for the following photograph in the comments section and ACDIS Members Services Specialist Penny Richards will chose a favorite to win a prize. This one also comes from the 2014 ACDIS National Conference!

 

Pic 4-2

CDI Week Photo Caption Contest

It is time for the CDI Week Photo/Cartoon Caption Contest. Post your (tasteful and respectful please) suggested captions for the following photograph in the comments section and ACDIS Members Services Specialist Penny Richards will chose a favorite to win a prize. This one comes from the 2014 ACDIS Conference in Las Vegas!
Pic 5-2

CDI Week Cartoon Caption Contest

It is time for the CDI Week Photo/Cartoon Caption Contest. Post your (tasteful and respectful please) suggested captions for the following cartoon in the comments section and ACDIS Members Services Specialist Penny Richards will chose a favorite to win a prize.

 

Cartoon DRGs