All Entries Tagged With: "profession"

A Friday toast to lessons learned

Believe it or not there is an association for associations. And yes, Brian Murphy and I are soon to be members. Just as ACDIS provides a venue for CDI specialists to share best practices, the American Society of Association Executives (ASAE) and the Center for Association Leadership offers us helpful hints about how to help you. For instance, on the ASAE Blog “Acronym,” Brian Birch outlined a number of the valuable lessons he learned from his members.

I hope you can see where I’m going with all of this, my usual circular logic notwithstanding, since

'The Lesson' by Pablo Picasso. Don't we all have something to learn from one another?

what I’m hoping to convey is the power of circular learning. We all have something to learn from each other: The coder from the clinical experience of the nurse and the nurse from the regulatory understanding of the coder; the physician from the CDI specialist and CDI specialist from the specific knowledge of disease pathways locked away inside the mind of a physician.

So Mr. Murphy and I thought we’d put together a short list of items we learned from the members of ACDIS over the past few years. Things like:

• Once a nurse, always a nurse.
• Urosepsis is a four-letter word.
• Old physicians can learn new documentation tricks.
• Minutiae matters.
• It is easier to work with someone than for something.
• Be careful of the word acute.

And I think Brian Murphy and I learned the importance of the day-to-day work which CDI specialists pour their hearts into. As Mr. Birch wrote: “The best thing I have learned is that they are out there, professionals with strong minds and hearts who are just trying to make a better lives for themselves and their families.”

And so, a toast: To all the lovely lessons learned and all the casual teachers who have taken perhaps the briefest of moments to share their insights with me, their peers, and their coworkers. Please take a moment yourselves to post your own favorite lesson and give a shout out to the mentor who helped you most in the comment section below.

Talk about documentation catches, simple mistakes cause profound costs

Sometimes documentation mistakes caught by CDI professionals are the simple ones. Like an incorrect date. I recently came upon this news brief from New York Injury News which outlined the trials of HIV patient who lost his coverage due to inaccurate documentation of a blood-test date.

You find vital information in the medical record everyday. Tell us about some of your 'best find' stories.

As compassionate people living day-to-day it’s easy to vilify the insurance company for dropping a sick person from its coverage rosters, or point the finger at the patient for not keeping better tabs on his or her clinical and coverage information. Yet CDI professionals well know the costs of seemingly simple mistakes. This particular case ended up costing the insurance company, Fortis, $10 million for inappropriate denial of healthcare coverage and added untold difficulties to a young man’s life.

Well, I know that CDI specialists catch these seemingly simple mistakes all the time. So here’s a special request to ACDIS Blog readers—wouldn’t it be nice to receive recognition for those otherwise unseen documentation catches you make everyday? Send me your funniest, most heart wrenching, or simply ‘best catch’ documentation stories by the end of October. We’ll run them by our editorial panel and pick the best to publish. E-mail  me at mvarnavas@cdiassociation.com.

AHIMA calls for CDI presentations

Could CDI be becoming a healthcare buzz word? It seems like everywhere I looked over the past few weeks healthcare documentation improvement specialists played a prominent role.

Remember I mentioned the Health Care Compliance Association’s upcoming CDI presentation at its Physician Practice Compliance Conference in Philadelphia?  This week I heard about American Health Information Management Association’s (AHIMA) call for speakers for its June 2010 conference.

The AHIMA program focuses on CDI and coding and takes place in San Antonio, TX. Over the two-day speakers are expected to talk about CDI program challenges and best practices and explore the difficulties of communicating across CDI and HIM channels.  According to the AHIMA release, the deadline for presentation proposals is Friday, October 23.  For information, contact Kathy DeVault, RHIA, CCS, manager of professional resources at AHIMA at Kathy.DeVault@ahima.org.

Don’t worry the AHIMA program doesn’t overlap with the ACDIS 2010 annual show in Chicago — that’s June 3-4 (or 2-5 if you plan to attend the pre conference and take the CCDS exam). And not to repeat myself, but how great is it to watch the documentation improvement profession gain the credence it deserves from its sister organizations. Communicating a consistent message at a variety of professional organizations can help CDI illustrate its value to rest of the healthcare system in America.

Open letter to the President

Editor’s Note: The following is a mock letter, an editorial expression representing my response to President Barack Obama’s speech before elected officials on Wednesday, September 9, 2009.

Dear President Barack Obama, and esteemed and honored elected officials,

I write to you not in any official capacity related to my position as the associate director for the Association of Clinical Documentation Improvement Specialists (ACDIS) but rather as a citizen who is a firm believer in the cause these healthcare professionals represent.

Perhaps you have heard of clinical documentation improvement (CDI), perhaps not.  As a profession, CDI is relatively young. ACDIS itself is merely two years old. Hardly even a toddler. But the physicians, nurses, and coders who consider themselves CDI specialists are making great strides to help their facilities. Many of them save their programs millions in otherwise lost revenue annually. But while saving money represents a positive outcome from their venture it is not their mission.

These professional men and women crossed barriers of experience, reached out to each other to meet a singular goal–to improve patient care. They know that once all parties involved begin to speak the same language, dialogue begins to take place. They take the clinical knowledge of the physician and translate it into the complex languages of the healthcare coding and billing world.

The government already parses data collected by coders for all manner of initiatives. No doubt with an increased emphasis on electronic medical records an avalanche of information will be available to improve patient care, cut healthcare expenses, and seek out fraud and abuse in healthcare spending.

But none of these worthwhile initiatives will matter if the basic information written in the patient’s medical record by the physician cannot be correctly and compliantly translated into the coding and billing payment structure.

Physicians just want to take care of their patients. CDI helps them do just that.

The current struggle over healthcare reform appears to most Americans unending, the battle unwinable. And as you must realize those who vehemently seek to improve their current station will do just that. Just ask our ACDIS membership. I do not write this letter to say that the efforts of clinical documentation improvement specialists will solve all of the American healthcare system’s ills. This letter is written merely to inform you that they are out there working hard to do what they can to help.

Sincerely,

Melissa J. Varnavas

Update physician education with tips from ACDIS members

A newcomer to the ACDIS group page on Facebook asked recently how to keep physician engagement in clinical documentation improvement high as CDI programs begin to mature.

To be sure, there’s always an initial excitement regarding new programs and the potential they hold for improvement. Sometimes, however, that energy begins to fade. Reading Tina Lewis Simpson’s comment I was reminded of a HealthLeaders Web cast, 5 Ways to Hospital-Physician Quality: Goals, Incentives, Dialogue, Infrastructure, Data, in which Rebekah Wang-Cheng, MD, FACP, medical director for clinical quality at Kettering Medical Center in Dayton, OH, offered several strategies to facilitate physician communication. Consider the following techniques to improve physician education and awareness of your CDI program:

• Educate one-on-one, face-to-face, in real time. When addressing a particular problem with physician documentation, don’t wait, says Wang-Cheng. Use a specific case that happened within the past day or two to illustrate your point.
• Educate in groups. Go where physicians gather, Wang-Cheng says. Offer education sessions during quarterly medical staff meetings, or specialty meetings
• Show data. CDI specialists constantly gather data, benchmark and report this data back to the physicians. When physicians see how appropriate documentation affects patient care and the overall mission/wellbeing of the facility they will be more likely to understand the mission behind your position.
• Walk in their shoes. Shadow a physician for a day to observe the pattern of their care. That way you’ll have a better understanding of the physician’s work flow. Armed with understanding you can adjust your query process to fit their needs as well as your own.
• Say, “Thanks.” If a physician is responsive to your inquiries, praise him or her for their helpfulness. Take your appreciation a step further, says Wang-Cheng, by sending him or her a thank you note to their home so they can show their family. “There’s nothing better than to be able to say to a spouse: ‘Look, someone said something nice about me.’”
• Start at the top. Approach physician leaders in various disciplines. This type of influence will help you “spread and sustain the education,” Wang-Cheng says.
• Listen as much as you talk. Emphasize with the physicians. Realize they have difficulties, both professional and personal, too. Don’t be afraid to admit ignorance but be sure to ask for their assistance when you do.
• Make the physician lounge a welcoming place. A CDI specialist may not have direct involvement regarding the physical location and ambiance of the physician lounge, but he or she can use the lounge as a way to get the word out about the CDI program. Visit often and leave specific, small tokens of appreciation from time to time.

Those interested in additional tips to gain physician support may want to click on Sylvia Hoffman’s blog posts, at right, including: Spring ideas to woo physician support and KISS method applies to CDI physician education, too.

Furthermore, thanks to North Cypress (TX) Medical Center Director of Clinical Documentation Improvement Mike Alcorn, LVN, there are some sample e-mail physician education packages available in our Forms & Tools Library. Read how he created his physician education strategy in CDI Strategies.

If you have any tips or innovative suggestions for how to spice up the physician education component for the more advanced CDI programs please post ‘em here. We love to hear what you’re up to. Besides what’s working for you may help solve a problem for someone else.

Look beyond query numbers for program assessment

Now is no time for finger pointing!

The case mix index is up and admissions continue to rise. You’d think this was wonderful news. Yet, the facility administration  complains that reviews are down and queries are low. You don’t have to be a math genius to know that something here does not compute.

Is the education given to physicians and allied health professionals being evaluated? Does anyone evaluate the improvement in documentation?

Numbers are classically low in the summer months in Florida due to the absence of our much loved snowbirds from Canada. Vacations from both CDI professionals and physicians take a toll on productivity. New residents start in July, and the heat index rises to 98 degrees (and I don’t mean the literal temperature, either).

Help! How do you rate the success of your clinical documentation department?

Query response rates are evaluated and the overall numbers of reviews are counted. The revenue elicited from these queries is tallied and viola, the success of a program is in the financial numbers. Wrong!

CDI specialists spend a good deal of their day speaking to physicians and educating them on the benefits of proper documentation. They attend huddles with case management, they are members of committees, they round with specialty teams, and they frequently make presentations at meetings and resident Grand Rounds. Does this not count for anything? There needs to be a better way to evaluate success.

CDI presentations commonly extol the virtues of proper documentation— how it improves mortality and morbidity scores and severity of illness statistics. Physician “buy-in” is stressed at every turn, but where and when do we get to discuss the importance of the hospital administration’s “buy-in?”

How is your CDI program structured? Take this ACDIS survey

Benchmarking tools are an important part of measuring your CDI program’s success. You need to know how you stack up against other facilities of the same size and structure as you. This rings particularly true you hope to expand your current clinical documentation improvement program or start one from scratch. Furthermore, as ACDIS continues to build and define these benchmarking reports we hope we’ll be able to identify some significant trends and best practices for our membership.

For example, as you can see from the chart below 73% of respondents so far said MCC/CC DRG optimization represents their program’s priority. We hope you’ll add your voice and experience to the survey to help us provide the best picture of CDI programs today. To take the survey, click here.

Nurses fight for rights as CDI professionals

Clinical Documentation Specialist?

I was reading an article (title undisclosed) recently that discussed the importance of hiring a CDI specialist in a certain hospital settings. They gave a glowing account of the attributes of the clinical documentation specialist and the benefits they have on the business side of medicine.

The article went on to describe how to select a trained applicant. It recommended that the hospital “select a clinically astute coding professional with a strong business background.” It went on to say that hospitals should “consider hospital coders with a business background as likely candidates, because they not only posses business experience, but they also have clinical knowledge and competency in IV infusion and other related coding areas.”

I was horribly disappointed with the implication that a (nurse) clinical documentation specialist could not do the job.

Last year our hospital hosted a team of CDI specialists from a nearby hospital who wished to gain information on growing their program. At the conclusion of the day the manager told us that prior to coming to our hospital he would not have hired an RN. He thought they were unable to understand coding rules and concepts. After spending the day with us, he no longer felt that way.

At the Florida Regional ACDIS meeting that same manager introduced us to his team and he was especially proud to introduce his newest team member—a nurse.

When are the walls going to come down? A majority of the ACDIS members who attended the meeting in Las Vegas were nurses, yet most of the resources for clinical documentation improvement are are geared for coders. I am confused!

When I made the transition from case management to CDI, I was excited to enter a new and growing field. CDI was presented as a new opportunity for experienced nurses who had a desire to grow professionally. Our department had no policies or procedures, or standards for recording or measuring success. We developed the program from scratch.

I am not a coder but I worked very hard to learn the little bit I have learned about coding. I read many books, have taken many courses and asked many questions. I am a Clinical Documentation Specialist. Why is it, that I am the only person who thinks so?

Looking for ‘love’: Tips needed to motivate CDI staff

Lots of people love their jobs, but what motivates CDI specialists to go that extra mile?

Self-motivation is a good thing and to some extent most people are  self-motivated. Particularly when it comes to clinical documentation improvement professionals. Let’s face it, it’s go-go-go job investigating query opportunities, working the nursing units, hunting down doctors. But what actually motivates professionals to go that extra mile? What makes healthcare professionals go that little bit further to either join a professional organization, go back to school, obtain their coding credentials, or sign up to take the test to join the ranks of the new ACDIS designation of certified clinical documentation specialists (CCDS)?

I imagine it might take a little more than mere encouragement, a little more than just a little love amongst professional colleagues. What do you all think? What are some of things you’ve been doing to help motivate staff members? Let me know! I need ideas!

~Jennifer Love

CCDS Exam: What you need to know before you go

If you’re one of the more than 100 people who signed up to take the Certified Clinical Documentation Specialist exam, make your way down to Florentine I on Caesars’ Promenade Level, as early as possible, on Saturday, May 16.

Registration begins at 7 a.m. and the exam begins promptly at 8 a.m.

Members of the ACDIS Certification Board spent many, many hours diligently working with Applied Measurement Professionals, Inc. (AMP) to create the most appropriate, fair, balanced test possible. AMP requires strict adherence to its test taking rules. Please keep in mind the following items:

You will need to show two forms of identification when you register. Acceptable forms of primary identification include:

• Current driver’s license with photograph
• Current state identification with photograph
• Current passport
• Current military identification card with photograph

Acceptable forms of secondary identification may include any type of credit card or identification with your name and signature.

You will be allowed to bring two books into the exam. These include:

• DRG Expert, published by Ingenix; and
• ONE of the following standard drug reference guides:
  • Mosby’s Nursing Drug Reference
  • Nurse’s Pocket Drug Guide
  • Physicians’ Desk Reference
  • PDR Nurse’s Drug Handbook
  • Nursing Drug Handbook/Lippincott’s

Other than your identification and these texts please do not bring any personal belongings with you. We strongly recommend that you leave your personal belongings in your hotel room, or check them with the hotel staff at the bell desk.

The test takes approximately three hours. Some people will finish early and others may require the entire three hours-however this is a timed examination. We will track the time and make announcements accordingly.

(Tip: Allow yourself enough wiggle room in your travel plans. We will begin reading the testing instructions at 8 a.m., the official “clock” starts once we tell you to open your test booklets. This may mean the test could take you until 11:15 a.m. or 11:30 a.m. to finish.)

You’ll be notified in roughly 30 days regarding your certification status. If you pass the

After four days of intensive CDI work you'll need some R&R pool side.

examination, you are allowed to use the designation CCDS. Passing candidates will receive a certificate. If you do not pass the examination, you may schedule a reexamination appointment by contacting HCPro, Inc., at 800/650-6787.

If you’re not rushing off for your plane post test, we highly recommend you take some much  needed celebratory relaxation time out by the pool. Put your feet up. You’ve just participated in a tremendous intellectual experience. So now’s the perfect time to start thinking about next year’s trip with the ACDIS crew. . . Ahhhh, Chicago!