Transcript RMC Building a great CDI Program

Health Information Management
Association of Hawaii
May 2, 2013
Building A Great CDI Program!
by Dana L. Brown, RHIA, CHC
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CDI DEFINED
CDI:
– Clinical Documentation Improvement
– Typically a concurrent record review
• Review occurs while the patient is “in house”
and on the mind of the physician
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Developing a CDI Program
Initial steps:
– Do you have a Mission Statement?
– Determine the direction and goals of your
program
– Focus on Compliance and Integrity
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CDI Program Components
• Placement of the CDI Program
• Qualified CDI Team
• Policies and Procedures
• Administrative Support
• Medical Staff Support
• Software & Tools
• Ongoing Communication and Education
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Placement of the CDIP
Where will the CDI program be within the
organizational structure?
Reporting?
Management?
» HIM
» Case Management
» Finance
» Compliance
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Building the CDI Team
Who will be on your team?
• Nurses/Clinical: RNs/LPNs
• Coders: RHIA/RHIT/CCS
• Other: CPHQ
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Skills of the Team Members
Nurses:
–Clinical Experience
–Experience talking to physicians
–Experience documenting in the record
–Education
–Personality
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Skills of the Team Members
Coders:
–ICD-9-CM
–MS-DRG assignment
–Chart Review
–Education
–Personality
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Educational Background of
the Team
• Anatomy & Physiology
• Medical Terminology
• Pharmacology
• 2 year and 4 year degrees
• Clinical & technical training
• Certification
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Traits of a CDI Specialist
What traits make a good CDI specialist?
– Inexperienced vs. Experienced
– Detail oriented
– Organizational skills
– Clinical understanding
– Understanding of coding rules
– Personality! A necessity
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Personality: A Necessity!
What personality qualities make a good
CDI specialist?
– Quiet vs. Outgoing
– Positive and upbeat
– An educator type
– Great at dealing with difficult people!
– Handles pressure well
– Willingness to interact with physicians & other key
in the clinical arena
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Coders & CDI: Teamwork
• No need for “us vs. them”
• Understanding must occur
“We’re a TEAM!”
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Understanding Roles…
The CDI specialist’s role:
– Concurrent chart reviews
– Concurrent queries
– Verbal interactions with physicians and mid-levels
– Maintaining data from reviews
– Interaction with the coders
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Understanding Roles…
The Coder’s role:
– Retrospective chart reviews
– Retrospective queries
– Occasional interaction with physicians
• Most interaction is written rather than face-toface
– Interactions with CDI specialists
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Working together the
stronger the better!
• Has to be a team approach
• CDI specialists support the Coders
• Coders support the CDI specialists
• Develop communication
• Have routine meetings
• Discuss DRG differences
• Education for all
• Support the team!
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Policy and Procedure
Development
Develop policies for:
– The program’s approach
– Initial Reviews
– Concurrent Reviews
– Frequency of follow-up
– Queries
– Reporting and Benchmarking
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Review Policies
Determine review methodologies:
• Timing of initial and concurrent reviews
– After admission
– After initial review
• Timing of follow-up reviews
– Long length of stay
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Query Policy
Develop a strong query process:
– Review AHIMA’s Query Practice Brief
– Determine the “rules”
• How to query
• When to query
• Types of queries
• Retention of queries
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CDI Program & Compliance
CDI Program with focus on Compliance
and Integrity:
• CDI must be included in facility Compliance Plan
• CDI activities approved by Compliance
• CDI activities dovetail with hospital &/or HIM
coding audit activities (internal/external, regulatory
agencies, RAC’s, etc)
• Regular and/or annual audits to validate program
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Reporting and
Benchmarking Policies
Tracking your results:
• Manual tracking
• Automated tracking
Reporting your impact:
• Query Response Rate
• “Impact” ($, CMI, Severity)
• By specialty or by provider
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Administrative Support
Necessary Involvement:
– “Buy-in” has to be from the top down
– Investment in the program
• Monetary
• Time
• Allocation of resources
– Active participation in the CDI Team
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Medical Staff Support
• Physicians understanding of role in CDI program is
critical
• Choose a Physician Advisor or Champion
– Well respected member of the staff
• Physicians must believe in the program and it’s
benefits to patients and facility as a whole – and to
them.
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When Physicians Believe…
Trust CDI specialist’s integrity
Willing to interact with CDI
Accepting of the query process
Documentation improves
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Software and Tools
Software:
– Electronic CDI computer program
• Tracks and trends
• Homegrown or “deluxe”
– Automated queries
– Automated tracking and reporting
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Software and Tools cont’d.
Tools:
– Encoder
– Coding books
– CDI reference books
– DRG books
– Clinical resources
– Internet access
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Building a “Bridge”
• A successful CDI program will “Build a Bridge”
joining CDI specialists and HIM Coders.
• The Corporate culture is that of “Bridge Builders”
• This “Bridge” will allow for ongoing interactions,
improved communication, better documentation and
greater success!
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Building a “Bridge” (cont.)
Ongoing Interactions:
Regular, positive and professional interaction
between CDI Specialists and Coders is the
essence of a strong and successful program.
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Building a “Bridge” (cont.)
CDI Team Interaction:
– Foster best interaction opportunities
• Formal
• Informal
– Ask yourselves what are the best interactions and
how do we achieve these ideals?
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Building a “Bridge” (cont.)
Interactions should be:
– Positive, encouraging and supportive
– No punitive results
– Educational:
• Clinical
• Coding
– Sharing of ideas and concepts
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Building a “Bridge” (cont.)
Interactions continued….
•
•
•
•
Don’t engage in us vs. them discussions
Realize everyone has knowledge to offer
Don’t focus on negatives…educate
Remember we are all part of the same team
– We are all working toward a common goal…good
documentation and great patient care.
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Building a “Bridge” (cont.)
Communication Opportunities:
Meetings…
– Have all the participants of the CDIP come
together to develop the plan for the program
– Document goals
– Determine how to present the message of your
CDIP
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Building a “Bridge” (cont.)
CDI & Coder Communications:
Keep the focus on:
–The good of the patient
–The good of facility
–The good of your program
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Building a “Bridge” (cont.)
Results of Communication:
– Trust is developed
– Understanding of roles
– Realization of the support provided
Teamwork!
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Building a “Bridge” (cont.)
Communicating with the Medical Staff:
– CDI Participation in physician meetings
– Required interaction during review process
Physicians want to document appropriately
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CDI Team Education
Regular education on coding
Regular clinical education
Attendance at local, state and national conferences
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Medical Staff Education
• Orientation of new physicians to the CDIP
• Continued education through verbal query
opportunities
• “Tip Sheets” & reminders
• Annual Reviews and Reporting
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Maintain Your Program
Continuation of education
Continuing need for growth
Continuing evaluation of the operation of your
program – INCLUDE outside audits.
Ongoing promotion of your CDI Program!
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Monitoring of CDI Program
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•
•
•
•
Validity of queries generated
Validity of working DRG assignments
Validity of CDI specialist’s DRG assignments
Missed query opportunities
Retrospective query follow-up rate
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Observation of CDI Query
Process
• Supported by clinical evidence and what was
the clinical evidence
• Asked in a non-leading manner
• Response by provider through appropriate
documentation in the patient’s record
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Successful CDI Program
•
•
•
•
•
Components are in place
Support from Medical Staff
Support from Administration
Measurable Success
Program Compliance & Integrity
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Success!
Tangible:
– Increased CMI
– Increased Severity
– How to measure success??
Intangible:
Better communication
Cultural dynamics
– Compiance Program – reaudits – compliance plan outside
auditors…
– Etc..
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THANK YOU FOR JOINING US!
Dana Brown, RHIA, CHC
President
Reimbursement Management Consultants, Inc.
(800)-538-5007
[email protected]
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