3 rd Annual Association of Clinical Documentation Improvement Specialists Conference

1. 3rd AnnualAssociation of Clinical Documentation Improvement Specialists Conference

2. Best Practices for Managing CDI Staff Across Multiple Campuses Lena N. Wilson, MHI, RHIA, CCS HIM Operations Manager Clinical Documentation Improvement Program

3. Presentation Objectives • Overview of Clarian Health’s CDIP • Clarian & CDIP structure • CDLs’ daily routine • Challenges of managing multiple facility types • Managing CDLs across multiple facilities

4. Clarian Health Overview • Clarian Health composition • Revenue cycle services composition • CDIP implementation dates • CDIP team composition • Clinical documentation liaisons (CDLs) • Characteristics • Daily routines • Tools • Monthly in-services

5. Clarian Health Composition • Hospital statistics • Location • Facility composition • Methodist • Indiana University • Riley Hospital for Children • Suburban hospitals • Clarian Arnett Health • CLARIAN HEALTH • IU Hospital • Methodist Hospital • Riley Hospital for Children • Clarian North Medical Center • Clarian West Medical Center • Clarian Arnett Health

6. Revenue Cycle Services Structure • Composition (facility & professional billing) • HIM • PFS • IS department • Compliance & quality (RAC) • HIM stats • Locations • FTEs

7. Implementation Dates University Hospital February 2007 Methodist Hospital January 2006 Riley Hospital for Children April 2007

8. Implementation Dates (cont.) Clarian North Medical Center August 2008 Clarian West Medical Center June 2009 Clarian Arnett Health August 2009

9. Clarian CDIP Team Composition • 6 RNs • Cardiac • Intensive care • Pediatrics • Internal medicine/family practice • Hematology/oncology • 2 RHIAs • Former IP coding supervisors • Solutions analyst • Physician liaisons

10. CDL Characteristics • CDL ~ clinical documentation liaison • Recruitment & training • Either RN or RHIA certification • Match experience with unit assignments

11. CDL Characteristics (cont.) • Traits of a good CDL • Confidence • Ability to convey topics to physicians • Presentation skills • The power of persuasion • Self-starter, motivated • Ability to work in a team environment

12. CDL Daily Routine • Concurrent rounding on nursing units • Staff/resident education • Formal • Informal • Physician rounding • Worklist data entry

13. Additional CDL Tasks • Quality/PSI holds • Post discharge clarifications • Mortality reviews • ROM < 4

14. CDL Educational Tools • CDL self-education • 3M Encoder • 3M Advanced Analyzer • MS-DRG book • ICD-9-CM coding book • Internet research • Journal articles • Professional association websites • Peers

15. CDL Communication Tools • Clarification form • Paper, electronic, & verbal • Pocket cards • Tabbed chart dividers • Adult • Pediatric

16. Monthly In-Services • CDL lead • Key groups to educate • Internal medicine/family practice residents • HEM/ONC residents • Emergency medicine residents • eICU residents • Surgical residents • Ad-hoc staff education via physician liaison

17. Multiple Facility Type Challenges • Composition • Administration • Location

18. Facility Composition • Location • Urban, suburban, rural • Academic vs. non-teaching • Service lines

19. Facility Administration • Facility administration • Service line directors • Quality improvement staff

20. Managing Staff Across Multiple Facilities • Define roles & responsibilities • Goal setting & projects • Quality initiatives • Expectations • Standardization • Communication • Praise and respect

21. Define Roles & Responsibilities • Clearly define roles & responsibilities • On an individual level • Begin with job description • Within the overall group & special projects

22. Goal Setting and Projects • Goal setting and projects • Help staff prioritize tasks • Work with staff members’ strengths while providing challenging tasks • Create a healthy competitive environment for staff • Every facility is important • Knowledge transfer amongst CDLs for “dos” and “don’ts”

23. Quality Initiatives • Quality focus • Determine priority(ies) for each facility • Research qualifications for quality measures • Core measures • Congestive heart failure • AMI • Pneumonia • Surgical quality improvement initiatives • Mortality improvement initiatives

24. Quality Initiatives (cont.) • Quality focus (cont.) • AHRQ PSI and HACs • Quality improvement staff • Are there improvements to be made in documentation? • Does education need to be provided to MDs regarding documentation? • Provide feedback • Wound care • Decubitus ulcers • Debridements

25. Expectations • Expectations • Communicate both in writing & verbally • Make realistic standards • Make integral/vital processes known

26. Standardization • New staff education • Peer- & management-developed training model • Cross-train CDLs to review at any facility • Clarification forms • Utilizing similar verbiage

27. Standardization (cont.) • Data collection • Streamline data collection • Cerner (electronic CF detail) • Standardize numbering methods • Account reviews • Clarification reasons

28. Standardization (cont.) • Feedback • Internal to revenue cycle • External to revenue cycle • Compliance meeting • Corporate audit committee

29. Communication • Check-in with your employees • Written • Oral • Frequency • Weekly • Monthly • Rounding • One-on-one time • Provide immediate feedback

30. Praise and Respect • Praise in public • Share good news with the group • Inspiration may be given to others • Criticize in private • Thank-you notes

31. Expansions • Determine staffing • Net new vs. transitioned from other areas • Facility details • Discharge volumes • Payer breakdown • Bed size

32. Expansions (cont.) • Education • Administration/service line directors • CDL • Physician • Ancillary staff • Implementation timeline • Priority to educate

33. Summary • Organizational composition • Goals • Systemwide vs. facility-specific • Team composition • Implementation dates • Education • Communication & feedback

34. Questions?

35. Thank you!!Lena N. Wilson, MHI, RHIA, CCSlwilson9@clarian.org