Health Information Management Association of Hawaii

May 2, 2013Building 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!”12

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-to-face

– 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!15

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

• 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

dana@rmcinc.org

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