Health Information Management
Association of Hawaii
May 2, 2013
Building A Great CDI Program!
by Dana L. Brown, RHIA, CHC
1
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
2
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
3
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
4
Placement of the CDIP
Where will the CDI program be within the
organizational structure?
Reporting?
Management?
» HIM
» Case Management
» Finance
» Compliance
5
Building the CDI Team
Who will be on your team?
• Nurses/Clinical: RNs/LPNs
• Coders: RHIA/RHIT/CCS
• Other: CPHQ
6
Skills of the Team Members
Nurses:
–Clinical Experience
–Experience talking to physicians
–Experience documenting in the record
–Education
–Personality
7
Skills of the Team Members
Coders:
–ICD-9-CM
–MS-DRG assignment
–Chart Review
–Education
–Personality
8
Educational Background of
the Team
• Anatomy & Physiology
• Medical Terminology
• Pharmacology
• 2 year and 4 year degrees
• Clinical & technical training
• Certification
9
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
10
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
11
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
13
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
14
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
16
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
17
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
18
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
19
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
20
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
21
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.
22
When Physicians Believe…
Trust CDI specialist’s integrity
Willing to interact with CDI
Accepting of the query process
Documentation improves
23
Software and Tools
Software:
– Electronic CDI computer program
• Tracks and trends
• Homegrown or “deluxe”
– Automated queries
– Automated tracking and reporting
24
Software and Tools cont’d.
Tools:
– Encoder
– Coding books
– CDI reference books
– DRG books
– Clinical resources
– Internet access
25
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!
26
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.
27
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?
28
Building a “Bridge” (cont.)
Interactions should be:
– Positive, encouraging and supportive
– No punitive results
– Educational:
• Clinical
• Coding
– Sharing of ideas and concepts
29
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.
30
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
31
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
32
Building a “Bridge” (cont.)
Results of Communication:
– Trust is developed
– Understanding of roles
– Realization of the support provided
Teamwork!
33
Building a “Bridge” (cont.)
Communicating with the Medical Staff:
– CDI Participation in physician meetings
– Required interaction during review process
Physicians want to document appropriately
34
CDI Team Education
Regular education on coding
Regular clinical education
Attendance at local, state and national conferences
35
Medical Staff Education
• Orientation of new physicians to the CDIP
• Continued education through verbal query
opportunities
• “Tip Sheets” & reminders
• Annual Reviews and Reporting
36
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!
37
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
38
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
39
Successful CDI Program
•
•
•
•
•
Components are in place
Support from Medical Staff
Support from Administration
Measurable Success
Program Compliance & Integrity
40
Success!
Tangible:
– Increased CMI
– Increased Severity
– How to measure success??
Intangible:
Better communication
Cultural dynamics
– Compiance Program – reaudits – compliance plan outside
auditors…
– Etc..
41
THANK YOU FOR JOINING US!
Dana Brown, RHIA, CHC
President
Reimbursement Management Consultants, Inc.
(800)-538-5007
dana@rmcinc.org
42