3 rd Annual Association of Clinical Documentation Improvement Specialists Conference

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

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

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

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

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

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

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

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

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

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

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

Additional CDL Tasks Quality/PSI holds Post discharge clarifications Mortality reviews – ROM < 4

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

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

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

Multiple Facility Type Challenges Composition Administration Location

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

Facility Administration Facility administration Service line directors Quality improvement staff

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

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

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”

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

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

Expectations – Communicate both in writing & verbally – Make realistic standards – Make integral/vital processes known

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

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

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

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

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

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

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

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

Questions?

Thank you!! Lena N. Wilson, MHI, RHIA, CCS