If any clinical documentation improvement (CDI) directors came to AHIMA’s CDI Summit looking to energize their clinical documentation improvement program, they probably left Thursday morning’s opening session with their brain buzzing. The 140 Summit attendees were treated to an inspiring mix of approaches to getting organization-wide acceptance of CDI during a panel discussion.
Panelist Lorena Chicoye, MD, who runs the CDI program at Baptist Health of South Florida, in Miami, warned the audience that she is not a “kinder, gentler, physician.” Due to that reputation, she says, physicians in her facility know that her team of CDI specialists—all of who are also MDs, “are coming after you,” so their documentation better be sound. She has also gone to great lengths to brand her team, nicknamed “CDI: Miami.” Every time she or a team member gives a presentation to physicians, she begins with the theme song from the television show “CSI:Miami” (The Who’s “Don’t Get Fooled Again”).
While that might sound lighthearted, Chicoye is deadly serious about improving her facility’s documentation quality. She replaced a physician who died in his chair, in a department that had been doing retrospective documentation reviews for 18 years on a 100 percent paper-based records system, and with a very low physician query return rate.
To turn things around, Chicoye hired a team of CDI specialists that are physicians, because, she points out, when battles over documentation break out, which they inevitably do, physicians want to talk to other physicians. The CDI physician specialists that Chicoye hires are all foreign physicians that are trying to get residencies in the US. Working as CDI specialists allows them to practice medicine. Since Chicoye took over the department and started preparing for the new documentation demands of ICD-10, the facility has moved to electronic records, and every CDI query is responded to in a timely manner.
Part of the quick response is due to the fact that all documentation queries are done in person, “because, if there are additional questions or comments, it’s a better conversation face to face… When there is a query problem, physicians must respond to ALL queries. All the CEOs [at each site] are backing me up. They don’t have to respond positively or negatively, but you don’t get to ignore my team. Period. Unless the doc is out of town, we get a response out of them,” Chicoye said.
One of the signs that Chicoye is doing something right is that since she’s been in charge, none of her charts has been pulled for a RAC audit, notable since Florida is one of the most heavily audited states by Medicare.
“We managed to clean up the charts to the point where they weren’t even pulled,” she noted.
Every Patient Counts
Panelist Jennifer Woodsworth, RN, BSN, CCDS, took a slightly more traditional approach to CDI at Swedish Medical Center in Seattle, WA. When she took on the CDI program in 2011, she implemented the motto “Every Patient Counts” to inspire her team members and remind them of their important work.
Woodsworth’s CDI specialists are all registered nurses and she doesn’t even interview candidates unless they have experience working in the emergency department or the ICU. Currently she has 20-22 CDI specialists working throughout five hospital campuses, and she is looking to add another RN for CDI quality. “To be promoted in my department, you have to be an expert,” Woodsworth said.
She also took the CDI program from focusing solely on inpatient records to outpatient and ambulatory records. She started this process by reviewing risk-based contracts and by looking to hire RN/HCC (hierarchical condition category)-specific coders. The key to approaching physicians in these settings was giving them CDI specialists who spoke their language—nurses with clinical backgrounds.
“Physicians couldn’t believe they had an RN to talk to in real time. Now we get calls from physicians at 9:00 p.m., and calls asking for help in identifying symptoms for depression.”