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Learn how Clarian Health effectively manages Clinical Documentation Improvement staff across multiple campuses. Explore team composition, daily routines, challenges, and best practices for successful CDI operations.
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3rd AnnualAssociation of Clinical Documentation Improvement Specialists Conference
Best Practices for Managing CDI Staff Across Multiple Campuses Lena N. Wilson, MHI, RHIA, CCS HIM Operations Manager Clinical Documentation Improvement Program
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
Implementation Dates University Hospital February 2007 Methodist Hospital January 2006 Riley Hospital for Children April 2007
Implementation Dates (cont.) Clarian North Medical Center August 2008 Clarian West Medical Center June 2009 Clarian Arnett Health August 2009
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 • 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
Thank you!!Lena N. Wilson, MHI, RHIA, CCSlwilson9@clarian.org