Do you collaborate with Case Management?

vanessa.falkoffvanessa.falkoff
in CDI Talk Archive
Hi everyone,

I am in need of information please. Does your CDI program work with Case
Management? I have 2 CDI Nurses for 460 beds and we review all Medicare
and all ICU/CCU beds so we usually manage a census of 120-140. I am now
being asked for both of us to spend 4 hrs a week in Case Management
meetings "to help them understand what documentation is needed." That's
10% of my resources.

I am concerned that this is going to end up being about assigning a
working DRG. We stopped assigning working DRGs in Dec11 and instead
focus on identifying the PDX and any CC or MCC on every case. This has
helped us to increase our review numbers 25% and we still maintain good
percentages for number of cases reviewed, number of queries per case,
and physician response to queries.

Does your CDI program work with Case Management? If so, what do you do
with them and how much of your resources are devoted to that?

Thanks so much in advance and have a great weekend!

Vanessa Falkoff RN
CDI Coordinator
UMC Las Vegas, NV
vanessa.falkoff@umcsn.com
702-383-7332

Comments

  • robert.hodges2robert.hodges2
    I don't work with case management, but I do collaborate with utilization review at times. Certainly not 4 hours each week though. You should take advantage of the opportunity to educate case managers, but since you are already reviewing cases and working with providers I'm not sure of the value added for that kind of time commitment. Are they going to be asking case management to start doing CDI work would be my question.

    Robert

    Robert S. Hodges, BSN, MSN, RN, CCDS
    Clinical Documentation Improvement Specialist
    Aleda E. Lutz VAMC
    Mail Code 136
    1500 Weiss Street
    Saginaw MI 48602
  • kmckaigkmckaig
    edited May 2016
    We are housed in the case management dept and we go to a morning huddle every day to meet with the case managers and social workers. We give lengths of stay and discuss what is going on with the patients and possible resources as well as barriers to dc and any commercial payer issues. Since all of the CDS were case managers, this is probably more helpful to the case managers than CDS but it does sometimes give as additional insight.


    Karen McKaig, BSN, RN, CCM, CPUR, CCDS
    Case Manager
    Clinical Documentation Specialist
    Baxter Regional Medical Center
    Mountain Home, AR 72653
    870-508-1499
    kmckaig@baxterregional.org
  • vdavis2vdavis2
    edited May 2016
    We do a joint venture model called CARE COORDINATION. We all help each other. Case Management (CM) -Intake (UR)- CDI

    We did a trial study to see if updating the DRG actually improved LOS. Did the changing the working DRG to our DRG really improve the LOS--NOPE! The CM's GLOS was actually slightly less than the actual DRG we assigned. Given that the working DRG usually had a lower GLOS, the difference gave the CM that extra push to make sure the patient's care was well orchestrated and efficiently monitored. Keeping the assignment of the working DRG increases the CM's awareness of the time frame needed to discharge the patient. (Now that is not to say we shouldn't work together or help a CM adjust the working DRG if we were asked to help them learn). If the pt has a major change in condition or has a surgical procedure, the CM should know about those changes and adjust the discharge plan accordingly.

    We also work to help each other... we may ask CM to follow up on a consult that wasn't completed or to encourage the nurse on the unit to collect the sputum sample we have been waiting for, or to tell us when a doctor comes up for rounds. We help them with getting ICD-9 codes for insurance authorizations, helping with audits, denials, etc. Our Care Coordination team will also use our physician relationships to help assist with tasks like an obs cases that Intake thinks should be inpatient. Our CDS team will use that face to face time as an opportunity to share what we do and to discover educational needs.

    I used to be a CM/UR coordinator and I worked directly with a CDI on our heart failure team. I always relied upon our CDS for detailed information about my patient's conditions because I was not able read every note and compile as much information as she did... I learned from her discussions and started reminding our residents/interns to make sure their documentation was up to par. I quickly learned to say things like "Will you make sure you note an acute on chronic CHF condition instead of flash pulmonary edema with h/o CHF." It became second nature for me to help a doc learn how to document using specific coding language since I also learned it from my CDS... Improved documentation helps everyone (Less queries, saved time, decreased LOS, increased morale... etc)

    "You get what you give..."
    You just have to find balance between what you give and what you take... it should be a symbiotic relationship :)

    PS: It didn't hurt that my CDS used to bake brownies every week and bring them to interdisciplinary rounds‼! Yummy… I really miss her!


    Vicki S. Davis, RN CDS
    Clinical Documentation Improvement Manager
    Health Information Management Department
    Alamance Regional Medical Center
    Office (336) 586-3765
    Ascom Mobile (336) 586-4191
    Fax (336) 538-7428
    vdavis2@armc.com

    "The difference between the right word and the almost right word is the difference between lightning and the lightning bug."- Samuel "Mark Twain" Clemens
  • dallend@einstein.edudallend@einstein.edu
    edited May 2016
    We do not assign DRGs - haven't assigned a DRG since MS DRGs were introduced.

    Care Management recently requested that we review all Vent charts and assign a working DRG to those cases only - they are looking at them due to transfer DRG issues. I only assign a DRG is the patient is trached, respiratory diagnosis with vent or sepsis with vent. Intubations for procedural purposes are not assigned a DRG. We are not planning to expand this. It takes too long and are much more productive when we do not assign a DRG (select a principal, list the secondaries - query if needed and move on).
    It takes more several hours to review the vent cases and assign the DRG - we have a hybrid record so I have to check the vent information, labs etc on line and then go to the unit to review the MD progress notes and consults.
    Debby Dallen,RN
    Clinical Documentation Coordinator
    Albert Einstein Medical Center
    Phila PA 19141
    215-456-8902
  • Unknown
    edited May 2016
    We are housed with Quality but we physically sit with coding and work very closely with the coders.
    I feel this is the appropriate fit for CDI as we serve as the go between with coding and the physicians. This in turn aids in getting a clean claim out the door and helps to prevent denials. This will only become increasingly important with ICD-10 being introduced.
    We have software that asks us for a working DRG and then a final DRG. We are trained to use the encoder system and we always look at charts for the MCC/CC capture as well as trying to look for clarity and specificity in all docuementation.

    Tina Simpson, BSN, RN, CCDS
    Clinical Documentation Coordinator/Clinical Denial Management
    White River Medical Center
    Batesville, Ar. 72501
  • paxnerospaxneros
    edited May 2016
    We assign a working DRG for M'Care, Tricare and Blue Cross. (Other Financial Classes by request) Our job is to focus on refining the PDx and obtaining MCC's and CC's. When we are able, we go after other documentation which needs specifying.

    The problem w/working DRG's is they are subject to change at anytime. Being spread as thin as we are we are not always able to get back to a chart for an update in the coding which could change the DRG and LOS.

    We also work closely w/ our CM Dept. We send our worklists to them daily which does have the DRG available. But as mentioned - we do not always get back to tweak the coding/DRG.

    When I worked in UM, all reviewers had working knowledge of ICD-9. We performed the initial coding to obtain our own working DRG. It worked very well for us at that time.

    Norma T Brunson, RHIA, CDIP, CCDS
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