Stacy Vaughn, RHIT, CCS Data Support Specialist/DRG Assurance Aurora Baycare Medical Center 2845 Greenbrier Rd Green Bay, WI 54311 Phone: (920) 288-8655 Fax: (920) 288-3052
Our department falls under the umbrella of Case Management. We house case management, utilization review, social services, and CDI.
Bill Freeman, RN, BSN Supervisor of CDMP® Case Management Jefferson Regional Medical Center P.O. Box 350 Crystal City, MO 63019 636-933-5324 - Office Telephone 636-933-5702 - Office Fax wfreeman@jhsmo.com www.jhsmo.com
Holly Flynn RN CCRN Manager Clinical Documentation Program Center for Clinical Excellence Box 356033 University of Washington Medical Center Seattle, Washington Phone: 206-598-5942 Email: hollyf1@u.washington.edu
I am supposed to crosstrain but I will also have clinical students (BSN) in the fall two days a week, so my director is really trying to keep me closer to only CDI since in the fall my time is very limited.
Theresa Woods, RN, MSN Jennings American Legion Hospital 1634 Elton Road Jennings, La 70546 Phone: 337-616-7297 Fax: 337-616-7096 twoods@jalh.com
We currently do CDI and medical necessity for all Medicare A/B. Once the medical necessity review is done, we turn the record over to the case manager. We do CDI for all Medicare and managed Medicare records. We are currently transitioning back to a straight CDI program. One of the challenges that we have found is our doctors are frustrated. They can't distinguish our roles from case manager to CDI. So often they want to avoid us because they are thinking that we are going to ask about status or length of stay. In addition, we utilize Executive Health Resource for our physician advisor group.That takes a large amount of our time, and does not allow us to spend adequate time doing CDI.
Bill Freeman, RN, BSN Supervisor of CDMP® Case Management Jefferson Regional Medical Center P.O. Box 350 Crystal City, MO 63019 636-933-5324 - Office Telephone 636-933-5702 - Office Fax wfreeman@jhsmo.com www.jhsmo.com
Thank You, Susan Tiffany RN, CCDS Supervisor Clinical Documentation Program Guthrie Healthcare System email: tiffany_susan@guthrie.org "Twenty years from now you will be more disappointed by the things you didn't do than by the ones you did do. So throw off the bowlines. Sail away from safe harbor.Catch the trade winds in your sails. Explore. Dream. Discover." Mark Twain
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Donna Fisher, CCS, CCDS Lead Clinical Documentation Improvement Specialist Health Information & Record Management Shands Healthcare at the University of Florida 352-265-0680 Ext 48769 fishdl@shands.ufl.edu
For those that are in the case management or quality departments, do you find that you have additional duties that are requested that take away from your CDI role? If so, how do you juggle?
Yes, but this is allowing me to get more of the information I need. I can ask specific questions to those who answer. And, I can find the area from where they are giving me the info, so I can determine a community standard.
CDI only; reporting to Mgr of Clinical Quality>Dir. Of Medical Staff Svs> VP and CMO
Is there anything else I can do for you? Clinical Quality Management would like your feedback on our ability to meet your needs. Please complete a satisfaction survey for our department.
When we were under quality it was decided that our program wasn't "pure" enough therefore the EMT decided to move us to HIM. At that time they also revamped our program and added two additional fulltime positions for a total of 3 FTE. Prior to that we had 1.5 FTE but really only 1 FTE was dedicated to CDI the other was actually absorbed into Infection Prevention.
Gina, would you elaborate on what the powers that be thought was "unpure" about being in quality?
Is there anything else I can do for you? Clinical Quality Management would like your feedback on our ability to meet your needs. Please complete a satisfaction survey for our department.
I don't really know their thought process. I can only guess that they felt the CDI was more apt to be pulled in different directions because that is the way our quality department works. For example if core measures needed help the CDI would focus more on that than on just CDI, just as the .5 FTE that was supposed to be dedicated to CDI ended up doing all Infection Prevention. Currently we generally don't prompt for core measures unless it is something that will "move" the DRG (not that I agree with this...I think we need to focus on both quality and revenue. I believe if we improve our quality scores we will also gain revenue). That's not to say that we don't ever prompt for quality changes--it's just not our focus.
Thanks. Our roles are dedicated CDI, but we also watch CMS quality measures and SCIP quality measures. We don't have primary responsibility for them, but are "another set of eyes." If I don't have time to do it, I don't, and everyone seems to be ok with that. I focus more on making sure if alternative PDx exist, that the case manager knows that and makes sure she gets both sets of quality measures met, just in case.
Is there anything else I can do for you? Clinical Quality Management would like your feedback on our ability to meet your needs. Please complete a satisfaction survey for our department.
Sorry if it came across wrong. I didn't mean the question shouldn't have been asked; I think the discussion is great. I just wanted to let people know the general numbers were out there in the survey if they wanted them.
To which hospital department do your CDI specialists report?
Dedicated CDI department 12 14% HIM/coding 28 33% Case management 20 23% Quality/PI 16 19% Finance 4 5% Other (please specify) 6 7% Total 86 100%
On your hospital’s organizational chart, who does this department (the answer to the question at left) report to? Case management 4 5% Finance 21 24% HIM/coding 8 9% Quality improvement/PI 10 12% Medical officer 7 8% Administration 22 26% Other (please specify) 14 16% Total 86 100%
What other duties do your CDI specialists perform in addition to chart review? Check all that apply.
Our Documentation Management department is a part of the Medical Information Department. Our Documentation Specialists are all RN's with varied years of experience.Recently, Medical Information has become part of the Revenue cycle at the hospital--as a result--we are part of the Revenue cycle also.
WHO you report to isn't as important as the interest and engagement in the program of the individual managers/directors/executives.
I think a single structure is better: 1) CDS > HIM > CFO
Rationale: if you only report up through the same chain of command there is apt to be less conflict of goals. In this example, the HIM director understands how better documentation affects coding. Since HIM reports directly to the CFO, the CFO has the power to approve holding records until query responses are obtained.
When you have CDI reporting one way and HIM another, my experience has been that the different directors may not agree and then you can't affect change easily.
Comments
quality
Stacy Vaughn, RHIT, CCS
Data Support Specialist/DRG Assurance
Aurora Baycare Medical Center
2845 Greenbrier Rd
Green Bay, WI 54311
Phone: (920) 288-8655
Fax: (920) 288-3052
Avery E. Trickey, RHIA
BroMenn Healthcare
Normal, IL 61761
309-268-5394
atrickey@bromenn.org
Charlene
management, utilization review, social services, and CDI.
Bill Freeman, RN, BSN
Supervisor of CDMP®
Case Management
Jefferson Regional Medical Center
P.O. Box 350
Crystal City, MO 63019
636-933-5324 - Office Telephone
636-933-5702 - Office Fax
wfreeman@jhsmo.com
www.jhsmo.com
Theresa Woods, RN, MSN
Jennings American Legion Hospital
1634 Elton Road
Jennings, La 70546
Phone: 337-616-7297
Fax: 337-616-7096
twoods@jalh.com
Theresa Woods, RN, MSN
Jennings American Legion Hospital
1634 Elton Road
Jennings, La 70546
Phone: 337-616-7297
Fax: 337-616-7096
twoods@jalh.com
Holly Flynn RN CCRN
Manager Clinical Documentation Program
Center for Clinical Excellence
Box 356033
University of Washington Medical Center
Seattle, Washington
Phone: 206-598-5942
Email: hollyf1@u.washington.edu
Heidi
Theresa Woods, RN, MSN
Jennings American Legion Hospital
1634 Elton Road
Jennings, La 70546
Phone: 337-616-7297
Fax: 337-616-7096
twoods@jalh.com
medical necessity review is done, we turn the record over to the case
manager. We do CDI for all Medicare and managed Medicare records. We are
currently transitioning back to a straight CDI program. One of the
challenges that we have found is our doctors are frustrated. They can't
distinguish our roles from case manager to CDI. So often they want to
avoid us because they are thinking that we are going to ask about status
or length of stay. In addition, we utilize Executive Health Resource for
our physician advisor group.That takes a large amount of our time, and
does not allow us to spend adequate time doing CDI.
Bill Freeman, RN, BSN
Supervisor of CDMP®
Case Management
Jefferson Regional Medical Center
P.O. Box 350
Crystal City, MO 63019
636-933-5324 - Office Telephone
636-933-5702 - Office Fax
wfreeman@jhsmo.com
www.jhsmo.com
CMO
Thank You,
Susan Tiffany RN, CCDS
Supervisor Clinical Documentation Program
Guthrie Healthcare System
email: tiffany_susan@guthrie.org
"Twenty years from now you will be more disappointed by the things you
didn't do than by the ones you did do. So throw off the bowlines. Sail
away from safe harbor.Catch the trade winds in your sails. Explore. Dream.
Discover." Mark Twain
Kelley Walrath
Documentation Specialist Coordinator
BSN - CCDS
352-671-2589 or x8426
DISCLAIMER:
Confidentiality Notice:This e-mail message, including any attachments, is for the sole use of the intended recipient(s) and may contain confidential and privileged information. Any unauthorized review, use, disclosure or distribution is prohibited. If you are not the intended recipient, please contact the sender by reply e-mail and destroy all copies of the original message.
Gina Spatafore, RN
Clinical Documentation Integrity Specialist
gspatafore@wtbyhosp.org
203 573 7647
Donna Fisher, CCS, CCDS
Lead Clinical Documentation Improvement Specialist
Health Information & Record Management
Shands Healthcare at the University of Florida
352-265-0680 Ext 48769
fishdl@shands.ufl.edu
Diane Draize RN, CPUR
Clinical Documentation Specialist
Door County Memorial Hospital diane.draize@ministryhealth.org
920-743-5555 ex 3143
of the journal
Thanks!
Heidi
Svs> VP and CMO
Is there anything else I can do for you?
Clinical Quality Management would like your feedback on our ability to
meet your needs. Please complete a satisfaction survey for our
department.
Sandy Beatty, RN, BSN, C-CDI
Clinical Documentation Specialist
Columbus Regional Hospital
Columbus, IN
(812) 376-5652
sbeatty@crh.org
"Obstacles are those frightful things you see when you take your eyes
off the goal." Hannah More
enough therefore the EMT decided to move us to HIM. At that time they
also revamped our program and added two additional fulltime positions
for a total of 3 FTE. Prior to that we had 1.5 FTE but really only 1 FTE
was dedicated to CDI the other was actually absorbed into Infection
Prevention.
Gina Spatafore, RN
Clinical Documentation Integrity Specialist
Gspatafore@wtbyhosp.org
203 573 7647
"unpure" about being in quality?
Is there anything else I can do for you?
Clinical Quality Management would like your feedback on our ability to
meet your needs. Please complete a satisfaction survey for our
department.
Sandy Beatty, RN, BSN, C-CDI
Clinical Documentation Specialist
Columbus Regional Hospital
Columbus, IN
(812) 376-5652
sbeatty@crh.org
"Obstacles are those frightful things you see when you take your eyes
off the goal." Hannah More
felt the CDI was more apt to be pulled in different directions because
that is the way our quality department works. For example if core
measures needed help the CDI would focus more on that than on just CDI,
just as the .5 FTE that was supposed to be dedicated to CDI ended up
doing all Infection Prevention. Currently we generally don't prompt for
core measures unless it is something that will "move" the DRG (not that
I agree with this...I think we need to focus on both quality and
revenue. I believe if we improve our quality scores we will also gain
revenue). That's not to say that we don't ever prompt for quality
changes--it's just not our focus.
Gina Spatafore, RN
Clinical Documentation Integrity Specialist
gspatafore@wtbyhosp.org
203 573 7647
measures and SCIP quality measures. We don't have primary responsibility
for them, but are "another set of eyes." If I don't have time to do it,
I don't, and everyone seems to be ok with that. I focus more on making
sure if alternative PDx exist, that the case manager knows that and
makes sure she gets both sets of quality measures met, just in case.
Is there anything else I can do for you?
Clinical Quality Management would like your feedback on our ability to
meet your needs. Please complete a satisfaction survey for our
department.
Sandy Beatty, RN, BSN, C-CDI
Clinical Documentation Specialist
Columbus Regional Hospital
Columbus, IN
(812) 376-5652
sbeatty@crh.org
"Obstacles are those frightful things you see when you take your eyes
off the goal." Hannah More
been asked; I think the discussion is great. I just wanted to let
people know the general numbers were out there in the survey if they
wanted them.
To which hospital department do your CDI specialists report?
Dedicated CDI department 12 14%
HIM/coding 28 33%
Case management 20 23%
Quality/PI 16 19%
Finance 4 5%
Other (please specify) 6 7%
Total 86 100%
On your hospital’s organizational chart, who does this department
(the answer to the question at left) report to?
Case management 4 5%
Finance 21 24%
HIM/coding 8 9%
Quality improvement/PI 10 12%
Medical officer 7 8%
Administration 22 26%
Other (please specify) 14 16%
Total 86 100%
What other duties do your CDI specialists perform in addition to chart
review? Check all that apply.
Physician formal educational sessions 58%
Quality/core measures review 40%
Developing CDI educational materials 71%
Care/case management 6%
Patient satisfaction surveys 1%
POA/HAC (present on admission, hospital-acquired conditions) 69%
Other (please specify) 30%
Don
Don
Donald A. Butler, RN, BSN
Manager, Clinical Documentation
PCMH, Greenville NC
dbutler@pcmh.com
WHO you report to isn't as important as the interest and engagement in the program of the individual managers/directors/executives.
I think a single structure is better:
1) CDS > HIM > CFO
Rationale: if you only report up through the same chain of command there is apt to be less conflict of goals. In this example, the HIM director understands how better documentation affects coding. Since HIM reports directly to the CFO, the CFO has the power to approve holding records until query responses are obtained.
When you have CDI reporting one way and HIM another, my experience has been that the different directors may not agree and then you can't affect change easily.
Just my two cents.