MD as CDS?
I am in need of some information. One of our VPs has heard from some consultancy group that MDs make the best CDS reviewers. I need to identify and communicate with any programs where you utilize MDs as the CDS. I'm not talking about advisors, but actual reviewers. I would imagine this to be cost prohibitive, but I need information first. Our program is currently all RN.
Sandy Beatty, RN, BSN, CCDS
Director of Clinical Documentation Improvement
Community Health Network
1500 North Ritter Avenue
Indianapolis, IN 46219
317-355-2016
sbeatty@ecommunity.com
Sandy Beatty, RN, BSN, CCDS
Director of Clinical Documentation Improvement
Community Health Network
1500 North Ritter Avenue
Indianapolis, IN 46219
317-355-2016
sbeatty@ecommunity.com
Comments
charts after the coder has finished them and look for queries that
might lead to additional diagnoses. They then advise the coders who
forward a "template" from Faircode with the query. They are much like
Executive Health Resources but for Clinical Documentation rather than
Case Management/Utilization Review. They will tell you that they don't
know coding guidelines etc but review for medical diagnoses from a
physician standpoint.
Last Fall, our hospital made a decision to do a 3 month trial with them
in conjunction with our CDS/Coder team. They were to only review charts
from 3 different diagnoses. About a month ago, my hospital decided that
the CDS jobs were duplicated with Faircode and because Faircode produced
numbers that showed a case-mix increase (of course, that was in
conjuction with the CDS program and the CDS were also showing a Case Mix
increase based solely on their efforts), they chose to eliminate 2/3 of
our CDS RN group and pay contractual fees to Faircode.
Hope this helps,
Karen
That is the only review such review
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
exception of one year when we tabled the program to put efforts into
case management changes going on. After that year, the CMI fell
dramatically and the brought back the CDS program in full force with
enhancements. That was 3 years ago and our CMI rose and has continued
to trend upward.
Such is the state of healthcare I guess.
Good luck with your search for answers.
Karen
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
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Thursday, June 06, 2013 11:37 AM
To: Romanello Angelisa
Subject: [cdi_talk] MD as CDS?
Importance: High
I am in need of some information. One of our VPs has heard from some consultancy group that MDs make the best CDS reviewers. I need to identify and communicate with any programs where you utilize MDs as the CDS. I'm not talking about advisors, but actual reviewers. I would imagine this to be cost prohibitive, but I need information first. Our program is currently all RN.
Sandy Beatty, RN, BSN, CCDS
Director of Clinical Documentation Improvement
Community Health Network
1500 North Ritter Avenue
Indianapolis, IN 46219
317-355-2016
sbeatty@ecommunity.com
(not a surprise coming from me, I know)
(these represent only my views, not those of ACDIS, my employer, any of
the other individuals or companies mentioned)
First, there is an older post on the ACDIS Blog that might be helpful
to look at:
http://blogs.hcpro.com/acdis/2012/01/thoughts-on-evaluating-vendorsconsultants/
There is another (small) consulting company that has a similar model as
to what has been commented by others. They train (generally retired,
local physicians) to look for specific diagnosis / indicators and then
present one of 50+ templates to the attending. They don't train coding
principles, etc. They attempt a rationale that these are not queries,
but rather educational sheets to the medical staff.
I have had the opportunity to be present during a presentation by this
company as well as have had the chance to speak at some length with a
facility that has engaged them.
Some/many may know that we've worked & are working with Dr Garry Huff
(who works very similarly to Dr Haik). Additionally, I've spoken with
Dr Gold and members of his company.
So I feel I have a perspective on several physician involved models.
So, some general observations. First, each of these companies I've
mentioned DON'T all do the same thing. I will really try to address
differences in models.
First, the model of the Physician as a primary reviewer.
I have grave concerns from a compliance perspective when the reviewer
is NOT trained in coding principles. I feel that significantly limits
the benefit of a concurrent (or a post code / pre bill) review process.
I have suspicions that almost inherently limits a process with WAY too
much emphasis on increasing revenue. One of the sources of possible
compliance risk. Further, there this handicaps the reviewer from
recognizing some of the query opportunities that are more driven by
coding guidelines and less by clinical factors. Additionally, the
reviewer would not be able to address some of the purely coding issues
and help to promote accuracy of coding practice (second set of eyes,
etc.)
Knowing what a physician reviewer will cost (at a minimum 2-4x a RN or
Coding professional), it is much more difficult to obtain equivalent
ROI.
When a physician is trained in coding principles, CDI strategies, etc.,
that can be a significant asset to the CDI program. This is the type of
model Dr Huff & Haik employ. I'd perhaps call these physicians
"enhanced" physician advisors. They are able to interact, education,
and collaborate with medical staff. They can handle escalation process.
They can address both specific and general diagnosis that are not
clinically supported. They are knowledgeable and comfortable with
coding principles. They are able to perform primary reviews (walk in
our shoes; see what the documentation actually looks like, etc.). These
physicians have a higher level of clinical insight to apply.
From reviewing briefly Fair Code web site, seems to be similar (only
knowledge for me is from the web), but I am not sure where the
variations are. They do appear to train their physicians on coding
principles. They do appear to focus on compliance and accuracy, not
solely on revenue.
From the commentary below, I wonder how closely Fair Code trains their
physicians, as the comments don't appear to fully support what was
described on the website.
I do like and encourage this approach of an enhanced physician
advisor.
One real drawback to focusing reviews to post coding / pre bill is that
the window and scope of opportunity to improve the accuracy for
documentation and coding is narrowed. A concurrent process I believe
can do much more -- thus seems to me the best practice is a
comprehensive package.
Not having worked with Dr Gold, but feel have a good general
perception. He does want to involve the medical staff (and I believe
specific champions) directly and closely with the CDI program. He does
seem to teach a mix of clinical and coding principles (and extends some
of those all the way out to the general medical staff). He does use a
model of primary RN/coder reviewers with close support by physician. He
seems to advocate medical staff leadership of the broad concepts of the
CDI program. Different, but from what I understand, the conceptual
model ought to be very effective.
OK ... more than enough.
Don
Donald A. Butler, RN, BSN
Manager, Clinical Documentation
Vidant Medical Center, Greenville NC
DButler@vidanthealth.com ( mailto:mDButler@vidanthealth.com )
Karen
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
Dr. Huff, also, has an in-depth and profound knowledge of compliance and quality issues. I can’t speak to any other MDs performing CDI work. IMO, both of these physicians can walk in a coder/CDI shoes, while also relating to the medical staff as a peer.
Paul Evans, RHIA, CCS, CCS-P, CCDS
Manager, Regional Clinical Documentation & Coding Integrity
633 Folsom St., 7th Floor, Office 7-044
San Francisco, CA 94107
Cell: 415.637.9002
Fax: 415.600.1325
Ofc: 415.600.3739
evanspx@sutterhealth.org
oversight (early dementia?) on my part. Secondly, I don't have a good
understanding of his firm's approach to CDI programs.
I will add, Dr Kennedy has taught the Physician Advisor Pre-conference
for 3 years now (the last 2 were for 2 days and co-taught with Dr Trey
La Charité.
I had the chance to attend last year and found it to be a tremendous
session. Strongly recommend. Benefit greatly any time I've had a
chance to hear Dr Kennedy speak.
Don
I agree with the thoughts expressed by several - it is important that an MD involved also have an appreciation of the coding rules. I have found this to be the case with all mentioned on this blog as I have studied their published materials and seminars.
Paul Evans, RHIA, CCS, CCS-P, CCDS
Manager, Regional Clinical Documentation & Coding Integrity
633 Folsom St., 7th Floor, Office 7-044
San Francisco, CA 94107
Cell: 415.637.9002
Fax: 415.600.1325
Ofc: 415.600.3739
evanspx@sutterhealth.org
(Oh, wait - it is not in the dictated summary - never mind)?!
Paul Evans, RHIA, CCS, CCS-P, CCDS
Manager, Regional Clinical Documentation & Coding Integrity
633 Folsom St., 7th Floor, Office 7-044
San Francisco, CA 94107
Cell: 415.637.9002
Fax: 415.600.1325
Ofc: 415.600.3739
evanspx@sutterhealth.org
Email me personally and I will be glad to share what we do at our facility.
Email jamie.dugan@bmcjax.com
thanks!
Jamie Dugan, RN
Clinical Documentation Improvement Specialist
Baptist Health System
Office: 904-202-4345
Cellular: 904-237-7253
Sandy Beatty, RN, BSN, CCDS
Director of Clinical Documentation Improvement
Community Health Network
1500 North Ritter Avenue
Indianapolis, IN 46219
317-355-2016
sbeatty@ecommunity.com
Sandy Beatty, RN, BSN, CCDS
Director of Clinical Documentation Improvement
Community Health Network
1500 North Ritter Avenue
Indianapolis, IN 46219
317-355-2016
sbeatty@ecommunity.com
Sandy Beatty, RN, BSN, CCDS
Director of Clinical Documentation Improvement
Community Health Network
1500 North Ritter Avenue
Indianapolis, IN 46219
317-355-2016
sbeatty@ecommunity.com
Sharon Cooper, RN-BC, CCS, CCDS, CDIP
AHIMA-Approved ICD-10-CM/PCS Trainer/Ambassador
Manager Clinical Documentation/Appeals/MDS/PPS
Owensboro Health
P.O. Box 20007
Owensboro, KY 42304
sharon.cooper@owensborohealth.org
(270) 417-4612 Office
(270) 316-9088 Cell
(270) 417-4609 Fax