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

Comments

  • edited May 2016
    There is a physician company out there called Faircode. They review
    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

  • edited May 2016
    I reviewed the Faircode website and the examples listed of charts in which they claim to have made an impact in the DRG. Based on the examples listed, it seems that an investment from a facility in the ongoing education of coders/CDS, effective/efficient auditing and along with the continued networking within ACDIS the examples listed would have been able to have been addressed by a CDS. It seems that sometimes facilities hire CDS and have great expectations for an almost immediate return on investment but never want to provide the ongoing education needed for continual CDS growth both individually and as a program. It seems unfortunate that a facility would rather pay a significant fee to a physician company rather than invest a much less amount in their own employees.
  • edited May 2016
    I agree. We've had a CDS program for the last 11 years with the
    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

  • edited May 2016
    We are all RNs also.

    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

  • Warning, LONG COMMENTS:
    (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 )

  • edited May 2016
    Thank you, Don!
    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

  • FTI, Dr. James Kennedy, CCS, has an excellent combination of clinical and coding skills. I believe he approaches the compliance issues with a unique perspective.
    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

  • Thanks Paul -- my lack of mention of Dr Kennedy was primarily due to
    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 am sure they are 'all excellent' - I have had the chance to work with Dr. Kennedy on several projects and have also attended his seminars. I like his approach to the CDI realm - he teaches you "how to catch the fish", so to speak.

    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
  • Don - If you exhibit any behavioral disturbances with that dementia, please be sure your attending so states so that I may compliantly and fully paint my picture of your care, thus accurately portraying the Medical Complexity of care rendered by the physician and the time and effort spent by the nursing staff dealing with your dementia.

    (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
  • edited May 2016
    Thank Paul - I needed that smile this afternoon! Linnea
  • edited May 2016
    Sandy,
    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
  • edited May 2016
    Does anyone know of a contact At Scott and White in the Austin/Temple, TX area? They are apparently using all MDs for CDSs. Thanks.

    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
  • edited May 2016
    LOL... We have your back, Don. I thank you all for the feedback. Apparently a hospital in TX called Scott and White have hired a team of internal physicians, to consultants, to do the daily CDI work. I have a VP who is now wanting to look at this.

    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
  • edited May 2016
    We are all RNs. Charlene
  • edited May 2016
    I meant not consultants!!! Add me to the patient care list with Don....

    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
  • We are all RN's as well.


    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
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