CDI Reporting Structure and Integration

sabullock

After the ACDIS conference and reading some other industry material I am wondering with the different reporting structures and integrations are you exploring changes to your current program.
For example - some programs have moved to quality from HIM/Revenue Cycle, a couple of presenters at ACDIS stated they no longer tracked financial impact, an industry white paper and a recent e-newsletter seems to advocate integration of CDI into utilization review and care coordination. I am curious if programs are restructing due to I-10, value based purchasing, anticipated decrease in revenue, etc. What is your reporting structure?
We now report to Chief Quality Officer and that has been a good fit.
Thanks
Shelia

Shelia Bullock, RN,BSN,MBA,CCM,CCDS,CCS
Director, Clinical Documentation Improvement Services
University of Mississippi Medical Center
2500 North State Street
Room S336
Jackson, MS 39216
T: 601-815-3079 I F: 601-815-9505
sabullock@umc.edu
www.umc.edu

sbeatty

When I joined this network, the CDI program reported to HIM>Revenue cycle. It now reports to CM>Quality/Risk. I feel that is a better fit. We do not own any of the quality metrics, but we communicate the PDx (working) to numerous team mates via email. We are also working on some interdisciplinary teams to improve quality metrics so that we can understand if we can contribute without disrupting our work flow, and still support these initiatives. That is an important piece that many don't consider. CDI is not about revenue, it is about quality patient care for which the reward for doing the right thing for the patient's medical record is a financial benefit.

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@owensborohealth.org

We report to the Director of Case Management, who reports directly to the CFO. I do not foresee this changing anytime in the near future.

Sharon

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

katysuegood@gmail.com

We recently switched from Care Coordination (case management and UR) to Clinical Values (quality). So far, so good. CDI needs to be intimately involved with both groups so I find it helpful that while we are now in quality, we have a decent understanding of UR/case management and know the staff in Care Coord as well. Under care coord, we reported up to the CNO and now we report up to the CMO. Honestly, the biggest difference I have seen in that switch is the amount of financial support our program has. Under nursing, I had to beg for books and we didn’t have a budget to even offer cookies/candy for CDI week. Now, we seem to get what we ask for. We just sent the entire team (8 CDI's) to the conference. Several also did the preconference and we sent 2 people to the MD advisor preconference.
So far, we are not accountable for the quality metrics but we do communicate with the Quality RN's regarding CHF/stroke patients, HACS etc. Hopefully we can keep that the way it is

Katy Good, RN, BSN, CCDS, CCS
Clinical Documentation Program Coordinator
AHIMA Approved ICD-10CM/PCS Trainer
Flagstaff Medical Center
Kathryn.Good@nahealth.com
Cell: 928.814.9404

sbeatty

That sounds like what we do. This program had languished with no leadership, and so is now a rebuild. The focus has always been revenue optimization and changing that mindset is a sales job not for the faint of heart!!!

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

dallend@einstein.edu

We are in HIM. We work closely with coding and coding management. We do communicate regularly with care management.

Deborah A Dallen,RN, CCDS
Albert Einstein Medical Center
Phila PA 19141
Clinical Documentation Coordinator
Health Information Management
215-456-8902

fishdl@shands.ufl.edu

We have been in HIM since the inception of our program 8+ years ago. We report directly to the Coding / CDI Manager. HIM is under Finance. Although our program reports to HIM/Finance, we work very closely with our Quality Improvement team, participating in their AHRQ (PSIs & HACs) and Mortality Review meetings, as well as, quality-related UHC webinars / initiatives. We also have a seat at the table of the UM meetings. Our team of 7 consists of 4 RNs with case management/UR experience and 3 HIM professionals - 1 with CPC and 2 with CCS & CCDS credentials. We bring different skill-sets to the team and we all benefit from it. Although we are keenly aware of the financial impact associated with our queries, we are equally aware of the impact to severity, risk, LOS, CMI, as well as, quality metrics.

Donna Fisher, CCS, CCDS
CDI Coordinator
UFHealth Shands Hospital
Ph: 352.265.0680 ext 48769
fishdl@shands.ufl.edu

sbeatty

Do you have any issues around pay for a mixed discipline team, or how have you handled that? HR cited this as an issue when I suggested this recently... Sigh.

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

fishdl@shands.ufl.edu

Not really. The CDI Specialist's pay range is the same as for CM/UR. We have only had one RN go back to bedside nursing so she could pick up more hours to earn more money.

Donna Fisher, CCS, CCDS
CDI Coordinator
UFHealth Shands Hospital
Ph: 352.265.0680 ext 48769
fishdl@shands.ufl.edu

evanspx@sutterhealth.org

We report to Quality - I like that reporting structure. We are a small team at this time, but hope to expand.

1 RHIA and 2 RNs - all of us have the CCDS credential.

We structure PD to state CCDS or CDIP 'preferred'. No differentiation in pay (RN versus RHIA) as this is based upon individual merit. However, our pay structure does acknowledge educational levels. For example, an RHIT (AS) may not earn as much as an RN or RHIA. But, this is not set in stone.

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

paxneros

We report to Coding HIM which also reports to Rev. Cycle - along w/RM/CM.

When I worked in UM we reported to Quality and also to Finance at times. I feel we really made the difference in CMI and LOS when we worked under Finance.

The best part of working in UM was all UM Coordinators had been trained to code in ICD-9 CM. And I mean hands on, in depth coding experience. All staff had been coders because at the time there were no trained HIM coding staff at the facility - or for that matter in the surrounding area! Nurses (and myself), performed the coding at our hospital.

So our UM dept - myself included - we performed our own admitting coding, arrived at our own DRG/LOS & updated it to suit our needs. (Adding procedures or changing PDx - no such animal as MCCs/CCs. )

I see that as an area of focus now that I work in CDI. I'm providing DRGs to people who w/some coding background ...you follow where I'm going. And actually some of the UM staff are starting to take coding classes.

There are rumors of us moving to RM in the future - not sure how reliable but well-rounded personnel can work wherever they are needed. In every area I have worked you can be sure that after so many years - some long-some short- someone will come along who feels it works better in a different area.

Norma T. Brunson,RHIA,CDIP,CCS,CCDS

afloyd

We report to our CFO. We were under Quality when our program began in 2009 but have been under the CFO for the past year. We work closely with Coding which is also under the CFO but we walk the line between revenue and quality issues with everyone in the big scheme of things understanding this. We all work as a team regardless of the official structure. Revenue Cycle, Quality, Cores, Risk Management, etc, etc, etc. It takes a team approach with all of the changes and impending changes coming up in the near future. I'm glad to work for a group that can work closely to get the job done and not be afraid to cross the line into the next camp.

April Floyd, RN, CCDS
Director CDCI
Anderson RMC
Meridian, MS
601-553-6299

elizabeth.hynd

I will be away from the office starting on June 10th and will return on June 17th.