Physician Advisor Role

fishdl@shands.ufl.edu

For the CDI Programs who currently have a Physician Advisor / Physician Champion / Physician Liaison, I would be interested in the number of hours per day / week they are dedicated to the CDI Program and do you feel the time is sufficient? What are some of the areas and situations you find it most beneficial to have their support, guidance, and expertise? Any other information or experiences you would be willing to share is greatly appreciated.
Thanks!
Donna Fisher, CCS, CCDS
Shands at the University of Florida

NormaB

Hi Donna!

I would also be interested in this information!

N.Brunson, RHIA, CCDS
Bay Medical Center

kfrosch1

I would be interested in this information also.

Karen Frosch, CCS, CCDS
Christiana Care - Performance Improvement
Clinical Documentation Improvement Manager
302-733-4642 (office)
"Attitude is a little thing that makes a big difference" Winston
Churchill

digardsk

Hmmm...we do not find out physician advisor helpful or accessible. Hours per week are not met.

Please try to find the right person for the job! Not just someone who envisions a few extra bucks, or is made to do it through some other role.

twoods

Same here. Not much from our advisor.

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
"Attitude is a little thing that makes a big difference." Winston Churchhill

dbutler

I'd like to see a formal poll (with multiple questions on the topic of physician advisors). From conversations with ACDIS, the interest is there to do that however there are scheduling and priority aspects that influence which topics are taken on & in what order.....so I hope it is more a matter of when such a poll will be offered.....

Anyway, we have been trying to get a good, solid physician advisor role established.
The largest challenge is obtaining consistent, devoted time. Generally, the physicians that we've had in the role (part time of 4-8 hours a week, with at least a couple advisors), initially were doing this "in addition" to their full time work. That has been problematic -- really need someone who is devoted and inspired for that to work out (have had mixed success overall, also have lost a couple to relocations).

We finally are at a point where we are recruiting for an Associate CMO who would essentially be half and half between UR & CDI/HIMs. For the CDI part, the role will certainly have a large "working" aspect vs executive leadership.

The helpful benefits in the past have been group teaching with coders & CDSs on various clinical topics -- very well received!, actual hands on chart review with suggested coding and queries (significant results there), individual conversations with peers to foster understanding and collaboration as well as short group presentations on focused topics, individual case consulting for clinical insight, peer to peer conversations about specific case query, systems work (such as with documentation templates in EHR, forms....).....really, the typical things that most programs would like to achieve, but coming from a physician has more weight.

Probably the most value to me is the work an advisor can do with the medical staff along with the partnership with the CDS / coder team.

The hours -- suggest varies significantly depending on what specific tasks are desired. A couple hours a week (average) for even larger hospitals might be enough for just education of peers and improved collaboration. That can scale up in my opinion to (in theory) two or more FTE's for larger hospitals (I could easily keep one or more FTE busy and we have 800 beds). BUT...any EFFECTIVE time and interest you can consistently obtain is of considerable value (what I want is not the measure, but what I do with the time & effort offered is the true measure).

Don

Donald A. Butler, RN, BSN
Manager, Clinical Documentation
PCMH, Greenville NC
dbutler@pcmh.com


Never give in. Never, never, never, never--in nothing, great or small, large or petty--never give in, except to convictions of honor and good sense. Never yield to force. Never yield to the apparently overwhelming might of the enemy
Sir Winston Churchhill

NormaB

We originally assigned the Medical Director for Physician however I almost the same breath we we told he would not have "time".

I've put a bug in a few ears ustb in case someone asks if I have ideas. One, is already the Resource Management PA and is paid for4 hours a week. I've heard he is slightly underutilized. I thought if there were any questions in the future as to his continued service we might raise our handto help him out with hours.

We don't really have aany interventions for a PA but someone to assist with physician education would be great!

N.Brunson, RHIA, CCDS
Bay Medical Center

kshumpert

I share a physician advisor with case management and UR. The amount of time spent with him varies. I have found him most helpful with diagnosis criteria and working on criteria. He reviews RAC charts with me as well. I would say that it is most beneficial to have a physician that does not have a private practice. It seems that they really worry about irritating other physicians and possibly a concern that consults would be affected.


Kathy Shumpert, RN, BSN

Clinical Documentation Improvement Specialist
Howard Regional Health System
Office 765-864-8754
Pager 765-604-0424
Fax 765-453-8152

Proofread carefully to see if you any words out. ~Author Unknown

pfowler

I would like to know how you get your physicians to not document acute
on chronic renal insufficiency.

Patsy Fowler RN, MSN, CCDS
Certified Clinical Documentation Specialist
Marion Regional Hospital
PO Box 1150
Marion, SC 29571
Office 843-431-2044
Cell 843-431-2863
Fax 843-431-2432

twoods

Ours do it all the time too.

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
"Attitude is a little thing that makes a big difference." Winston Churchhill

robert.hodges2

I did a lot of education for my providers on this and have a handout on it on the forms and tools section of the ACDIS website. Basically I tell them that insufficiency is for acute conditions only. Anything chronic needs to be documented per National Kidney Foundation guidelines.

It's a battle and it takes a lot of discussion and education, but so far things are getting better here.

Robert

Robert S. Hodges, BSN, MSN, RN
Clinical Documentation Improvement Specialist
Aleda E. Lutz VAMC
Mail Code 136
1500 Weiss Street
Saginaw MI 48602

Melindascharf

We have had the same issues with our physician advisor that is seems everyone else has had. He has a private practice and many other commitments so we do not get as much time as we feel is needed. He does not have a coding background and therefore is not very comfortable discussing the subject. (my theory) We have had to really encourage him to seek out individual doctors to speak to, rather than taking the initiative and speaking to the md's who are not cooperating.

Melinda Scharf RN,BSN, CCDS

NormaB

Part of it is the day to day education on the floor. I usually ask them to use "insufficiency" when they are speaking of a patient who has a "history" of renal problems. OTherwise they need to use the CKD criteria or document as failure.

Our query for ARenalF only mentions "failure" in the several listed choices.

We also see this with "Ac Respiratory Insufficiency".

N. Brunson, RHIA, CCDS

twoods

Nancy, would you share your renal criteria?

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
"Attitude is a little thing that makes a big difference." Winston Churchhill

robert.hodges2

Nancy,

I have to respectfully disagree with you here. Chronic renal insufficiency codes as chronic kidney disease - unspecified (585.9). Also, when I did my literature review, every time I looked for renal insufficiency, I was directed to acute insufficiency. For continuity of care I discourage the use of any chronic insufficiencies.

Robert

Robert S. Hodges, BSN, MSN, RN
Clinical Documentation Improvement Specialist
Aleda E. Lutz VAMC
Mail Code 136
1500 Weiss Street
Saginaw MI 48602
 
P: 989-497-2500 x13101
F: 989-321-4912
E: Robert.Hodges2@va.gov
 
"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.edu

Our physicians will document insufficiency at times - we just leave a query if it's appropriate to clarify diagnosis.

Unknown

We are setting up the role of our physician advisor so I am interested in this discussion. Is your advisor involved in physician training? Does your advisor speak at section meetings regarding documentation?





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