Opportunity for Advancement?

ggoodman@virginiahospitalcenter.com

Hello fellow CDI Takers!

I have a question for you

I have been doing CDI at my facility for 6 years now.
We have a CDI Team of 2 and I have been solo for the past year.
We just hired a second CDI who will start in a few weeks, yay, I never thought it would take so long to find a great candidate!
The new CDI will be the third person I have worked with (due to a retirement and an internal job change).

Here is my question: with such a small team of just two CDI's do you see any opportunity for additional leadership responsibilities or career advancement?
I'd love to see our department grow and hire a third staff member but there are no plans for that at this time.
My hope is that if our department does grow perhaps I could be promoted to a "Lead CDI" position.

My current responsibilities include: concurrent chart review/Query, pre-bill reviews of all death charts and records at risk for readmission, I am involved in a one day stay committee, and I provide physician education regarding best documentation practices. Of course I will also be providing one on one training for our new CDI staff person.

My annual review is coming up in a few weeks and I am brainstorming some ideas for items I want to discuss at this time.
I'm trying to think of new initiatives we can explore that we are not currently doing.
What additional responsibilities can I take on, how can I prove the need for additional staff, etc?
I'm also wondering if any of you have any thoughts about CDI career advancement/promotion at your facilities, do you have a CDI ladder, etc?

I am passionate about CDI and I love where I work - I am just exploring ways to create possible new, professional advancement opportunities within my organization.
Thanks for taking the time to read this, please let me know if you have any insight!
Thanks,
Greta




Greta Goodman, CCDS
Clinical Documentation Improvement Specialist
Health Information Management
Virginia Hospital Center
1701 North George Mason Drive
Arlington, VA 22205
703-558-5336
ggoodman@virginiahospitalcenter.com

cmclose@saintfrancis.com

Solo for only 1 year? Lucky~ I have been solo for 4

lsipos@monument.health

Hello! I am the only certified CDS we have, and there are 6 total CDI! I have worked here the longest (5+ years), do the training, developed the training manual, developed and wrote/templates for Meditech queries, developing ICD-10 queries, review audits for first level review/denials, and a myriad of other issues related to being the longest tenured of the CDI. I am pretty much the "go-to" for questions, etc. (not sounding conceited, I have just been through all the issues of being a new CDI, and working in this role for so long!), and though I have thought of, and brought up the idea of LEAD CDI at my evaluations-having done so- it seemed pointless.... My (CCDS) Certification doesn't even get me anything more for this position! I have wondered about the benefit of letting it lapse, but have considered traveling CDI in the future so I keep It current for myself-not relative to what it benefits me in this position...

I would like to think there would be a CDI ladder- but for me, there doesn't seem to be anything other than climbing up the steps with the rest of my peers and we all just sit on the top rung together!

Juli

From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Wednesday, April 22, 2015 2:09 PM
To: Bovard, Juli
Subject: RE: [cdi_talk] Opportunity for Advancement?

Solo for only 1 year? Lucky~ I have been solo for 4

lsipos@monument.health

OH, and let me add, for the role of CDI at my institution you must be a RN-and so our wage is based on RN role with wage based on tenure and past pay raises/annual evaluations etc. I know that though I have been in this role the longest, there are others who have been employed at the institution longer-so I am sure they make more than I do.... Because they have been a nurse here longer than I.

Over the past several years, we have not gotten raises at our institution as it wasn't fiscally possible. You can be an exemplary employee with rave reviews and all top scores on your evaluation and there is no compensation for that. It makes me glad I like my job as a CDI.



From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Wednesday, April 22, 2015 2:09 PM
To: Bovard, Juli
Subject: RE: [cdi_talk] Opportunity for Advancement?

Solo for only 1 year? Lucky~ I have been solo for 4

dvitalone1

Sounds like you work at my facility. I started the program here 5 years ago and I too the only CCDS



F

katysuegood@gmail.com

What dept are you under? I have been the "CDI program coordinator" since I started 4 years ago. We were a 2 person team then and are a team of 7 now. But the career 'ladder' for us would be up our dept, not necessarily sticking with "CDI" itself. We are housed under Clinical Values (quality) so the trajectory would be up to the CVD manager (managing CDI/QMRN/IP nurses), then directors role. If I was onsite, I'm fairly certain I would currently be in a manager's position but I have stagnated because I need to work offsite. No complaints here though sometimes I get antsy....

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

evanspx@sutterhealth.org

So are we all in agreement that the CCDS credential 'should matter'? Does it distinguish one as a professional proficient in all skills, abilities, and knowledge required to perform in this profession?




Paul Evans, RHIA, CCS, CCS-P, CCDS

Manager, Regional Clinical Documentation & Coding Integrity
Sutter West Bay
633 Folsom St., 7th Floor, Office 7-044
San Francisco, CA 94107
Cell: 415.412.9421

evanspx@sutterhealth.org

evanspx@sutterhealth.org

I agree, which is one reason I continue to be vexed as I review the Job Board on ACDIS: Evidently, I, and other professional coders that have distinguished themselves in this arena, are not welcome to apply for even an entry level CDI job.

Paul Evans, RHIA, CCS, CCS-P, CCDS

Manager, Regional Clinical Documentation & Coding Integrity
Sutter West Bay
633 Folsom St., 7th Floor, Office 7-044
San Francisco, CA 94107
Cell: 415.412.9421

evanspx@sutterhealth.org

katysuegood@gmail.com

I find that incredibly frustrating too Paul. I would love to add a coder to our team but it was decided that “RN” was a must. I find this unfortunate. That being said, I think that even without that there would be potential to use your background in both CDI and Coding to move into a higher level position “up the ladder” within HIM? Possibly program where CDI is housed within HIM? I feel like there would be immense value to having someone with your credentials as a HIM director (for example) over CDI/coding/transcription/clerical/etc staff. At our facility, CDI is not under HIM but our HIM director’s background is transcription, not coding, and that didn’t matter as it would be unlikely that a candidate would be an expert in all the areas falling under HIM, just like in my department our director’s background is in quality but he is over patient safety, CDI, infection prevention, quality nurses, etc….

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

amkelly3@partners.org

Hi all,
I think you have to show value add. The easiest most impressive way to do that is to show the dollars.
I was able to make the case for 2 additional FTEs based on return on investment. ROI= gain-cost/cost. Gain = the modeled financial impact; Cost = RN salary + fringe + orientation costs.
Good luck!
amk

evanspx@sutterhealth.org

Paul Evans, RHIA, CCS, CCS-P, CCDS

Manager, Regional Clinical Documentation & Coding Integrity
Sutter West Bay
633 Folsom St., 7th Floor, Office 7-044
San Francisco, CA 94107
Cell: 415.412.9421

evanspx@sutterhealth.org

evanspx@sutterhealth.org

Thanks, Katy

I was speaking more generally as to what I observe regarding RHIT or RHIA with the CCDS credential. Personally, I am in a great position. I have been the Regional Director of CDI in the Quality Department for about 5 years. Acknowledging some RNs are ‘great’ fits for this field, so, too, are some coders. There is a wide range of education amongst coders, just as with nursing.

Paul

Paul Evans, RHIA, CCS, CCS-P, CCDS

Manager, Regional Clinical Documentation & Coding Integrity
Sutter West Bay
633 Folsom St., 7th Floor, Office 7-044
San Francisco, CA 94107
Cell: 415.412.9421

Unknown

Greta

We have a position that's a step higher, called a CDI Auditor. That person audits charts for the staff and provides further education (we never stop learning in this job); helps with audits for other initiatives within the organization such as audits on UTI charts to see if any of them might have qualified for sepsis, etc. We do a lot of work with PEPPER reports and other audits to make sure we're not missing anything.

Just a thought.

Linda

Linda Haynes, RHIT, CCDS | Manager, Clinical Documentation (CDI/CCCA) | Legacy Health
19300 SW 65th Ave. | Tualatin, Oregon 97062 | 503-692-8862 | lhaynes@lhs.org

catladyrn

Well, Paul, when you decide to move to West Georgia, you can come work in my department . I have both coders and RNs on my team and that is just how I like it. I recently filled two positions, one with an RHIT, one with an RN, and I'm currently hiring for an additional full-time position. I love the balance and the combination of knowledge a mixed team provides. What frustrates me is the number of applications I get from RNs, despite what I've put in the job description, who basically have no other qualifications related to CDI than the license. No bedside experience in M/S or ICU, which for me is critical. A lot of case managers who think that CDI and CM skill sets are the same. Nurses who want a M-F job. Nurses who haven't taken five minutes to find out what we do but have a sense of entitlement anyway. Sheesh. I'll take a good, smart coder any day.

As far as the OP, I don't know the answer in a small department, other than seeing if you can convince them to carve out your team as a separate department and institute you as the manager. See if you can bring those extra tasks you perform into a revised mapping of your department's responsibilities and revamp the job descriptions.

Renee

Linda Renee Brown, RN, MA, CCDS, CCS, CDIP
Director, Clinical Documentation
Tanner Health System

fishdl@shands.ufl.edu

I’ve noticed the same thing and find this extremely frustrating. After developing and nurturing the CDI Program in a large academic medical center & expanding it from one CDI Specialist (me) to a team of eight CDI Specialists over the course of nine years (4 HIM Professionals & 4 RNs) – I am not “qualified” to apply for most CDI positions because I do not hold an RN credential. I developed our training manual and trained most of the RNs who joined our team. I sat for the CCDS exam the first time it was offered (Las Vegas in 2009) and passed. I was promoted from CDI Specialist to Lead to Coordinator, and eventually to CDI Supervisor. I am very familiar with quality metrics (Core Measures, PSIs/HACs, Severity of Illness/Risk of Mortality, etc.) in addition to MS-DRGs, APR-DRGs, POA indicator assignment, query best practices, electronic query development in both ICD-9 & ICD-10, inpatient coding guidelines, program impact analysis, etc. – and still I am excluded because I am not an RN.

It seems the RN credential carries more weight in the CDI industry than the CCDS or CDIP credential – I’m baffled…

Donna Fisher, CCS, CCDS

annnd2009@gmail.com

Hi all!

I totally understand from a personal level how people feel. I really do. It may not be right but it really is not uncommon in many roles.

Many manager roles require a Masters degree. Many CDI positions actually require BSN. I have seen very experienced 20+ ICU Veterans be unqualified as an associates degree prepared RN, but a BSN prepared nurse with 3 years nursing home, 1 med-surg and 1 ICU IS QUALIFIED.

Sometimes it's because people who understand nothing feel they can trust you based on degree (intelligence in their mind). I know we have all known a lot of initialed people with Masters and higher that baffle that they are in their position.

So much is politics. SO MUCH. The more you get to witness it first hand it can be disheartening how much is an " all about me and my accolades" world, and sadly far less about knowledge and ability to PERFORM a job well. It can be a lot of who can show up at meetings look good and nod pretty.

In fact I think MANY are not very knowledgeable. I incorrectly assumed I figured it out-but found out THE PETER PRINCIPLE is a known phenomenon. Degrees help create the illusion of competence ( not to say true of all).

Many consultant jobs are the same.

My regards and understanding at the unfairness of it all.

ggoodman@virginiahospitalcenter.com

Good Morning!
Thanks so much for all the great responses!
I do like the idea of creating a position called CDI Auditor.
This past year I did start auditing some of our records and I really enjoy it!
I also have a CCDS and while it is not a job requirement it was encouraged.
It did not get me a bonus or an increase in salary but I was reimbursed the cost of the exam which was nice.
Our CDI program is housed under HIM. Basically it's me (soon to be 2) and I report directly the HIM Assistant Director who is also the coding manager.
Within our department the only person above her is the HIM Director. So there is definitely limited growth within our department unless we create a new position some day.
I also agree with all of the comment regarding the fact that most job postings require an RN. I also am not an RN.
Though I would hope my CCDS, Masters of Social Work, experience as an ICU case manager and 6 years of CDI would mean something if I did ever apply for another position elsewhere! I would hate to think that experienced CDIs are turned away from jobs and considered unqualified because they are not an RN.

Have a great day!
Greta

evanspx@sutterhealth.org

I agree, but one point is that the CCDS credential is supposedly valued and accepted as evidence of baseline competence…so, either this is a true statement, or it is a false statement.

Paul Evans, RHIA, CCS, CCS-P, CCDS

Manager, Regional Clinical Documentation & Coding Integrity
Sutter West Bay
633 Folsom St., 7th Floor, Office 7-044
San Francisco, CA 94107
Cell: 415.412.9421

don.cdi.rn@gmail.com

Might be worthwhile to start looking into expanding the scope of your program (which would lead to the stronger possibility of establishing a team lead/new department).


How many beds? are you reaching 90% of your target population? is there the ROI to justify expanding the target population (almost certainly yes)? how does your organization compare to benchmarks in CMI, cc/mcc capture, the pepper report, etc.?


For auditing -- certainly an area worthwhile considering expansion. Worth looking at either select populations (such as all expired cases for maximum SOI/ROM; post coding / pre-bill reviews of certain cases -- there almost certainly is a financial ROI there; audit of query compliance; audits of any areas of interest to the greater organization -- specific service lines for example).


Donald A. Butler, RN, BSN
Manager, Clinical Documentation Advisor Program
Vidant Health, Greenville NC
252-847-6855

evanspx@sutterhealth.org

Thank you, Renee

I view this as a compliment considering your expertise, experience, and proven competency in this profession.

Paul



Paul Evans, RHIA, CCS, CCS-P, CCDS
 
Manager, Regional Clinical Documentation & Coding Integrity
Sutter West Bay
633 Folsom St., 7th Floor, Office 7-044
San Francisco, CA 94107
Cell:  415.412.9421

evanspx@sutterhealth.org

fishdl@shands.ufl.edu

Perhaps someday the job posting requirements will state: CCDS required.

After sifting through all the applications and conducting many interviews – I would have jumped at the opportunity to hire someone with a CCDS credential – regardless of their other credentials, or lack thereof!



I agree, but one point is that the CCDS credential is supposedly valued and accepted as evidence of baseline competence…so, either this is a true statement, or it is a false statement.

Paul Evans, RHIA, CCS, CCS-P, CCDS

Manager, Regional Clinical Documentation & Coding Integrity
Sutter West Bay
633 Folsom St., 7th Floor, Office 7-044
San Francisco, CA 94107
Cell: 415.412.9421

shume

In my experience, the CCDS does not appear to be valued…unless you are also a BSN….I was removed from my CDI position which I created 3 yrs ago due to not having a nursing background when a new corporation took over…

Let me also say that at one time I was a practicing PA in surgery and internal medicine and then a practicing podiatrist in solo practice which I left due to injuries that would not allow me to perform surgery….

I did not keep up my podiatry license due to not using it as well as the cost…one needs a physician’s salary in order to afford it…



Is there a way for ACDIS and AHIMA to take a stand on this issue ? Has anyone asked them ? just a thought …



Sheila Hume, CCDS

evanspx@sutterhealth.org

Shelia


1. It is ridiculous that you would not be retained considering you have the clinical knowledge of a PA and a Podiatrist. (I find that incredulous – are people really that ‘rigid’)

2. AHIMA and ACDIS offer what many consider to be ‘competing’ credentials, so, I’d not expect a united front from them on this issue.



Paul Evans, RHIA, CCS, CCS-P, CCDS

Manager, Regional Clinical Documentation & Coding Integrity
Sutter West Bay
633 Folsom St., 7th Floor, Office 7-044
San Francisco, CA 94107
Cell: 415.412.9421

evanspx@sutterhealth.org

shume

Yes it is and yes they are…. And it is unfortunate that two of the most important organizations for CDI cannot work together….:(

Unknown

Greta-one more thing: with the CDI Auditor position, I required a CCDS and a minimum of 2 years experience to help justify the higher rate of pay. Good luck!

Linda

Linda Haynes, RHIT, CCDS | Manager, Clinical Documentation (CDI/CCCA) | Legacy Health
19300 SW 65th Ave. | Tualatin, Oregon 97062 | 503-692-8862 | lhaynes@lhs.org

F