Physician Queries Boot Camp
Has anyone attended the Physician Queries Boot Camp? I am interested in your opinion because I am seriously thinking about making a career change into another area of nursing. I have been a Doc Spec for approx 5 years and I enjoy doing chart reviews. According to my boss, I am still missing query opportunities. I thought maybe this boot camp would be something to consider.
In addition to the bootcamp, I would like to know what your working condiditons are. Do you work in a quiet, professional environment or do you have to endure a noisy, distractable, sometimes, unprofessional environment like I do?
Thank you for any suggestions
Regina McCroskey, BSN
In addition to the bootcamp, I would like to know what your working condiditons are. Do you work in a quiet, professional environment or do you have to endure a noisy, distractable, sometimes, unprofessional environment like I do?
Thank you for any suggestions
Regina McCroskey, BSN
Comments
I loved your description of your working environment - "noisy, distractable, sometimes, unprofessional". That sounds like what my world was like when I was a CDS. Noisy in the office, noisy on the floor and comments from people that they would never consider saying to their friends or family.
What types of opportunities does your boss feel like you're missing?If you're expected to focus your chart analysis on CCs, MCCs and "moving the DRG", I would agree that you might be missing opportunities for additional documentation - stuff that has no impact on the DRG but might result in more detailed code assignment.
About 60% of my queries (back in the day) had nothing to do with the final DRG assignment- and this was before MS-DRGs. Administration felt like this was a waste of my time, i.e., "why waste your time querying for things that 'don't matter'.
But, when we did make the change to MS-DRGs we didn't have to worry revising our process to get the "new stuff" because we had been querying for that specificity already. We're looking at the same scenario with the transition to ICD-10. If the concurrent CDS are discouraged from querying for things that don't impact the DRG, your coders will be doomed when it comes to being able to assign the new, more specific diagnosis and/or procedure codes.
"Has anyone attended the Physician Queries Boot Camp? I am interested in your opinion because I am seriously thinking about making a career change into another area of nursing. I have been a Doc Spec for approx 5 years and I enjoy doing chart reviews. According to my boss, I am still missing query opportunities. I thought maybe this boot camp would be something to consider.
In addition to the bootcamp, I would like to know what your working condiditons are. Do you work in a quiet, professional environment or do you have to endure a noisy, distractable, sometimes, unprofessional environment like I do?
Thank you for any suggestions
Regina McCroskey, BSN"
Dawn M. Vitalone, RN
Clinical Documentation Improvement Speicalist
Community Hospital
Munster, IN 46321
Since you really enjoy what you do, don't give it up!! If specific, concrete feedback is not forthcoming, perhaps instead of changing roles, you might consider changing organization? An experienced CDS ought to have absolutely no problems finding a new job!
Work environment -- within my organization both over the past 6 years as well as currently across our 9 person team there is variation. There is importance with being on the floors and having direct personal contact with physicians (and unavoidably more noise, distractions, etc.). Our role (nationally) is in some sense an add-on, so the availability of decent space (on units or where physicians are most likely to be found) I suspect is a chronic, almost universal problem when there is such competition for work space across multiple disciplines, not the least of which is bedside nurses & direct care providers.
Don
a frustration point with our provider staff. I continue to feel our
program is insignificant, a "waste of time", "pointless", etc
............................ I have been in this role for 5 years and have
great difficulty in motivating my self and my staff....
Thank You,
Susan Tiffany RN, CCDS
Supervisor Clinical Documentation Program
"Twenty years from now you will be more disappointed by the things you
didn't do than by the ones you did do. So throw off the bowlines. Sail
away from safe harbor.Catch the trade winds in your sails. Explore. Dream.
Discover." Mark Twain
CDI should be part of the Quality and risk management team, to review the physician and nursing documentation, to identifying the problem and focus area, to prevent and unnecessary complication code due to physician documentation error, to educate and improve the nursing documentation, to review complication and mortality cases, identify the causes, (true complication? Documentation issue or coding errors), after all, CDI is one very important role!
I'd like to comment with a 'manager hat'.
From Regina's comments, context and tone, I presume that there have been appropriate examinations and feedback. That the performance is not up to the standard of the team at her facility. I will also presume further that there have been (more than) reasonable efforts to help & support her, and that she has genuinely put in the time and effort also.
It is a tremendous investment in time, energy, resources and money to train a new CDS. One does not want to throw that effort out quickly, and usually one is willing to put in a lot more effort when indicated. The ACDIS on line poll questions fully support this (how long to get up to speed, how long is orientation, how long to achieve expertise) But there does come a point....
From that perspective, what hypothetical coaching advice might I give?
(I have been in a similar position with a staff member before and it was not working. Tried, wanted, but just not a fit.)
*It certainly seems like there is the desire & commitment to succeed. However, the CDI role is one where a fair percentage of experienced, excellent nurses are very heavily challenged, and not everyone will end up succeeding.
*If genuine efforts on all parts have been made, it is time to consider whether this every going to be a good fit.
*Part of leadership is to have this kind of tough conversation -- things are not working out, but I can honestly say I will strongly support moves into another nursing role -- I believe you are an excellent nurse but this role is not for you. We need to find an avenue for you to succeed and have both satisfaction and professional joy again.
*Frankly, if we are not able to work this out, I will be considering termination due to a lack of meeting minimum expectations.
BTW: If work environment is an issue that is contributing to the difficulty with success, I am afraid it is unlikely to find a significantly better environment. Most CDS's function in a similar setting.
Also, as a leader, I really have to examine how this impacts the entire team's effectiveness. At some point, the team will suffer and possibly disintegrate or deteriorate. This factor also weighs heavily.
Don
I have to ask myself, how much is because of myself &/or my team? what more could we do?
What is the large political & cultural environment? It takes years for a cultural change.
How can I redefine and present my program, show it's worth and value (to the organization and the medical staff)?
Can I see myself continuing to have fun and find satisfaction with CDI activity in a different setting?
After reflection, I hope to see some answers, and some solid idea of longer term trends. In that context -- address the fundamental choices -- a role change &/or an organizational change? what/where is the expected benefit from my point of view? It really depends on how we each perceive the outlook.
I personally see hope (large organizations are not terribly speedy, so I also need patience) and will be continuing to grow forward.
I also see very real and significant potential for the CDI role for a number of years -- I suspect it will continue to be a growing and expanding area that offers a number of opportunities because it is fairly wide open.
Don
A friend of mine joined the CDI team and absolutely hated it, claimed it was a waste of time, pointless, everything that Susan said. She and I had a long talk and she ultimately returned to her previous job. Shortly after that, I was named the CDI team leader - sort of a quasi-supervisory position. Looking at the numbers from the last year, I had written almost 700 queries, the other team member almost 600 and my friend had only written 154. It was pretty obvious it was not a good fit for her.
I think with CDI you either love it or hate it. If you love it, the frustrations are easier to put up with.
When Adam and Eve were booted from the Garden of Eden, they were told by God that they would work for a living, it was not going to be all peaches and cream so to speak. Every job that I have ever held has had its frustrations. Some were more bearable than others. But if you love what you do, you can generally find a way to work through those frustrations. I consider the frustrations in CDI a challenge. And each time a physician sees the light and asks for help with documentation or to have me perform a chart review to show them areas of improvement (or give pats on the back when they've done a good job) it is a challenge I have overcome.
Sharon Cole, RN, CCDS
Case Management
254.751.4256
srcole@phn-waco.org
Totally agree with you Sharon
Tracey