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acdis
Fifth Annual Conference
Eight members of the Kissing Statue Walking Club rose before 5 a.m. to
walk to the historic San Diego site, bond with fellow CDI ­professionals,
laugh, and enjoy the sunrise. They are: Merle Swoope, from St. Mary
Medical Center in Apple Valley, Calif.; Kyle Jossi, from Holy Cross
Hospital in Silver Spring, Md.; Stephanie Hur, from Covenant Health in
Lubbock, Texas; Amy Staples, from Cary Medical Center in Caribou,
Maine; Buena Esther, from Mercy Hospital in Springfield, Mo.; Vivian
Gannon, from Chesapeake (Va.) Regional Medical Center; Norma
Brunson, from Bay Medical Center/Sacred Heart Health System in
Panama City, Fla.; and Penny Richards, ACDIS member services specialist at HCPro, Inc., in Danvers, Mass.
SAN DIEGO 2012
Associate director’s note
CDI professionals show spirit in San Diego
Although it isn’t hard to believe how ACDIS and the
national conference has grown in the past five years, it is difficult to take it all in and accept that growth (and its importance)
for what it really stands for—the professional dedication and
advancement of thousands of people who work in the CDI role.
When nearly 900 professionals converged on the Manchester
Grand Hyatt in downtown San Diego, Calif., in May 2012,
they marked the largest, most spirited conference yet.
This year, the physician advisor’s CDI pre-conference
seminar expanded to two days. It featured Trey La
Charité, MD, an ACDIS Advisory Board member and the
physician advisor for the University of Tennessee Medical
Center in Knoxville, and James S. Kennedy, MD, CCS,
ACDIS Advisory Board member and a director at FTI
Healthcare in Brentwood, Tenn. (Read Kennedy’s related
Q&A on p. 9.)
It also marked the first ICD-10 for CDI Boot Camp
taught as a pre-conference session by the ever-vivacious
Adelaide M. La Rosa, RN, BSN, CCDS, director of the
CDI program at St. Francis Hospital-the Heart Center in
Roslyn, N.Y. By the completion of the two days’ sessions,
she had a loyal following of “La Rosa groupies” who made
the Long Island resident promise to share photos of her
mother and pet puppies. (Read a recap of La Rosa’s tips on
p. 8.)
ACDIS Director Brian Murphy tends to be a bit of a celebrity at the
conference. Everyone wants their picture taken with him.
The ACDIS Conference Committee chose the winner of
the CDI Professional of the Year award: Cathy Seluke, RN,
BSN, ACM, CCDS, supervisor for clinical documentation
compliance at MaineGeneral’s Waterville and Augusta campuses. Conference attendees also recognized the winners of
the Recognition of CDI Professional Achievement awards:
Dee Schad, RN, BSN, CCDS, an ACDIS Advisory Board
member and founding leader of the Indiana ACDIS chapter, and Robert S. Hodges, BSN, MSN, RN, CCDS, CDI
specialist at Aleda E. Lutz VA Medical Center in Saginaw,
Mich. (Read about their efforts on pp. 4–6.)
The tradition of wearing ACDIS colors on the first day of
the conference received tremendous support—this spring, the
color of choice was pale orange and peach accessorized with
all sorts of purple paraphernalia. Physician advisors donned
purple ties. Men wore orange dress shirts and purple socks.
The ladies wore purple hats, and a few even had their manipedis done in ACDIS colors.
ACDIS attendees also joined in the fun for the secondday tradition of wearing clothing that represented some
aspect of their home state. Some wore the standard baseball
caps and football jerseys, but a few others touted more creative options—the ladies from Maine wore headbands with
waving lobster claws, and the folks from Texas all wore
colorful bandanas. (View photos of the fun on pp. 17-18.)
Melissa Varnavas and Carol Sedlacek. Sedlacek earned a spirit ribbon for
bringing one of the speakers a treat from an area bakery.
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July 2012
© 2012 HCPro, Inc.
There’s a good reason for the garb; believe it or not—it’s to
help facilitate networking. Name tags can be difficult to read,
and in a group as large as ours it can be tough to find others
from your home state.
Another tradition created a few years back is the local
chapter networking lunch on the second day of the conference.
This year, our host was the California ACDIS chapter, which
led an ACDIS bingo game. Instead of letters and numbers,
however, chapter members read out hints of CDI- and San
Diego–related trivia, and volunteer “runners” gave prizes to
tables of winners. Half the fun is finding the table for your
state and meeting others. In fact, the activity actually spurred
the creation of the Arizona ACDIS chapter.
To recognize the outpouring of CDI spirit this year, the
ACDIS team had special ribbons created. The administrative
staff gave them to individuals deemed to have gone above and
beyond in showing their CDI pride, helping other attendees,
illustrating their appreciation of a given speaker, or getting the
most from their conference experience.
For example, one CDI spirit ribbon went to Carol
Sedlacek, who was so energized by the ICD-10 for CDI
Boot Camp presentation that she stopped at a bakery and
brought in some tasty treats for the speaker. Another ribbon winner, Raymond Salcido, asked the hotel staff and
ACDIS administration if he could take a few of the leftover
boxed lunches to give to the homeless in the area. Other ribbons went to a group that, prior to the start of a program,
marched to the front of the room equipped with sticky
notes, highlighters, and pens—clearly ready to absorb all
there was to learn from the session.
And there was a tremendous amount to learn. The 2012
conference featured five different tracks, including quality,
ICD-10, and program management. All the PowerPoint
presentations from these tracks, as well as those from all the
previous conferences, are available to ACDIS members on
the Forms & Tools Library. (Read what one attendee had to
say about her conference experience on p. 13.)
The 2012 ACDIS Conference was by far the best yet ... but
that doesn’t mean we can’t aim higher.
In 2013 we’ll be in Nashville, with an expanded schedule of
two-and-a-half days and more than 30 speakers! Can’t wait to
see you there!
Dexter D’Costa, MBBS, MHA, CRCR, regional director of clinical documentation integrity at Kaiser Foundation Health Plan, Inc., & Hospitals
in Oakland, Calif., and Romerl “Cris” Gumayagay, CCDS, CCS, CDIP,
healthcare compliance officer at the University of Southern California
in Los Angeles, pose in front of the announcement for the 2013 ACDIS
Conference in Tennessee.
2012 CDI Professional of the Year
Cathy Seluke pushes for CDI focus on quality
The only person at MaineGeneral Medical Center surprised that Cathy Seluke, RN, BSN, ACM, CCDS, was
selected as the ACDIS CDI Professional of the Year for
2012 was Cathy herself.
Seluke is supervisor for clinical documentation compliance at MaineGeneral’s Waterville and Augusta campuses.
She received nominations from nine of her coworkers, an
unprecedented effort to put her commitment and devotion
in the national spotlight. While honored by the recognition
and humbled by the respect her colleagues demonstrated,
Seluke kept her sense of humor—she showed up at the
2012 ACDIS Conference in San Diego sporting a tiara.
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July 2012
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“I was pleasantly shocked when [ACDIS Director]
Brian Murphy called to tell me I was the CDI of the Year,”
she says.
Seluke built on her experience in quality improvement
and medical staff performance improvement when she
moved into a multi-role case management/information
review/CDI position in 2001.
“Use clinical knowledge to translate clinical reality into codable terms.”
—Cathy Seluke’s mantra
“CDI was a new program at MaineGeneral,” she says. “I
was interested in the case management aspect, and CDI was
an ‘add on.’ The hospital had hired a vendor and we had
training on CDI, but it was really very financially focused at
the time.”
The program went through multiple evolutions. Case
management initially included utilization review (UR)/
CDI ­nurses, social workers, and discharge planners. Then
staff were given roles where everyone did everything (“a
total disaster,” Seluke says); later, CDI and UR were combined into a separate role. Finally, in 2008, CDI became
a stand-alone unit. Seluke calls it “the best move we ever
made.”
She now leads a team of six CDI professionals and splits
her time between the Waterville and Augusta campuses,
located 30 miles apart. MaineGeneral is building a new
­facility in Augusta that will house all of the inpatient services
beginning in December 2013. Outpatient services will be
based in Waterville.
The challenge and the reward
Looking back over the last 11 years in CDI, Seluke says
the biggest challenge she faced was convincing her administration that the CDI function needed to be separated from
standard nursing roles of direct patient care or ­utilization
management. There was a need to promote collaboration
with those teams but not have the nurses involved in data
­extraction.
Along the way, Seluke discovered that CDI is really a
wonderful job. “This is a great job for nurses because it
allows them to use their critical thinking and communication
skills,” she says. “A huge part of the job is the relationshipbuilding we do, learning to approach the physicians and talk
to them in a language they understand. In doing that, we are
able to influence them and improve outcomes.”
Before the advent of a focused CDI effort, Seluke
says she was mining charts for CCs (there were no MCCs
back then) and optimizing the DRGs for the best result.
As long as the work had that focus, she said couldn’t buy
into it.
“When I understood more about coding, I saw that
[code assignments] didn’t reflect clinical ­reality,” she says.
That’s when her mantra was born: Use clinical knowledge to translate clinical reality into codable terms.
The role ACDIS plays
Seluke found ACDIS on the Web and was immediately
hooked. She advises anyone starting out in CDI to join
ACDIS, find a mentor, and shadow someone who is already
on the job. “It’s been a huge, wonderful resource. There’s
nothing like having your own professional organization and
great people to network with.”
Seluke thanks her team for helping her capture the
CDI Professional of the Year award. She also calls out Lisa
Simm, MaineGeneral’s administrative director of quality care
­management. “She backed me up when I wanted to split out
CDI from UR and care management. That made all the difference,” Seluke says.
Perhaps it did. Either way, it was Seluke’s commitment
to her hospital’s CDI success that earned her honors as the
2012 CDI Professional of the Year. And she’s got the tiara
to prove it.
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July 2012
© 2012 HCPro, Inc.
2012 Recognition of CDI Professional Achievement
Robert S. Hodges works to expand CDI, support professionals
There are more than 150 veterans’ medical centers
across the United States. Soon, many of those facilities will
be ­hiring new CDI staff and implementing new CDI programs, says Robert S. Hodges, BSN, MSN, RN, CCDS,
CDI specialist at Aleda E. Lutz VA Medical Center in
Saginaw, Mich.
Hodges, winner of the 2012 Recognition of CDI
Professional Achievement award, was charged with the
task by the VA system. He reached out to the ACDIS
Advisory Board for help and is working with a team of
VA CDI volunteers to develop a VA-specific CDI program guide and VA-specific educational programs for
new CDI ­specialists.
Hodges is a mainstay on the ACDIS message board
“CDI Talk,” but he did not start out being the professional
guru many now deem him to be.
At the outset, he knew only that he wanted to work in
Robert S. Hodges, BSN, MSN, RN, CCDS, CDI specialist at Aleda E. Lutz
VA Medical Center in Saginaw, Mich., poses with award sponsor Steven
Robinson, MS, PA, RN, CDIP, CPUR, CDI senior director of Maxim Health
Information Services based in Columbia, Md.
healthcare and enrolled in ­pre-pharmacy course work.
“I hit the calculus class and wasn’t so sure anymore,” he
laughs.
He enlisted in the Army Reserve as a medic and “met
some cool nurses” who changed his professional outlook.
Thanks to them, Hodges entered nursing school and enlisted
in the Army as a nurse.
The Army implemented its first computers for nurses in
the late 1980s. Hodges recalls entering care plans into the
system and wishing for an understanding of how to use and
manipulate the data collection process.
“I knew there had to be a better way, but I didn’t have
that skill set to do it,” says Hodges.
So in 1994, he decided to earn his master’s degree in
the newly formed field of nursing informatics from the
University of Utah College of Nursing in Salt Lake City.
At that time, there were only two informatics courses
in the country. “The field was really in its infancy,”
he says.
Upon graduation, he took a position at Brooke Army
Medical Center in San Antonio as its nursing informatics
officer, helping the VA construct a new building with an
eye toward electronic health record implementation.
“It was a ton of work and an education unto itself,”
says Hodges.
Afterward, he became the director of Womack Army
Medical Center in Fort Bragg, N.C., where he took charge of
“everything communications related.”
After three years in the role, he moved to Covenant
Healthcare in Saginaw as a manager of its case management
department. During his time at Covenant, he watched as the
facility implemented its first CDI program.
“I saw what the CDI program was looking at and how
it was in line with what we were doing as case managers. I
could see how the two things worked really hand in hand.
The case managers worked with the CDI specialists. They
talked back and forth. They would ask one another if they
had seen a particular physician and ask each other to remind
the physician of different things. There was a lot of collaboration,” Hodges says.
Just as he had enjoyed being on the cutting edge of the
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5
newly formed field of informatics, Hodges found renewed
energy and excitement in the growing opportunities associated with CDI.
When the VA posted a position for a CDI nurse, he
applied and earned the spot.
“I saw it as an opportunity to do something new, something I was interested in, and something I could be obsessive
about,” he says.
At the time, Hodges wasn’t aware of any other CDI
programs in the VA system. He researched the role on the
Internet, found and joined ACDIS, purchased all the reading materials he could, and began to build the CDI program at Aleda E. Lutz as its sole CDI ­specialist.
The facility has 60 long-term acute care and 20 acute
care beds, 100 providers, and 800 total staff, with 29,000
total annual encounters. The majority of care provided there
is done on an outpatient basis, he says.
Hodges began by assessing the facility and its CDI
program needs, reaching out to its physicians, and developing plans to illustrate how improved documentation could
enhance the care provided to veterans.
“We’re not a big place, we’re a small place,” he says.
“So that’s nice—the providers know me and I know them.
We talk with each other and we have mutual respect and
­understanding.”
He also attempted to reach out to other CDI programs
within the VA. Initially, he only found one other program
in New York, but after a little research, he connected with
other programs in Ohio and joined with leaders to teach all
the coders in the region about CDI efforts.
After that, word started getting out, Hodges says, and
soon he was recruited to help develop standardized query
policies and procedures for the VA. Once the team of six
participants created its draft, it was sent to the ACDIS
Advisory Board for feedback.
After more than six months of work, the team published
the tool—complete with appendixes featuring types of queries and how to use them—in September 2011.
“His experience and knowledge were instrumental in
developing a national VHA standardized provider query
process,” wrote Lisa George, coding coordinator for
Veterans Integrated Service Network 2 in Syracuse, N.Y.,
in her nomination of Hodges for the 2012 Recognition of
CDI Professional Achievement award.
The physician query tracking process Hodges helped
create is a “critical building block to an overall clinical
­documentation improvement strategy” for the VA ­healthcare
system, wrote Jacki Bebb, MA, RHIT, CCS, CCS-P,
HIM specialist for the Department of Veterans Affairs in
Washington, D.C.
Hodges hopes to have the next phase of the VA CDI
program guide and education complete within the next six
months. Rolling out CDI programs to all VA facilities will
take more time.
“You can’t do everything at once,” he says. “That would
be too difficult.” Instead, he suspects the VA will roll out
one region at a time and bring forward one set of educational plans to the next group of facilities.
“We want to do it smart and we want to do it right,”
Hodges says. “The better the record is here, in Saginaw,
Michigan, the more complete the record will be when our
veteran goes to Florida for the winter. The physicians there
will know if a patient has CHF and iron deficiency ­anemia.
“I want the record to be the best possible reflection of
the care we provide to veterans so we can ensure the care is
the best we can give. I’ve been taking care of soldiers and
their families most of my professional life, so I have a vested
interest in this,” he says.
Although Hodges was surprised and honored by the
award, he gives credit back to the ACDIS association
­membership.
“When I first started, I was doing everything on my
own,” Hodges says. “I was looking for educational tips, trying
to learn how the CDI workload is captured, and what metrics to use to justify the program and show its success. Then
I found ACDIS, found the Forms & Tools Library, joined
‘CDI Talk,’ and started asking all my ­questions.”
And he got answers.
“All these wonderful people replied and were really very
willing and wonderful about sharing their expertise with me,
helping me to get my program going here,” says Hodges.
Just as Hodges helps raise awareness about CDI efforts
throughout the VA system, he is equally generous with his
time and knowledge with other ACDIS members.
“Now that I know enough to be dangerous, I’m able to
share with others,” he says. “That’s really paying it forward.”
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July 2012
© 2012 HCPro, Inc.
2012 Recognition of CDI Professional Achievement
Dee Schad follows pay-it-forward motto
Dee Schad, RN, BSN, CCDS, never really wanted to
be a CDI specialist. In fact, she never even really wanted
to be a nurse—she dreamed about being a stay-at-home
mom. But sometimes the unexpected happens and changes
the course of our lives. That’s what happened to Schad,
who received 2012’s Recognition of CDI Professional
Achievement award at the 5th Annual ACDIS Conference
in San Diego in May.
Now the director of care coordination and CDI at Clark
Memorial Hospital in Jeffersonville, Ind., Schad is not only
a mom but an ACDIS Advisory Board member and founding leader of the Indiana ACDIS chapter, inspiring others to
fulfill their potential and spreading the word about the influence of CDI efforts on patient care.
“[She] has been an inspiration to me and other CDI
professionals. When she speaks about clinical documentation, there is a gleam in her eye and excitement in her voice,”
wrote Robyn Copeland, RN, MSN, CDI specialist at King’s
Daughters’ Hospital and Health Services in Madison, Ind.,
in nominating Schad for the award.
How did Schad’s life lead her to this role? “Well, that’s a
funny story,” she says, recalling more than 10 years’ worth of
attempts to have children. The effort and energy took its toll
and, finally accepting her fate, Schad instead pursued a career
as a nurse, appreciating the care she’d received. She went
back to school and was about to graduate when she became
pregnant. “It was a total surprise that turned out to be the
most wonderful thing in my life.” Schad says.
Schad continued on with her nursing career, working in
the intensive care and critical care units. When she turned
to CDI, it was difficult to find anyone with CDI experience.
Nevertheless intrigued, Schad saw an opportunity. “The role
sounded interesting, so I took a chance.” Schad enrolled in
a local college course, earned a certificate in coding technology, which helped “shed some light on things.”
She started the CDI program at Clark Memorial
Hospital with help from Atlanta-based J. A. Thomas &
Associates. There, she met Melinda Tully, MSN, CCDS,
CDIP, senior vice president of clinical services and education, who inspired Schad to look beyond the simple duties
of the CDI specialist to its importance in patient care.
“She was just such a great positive influence on me,”
Dee Schad, RN, BSN, CCDS, an ACDIS Advisory Board member and
founding leader of the Indiana ACDIS chapter, poses with award sponsor
Steven Robinson, MS, PA, RN, CDIP, CPUR, CDI senior director of Maxim
Health Information Services based in Columbia, Md.
says Schad of her mentor. “I saw the passion she had and
loved her encouragement and enthusiasm.”
Schad decided to carry that energy not only to her
coworkers but to other CDI professionals in the area. She
found and joined ACDIS, earned her CCDS credential, and
launched the Central Indiana ACDIS chapter.
“Ever since day one, I’ve believed in a local networking group,” Schad says. “In the beginning the facilities and
the professionals could be so territorial. But we needed
to become partners with one another, to learn from one
another, because we share the same physicians, we share the
same patient populations. I thought if all our CDI programs
network together—and learn from each other, even—we can
help each other out.”
Although her original aspirations may have been simply
to work as a loving mother to her children, Schad’s somewhat accidental career path gave her a much larger group of
individuals to foster and teach.
“I want to help grow this profession,” Schad says. “I
want physicians and facilities to see the positive effects of
this effort and to really understand the power of their documentation and the impact of accurate coding on patient care.
I believe in it.”
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July 2012
7
ICD-10 for CDI Boot Camp: ‘Put your nickel down’
With apologies to those who were unable to attend
the two-day ICD-10 for CDI Boot Camp premiere in
San Diego May 8 and 9, the following is a series of paraphrased quotes from inestimable educator Adelaide M. La
Rosa, RN, BSN, CCDS, director of the CDI program at
St. Francis Hospital-the Heart Center in Roslyn, N.Y. La
Rosa is an AHIMA-approved ICD-10-CM/PCS trainer
and ambassador who currently provides training in ICD-10CM/PCS to nearly 50 facility staff members and chairs St.
Francis’ ICD-10 steering committee.
La Rosa’s coworker Jean Marie Roth, RN, assistant
director of the St. Francis CDI program, helped keep La
Rosa on target as she shared tales from her own life. La Rosa
frequently turned to her counterpart, asking, “Do I have
time for one more story, Jean?” before launching into a tale
about an unfortunate health experience and subsequent documentation and coding requirement related to her ­mother ...
or her mother’s dog Joey.
Roth played the proverbial straight man to La Rosa’s
comedic embellishments of her experiences ensuring appropriate documentation, incorporating ICD-10 requirements for
additional specificity, and educating physicians. Enlivening
and enjoyable as the tales were, La Rosa and Roth provided
multiple pearls of wisdom for attendees to take away. No
doubt you’ll enjoy reading and sharing these tidbits, too.
(Remember, La Rosa is from Long Island, N.Y., so be sure to
imagine her talking in a sometimes-thick Long Island accent!)
»»“The books must speak to you,” La Rosa told the class,
encouraging them to make sure they have solid information
to support any assertion they make. CDI specialists and
­coders who query physicians need to know what the Official
Guidelines for Coding and Reporting for both ICD-9 and ICD-10
state. They need to know the “letter of the law,” La Rosa
says, and be able to point to the actual guidance in the text.
»»“The pen is more powerful than the scalpel.” La Rosa
uses this phrase with her surgeons to explain the value of
their documentation in the process of patient care.
»»“Put your nickel down!” is what La Rosa tells physicians
when they’ve documented a series of symptoms but have
neglected to indicate any possible, probable, or likely principal diagnosis. “At some point,” she says, “the physician
must place their bet and document their impression of
what principal diagnosis they are treating.”
»»“RAC them back!” said La Rosa, referring to Recovery
Auditors and other auditing organizations, which review
medical records and billing practices to look for ways to
deny a claim to save (and/or collect) money. CDI professionals can proactively ensure physicians completely
document the care provided to a particular patient during
a given stay. Furthermore, facilities need to constantly
review recovery audit targets, examining Program for
Evaluating Payment Patterns Electronic Reports and targeting CDI record reviews to the appropriate areas.
»»“It’s not about the DRG; it is about communication
of care.” La Rosa constantly reminded her Boot Camp
attendees that while tracking your CDI ­program’s return
on investment is a necessary part of program advancement
and advocacy, La Rosa says, you should also track how
CDI efforts affect the MS-DRG or All Payer Refined
(APR)-DRG assignment. As long as CDI specialists focus on capturing the entire clinical picture of the
patient’s episode of care, the improvements will follow—
and they will be both financial and quality related.
»»“We’re here to do it together,” said La Rosa regarding
the integrated nature of the documentation improvement
effort. Coders, case managers, nurses, and obviously physicians all play a role. “If your CDI program doesn’t meet
with these different professionals on a regular basis, start
doing so,” she said.
Adelaide La Rosa’s mother, Carmela Costagliola, with her dog Joey. La
Rosa lovingly used descriptions of her mother and pets as examples for
documentation specificity.
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July 2012
© 2012 HCPro, Inc.
Pre-conference Q&A: ‘The Physician Advisor’s Role in CDI’
Editor’s note: James S. Kennedy, MD, CCS, is an ACDIS Advisory
Board member and a director at FTI Healthcare in Brentwood, Tenn.
Kennedy co-presented the ACDIS pre-conference event, titled “The Physician
Advisor’s Role in CDI: A Collaborative Approach for Success,” which took
place Tuesday and Wednesday, May 8–9, from 8 a.m. to 4 p.m. This
Q&A was originally published on the ACDIS Blog.
Q: What role should CDI physician advisors play in
audit review and data analysis?
A: CDI physician advisors are critical to the entire process of ensuring the integrity of coded administrative data
(ICD-9-CM and CPT) and its application to physician and
hospital quality and cost efficiency measurement.
CDI is the process of preventing and reconciling inconsistent, incomplete, imprecise, conflicting, or illegible documentation to bridge the gap between treating physicians
and coders. Physician advisors must be able to analyze data
derived from these codes to target their efforts and should
review the results from documentation audits as to hone
their message.
Examples of these activities include:
»»Data analysis. ICD-9-CM coded administrative data
is primarily used to determine, measure, and report severity- and risk-adjusted outcomes and cost data for various
metrics. These include cost, length of stay, complications,
mortality, readmissions, and the like.
Risk and severity adjustment means that the actual
­metric being measured (observed) is compared to the likelihood of that metric occurring (expected). CDI ensures the
integrity of the expected metric, usually increasing it since
many clinical descriptions are incomplete or imprecise, thus
reducing the risk-adjusted metric.
Take, for example, the Colorado Hospital Report Card.
Note that Colorado reports an actual mortality rate and a
“risk-adjusted” mortality rate. There are instances when the
risk-adjusted mortality is less than the actual mortality since
the death rate is less than expected. There are others, however,
where the risk-adjusted mortality rate is higher than the actual.
Another aspect is measuring complications of care. Some
facilities code incidental serosal tears as “accidental lacerations.” Physician advisors would want to analyze Patient
Safety Indicator data at their hospitals (e.g., from ThomsonReuters, the Delta Group, and the like) to ­determine if the
data driving these metrics is accurate.
For example, look at the website “CareChex,” a division
of the Delta Group, to see how it ranks overall surgical care
in Chattanooga, Tenn.
Physician advisors should partner with their chief
quality officer to learn how these risk-adjustment
­methodologies work and how the definition, diagnosis,
documentation, and coding of these conditions ­factor
into them.
Armed with this information, the physician advisor can
help develop systems that work with providers to accurately
capture these metrics.
»»Chart audits. Physician advisors are integral to the chart
review, given that they recognize the clinical scenarios that are
often not documented completely and precisely. Imagine a
patient admitted with a pH of 7.02, a pCO2 of 100, a pO2
of 40, and stupor requiring mechanical ­ventilation but only
described as respiratory insufficiency with CO2 narcosis. This
patient has acute hypercapnic respiratory failure and could
potentially be labeled as ­having a metabolic encephalopathy. The physician advisor recognizes these scenarios and can
help concurrent reviewers and coders recognize the circumstances whereby query would be prudent.
AHIMA published a nice summary of the role of the
physician advisor, and you can read more in the January edition of CDI Journal.
Scott Entinger, James Kennedy, and Devon Santoro pose for a photo
onboard the cruise ship The Horatio Hornblower. The cruise was an
­after-hours activity sponsored by the CDI Search Group staffing firm.
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Q: How can a physician advisor help achieve buy-in
from the medical staff for CDI efforts?
A: One of the best ways I know to achieve buy-in from the
medical staff is to make CDI an academic exercise, emphasizing the definitions of clinical conditions. These can include:
»»Transient ischemic attack versus stroke. Note that the
24-hour time frame is completely eliminated.
»»Acute myocardial infarction vs. accelerated angina.
Note the critical role of properly calibrating troponins and
equating elevated levels with “symptoms of ischemia.”
»»Acute kidney injury. Note that it is only a rise of the
serum creatinine of only 0.3 mg/dl.
You can also ask the quality officers of your hospitals
to generate individual physician reports regarding their own
cost efficiency and outcomes, outlining the actual and the
expected outcomes. Should a physician see that his or her
expected mortality rates are higher than expected and that
CDI is a strong solution addressing the “expected” component, his or her participation and interest is likely to increase!
Q: How involved should the physician advisor be in
the day-to-day operations of the CDI program?
A: Given that most physician advisors have their own
private practices, they do not need to be involved with the
direct day-to-day operations of initiating queries. They
should, however, be available at designated times to support
concurrent reviewers and coders regarding the clinical circumstances assessments of clinical situations requiring query
and to aid in their construction.
If at times a physician does not respond, the physician
advisor may potentially have a collegial conversation about a
query. One must be cautious, however, to frame this conversation about defining a patient’s condition without putting
the physician on the defensive.
One of the fun things a physician advisor can do is support the development of the electronic medical record as to
make the capture of complete and precise documentation
less onerous to the practicing physician.
Q: What did you look forward to most about the
2012 ACDIS Conference?
A: ACDIS is everything a CDI professional, coder, or
physician advisor would want—clinical conversations, problem solving, medical informatics, and collegial interaction
with like-minded individuals working to solve the challenges
we all share.
It was be great to be with old friends and make new ones!
Not to mention that all this occurs in downtown San Diego,
in a phenomenal setting (a beautiful hotel), right next to
Balboa Park (let’s rent a bicycle and ride!), and close to Sea
World, the ocean, and all that makes southern California great!
I must say, however, that the most anticipated event for
me was the Physician Advisor pre-conference where Dr. Trey
La Charité and I spent two days training physicians from all
over the nation to understand and embrace CDI principles.
I feel that this contributes to the professional practice of
medicine and empowers physicians to successfully negotiate
healthcare reform. Needless to say, I was very excited about
the ­conference!
James Kennedy and Trey La Charité teach the two-day pre-conference session about the physician advisor’s role in CDI efforts.
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2012 Poster Session
Poster session exhibits describe program successes
If asked, could you describe your CDI challenges and
successes on a 36 x 48-inch poster? This year’s poster presenters in San Diego did just that. The posters are a visual
snapshot of program successes and offer you the opportunity to take tried-and-tested ideas back to your facility.
Along with their posters, each presenter provided a one-page
description of the poster and the program it showcased.
Posters were on display in the Manchester Grand Hyatt’s
Elizabeth Foyer, outside the main conference and exhibit halls.
This beautiful venue opened onto a veranda with views of the
San Diego Bay, and since it right along the main traffic area of
the conference, everyone was able to see the terrific work.
There were nearly 24 different presentations, including:
CDI program history and growth
»»Analyn Dolopo, University of California San Diego
Health, CDI Program Success
»»Lisa Romanello, CJW Medical Center, The GPS of CDI
»»AnnMarie Wells, CMC Main, CDI Growth in Evolving
Health Care Industry
»»Lynette Whitley, CMC Northeast, Program History
»»Margaret Scott, Baylor Health, Inpatient Documentation
Improvement Program
»»Valerie Bica, Nemours-Alfred Dupont Hospital for
Children, Pedi CDI, Not a Medicare Program
Educational/promotional lessons
»»Joi Freeman, Kindred Healthcare, Monthly Newsletter to
Clinical Staff
»»Cynthia Ziblis, St. Alphonsus RMC, CDI Newsletters and
Educational Flyers
»»Tim Weister, Mayo Clinic Rochester, CDI Education for
Providers and Medical Students
»»Diane Clement, Maine Medical Center, Advertise Your CDI Program
Multi-disciplinary enterprises
»»Donna McIvor, KP Northern California, Remote RNs in CDI
»»Wendy Platt, Baxter Regional Med Center, Using Your
Physician Champion to Captain Rough Seas
»»Ellen Mitchell, Lutheran Medical Center, Multi-Disciplinary
Effort to Improve Documentation
»»Kara Masucci, Morristown Memorial/Atlantic Health,
It Takes a Village to Reinvigorate the Program
Quality and mortality measures
»»Michelle Johnson, Quality Metrics
»»Alicia Gordon, Fletcher Allen, Mortality Scores and CDI Nurses
»»Pam Florence, U Kentucky HealthCare and UHC, What
Drives Mortality?
»»Dawn LaRoque, Riverside Health, CDI Impact on Mortality
Scores
»»Mary Shaughnessy, Northwestern Memorial, Mortality
Metrics Improvement
Additional efforts
»»Sylvia Hoffman, Hoffman Consulting, Avoid Leading Queries
»»Tara Kreiling, St. Mary Medical Center, Solve the
Documentation Puzzle
»»Susan Tiffany, Robert Packer Hospital/Guthrie, Regional
Network in Rural Community
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2012 Poster Session
Changes
continued from p. 13
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2012 acdis Education
Education recap
Avenues of learning expand CDI horizons
by Abby Steelhammer, MBA, MHA, RN
My brain has been on overload for
the past few weeks. The 2012 ACDIS
­Conference in San Diego not only
renewed my energy and passion for CDI;
it validated and ­supported many ideas
stirring in my head and offered so many
new ones that I have been trying to find a way to organize and
prioritize it all. Invigoration should equal application.
I come from a four-year-old program in a large hospital
system. While we have been very successful, it’s time to dust it
off, turn it up a notch, and push the limits of what we can do.
Quality focus
There were five tracks altogether this year, emphasizing everything from targeted clinical areas to ICD-10,
­compliance, CDI management, new initiatives, and quality
concerns. The biggest challenge I encountered each day was
making a decision on what to attend—the offerings were all
so relevant and timely to what we face each day. The keynote
speaker, Janet Lapp, was amazing. She sincerely motivated
and inspired us to “let it [the negative] go” and always move
forward to accept and take on change and process improvement with great intention, which is what CDI is all about.
In my organization, we maintain a very strong quality
focus and consistently look for opportunities to align our
efforts as much as possible to the overall goals and initiatives
set forth by our quality experts. One of the conference tracks
offered this year focused on CDI and the positive force we
can be in meeting an organization’s quality outcomes. While
the immediate reimbursement benefits of CDI can be very
impressive, the long-term quality gains are what sustain a program and connect us to the organizational mission and vision,
which is to always provide quality patient care.
During the conference, there was a presentation by Holly
Flynn, RN, CCRN, of the University of Washington Medical
Center. It was dedicated to CDI partnerships with medical staff
and HIM, and followed one medical center’s journey to unite
Conference attendees listen to a recap of compliance concerns related to physician queries.
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13
2012 acdis Education
with
the bigger picture to directly influence patient care. Flynn
Changes
was poisedfrom
and informative,
and I identified clearly with her
continued
p. 13
attempt to gain buy-in for CDI growth and initiatives by pushing an idea that ­embraces durable and sustainable goals by recognizing the possibilities and taking risks.
Then there was a presentation by researcher/sociologist
Gary David, PhD, who has devoted his time and livelihood
to studying CDI specialists as individual healthcare professionals in the workplace. As a CDI manager interested in
finding the right people for the role and committed to eliminating the many barriers we face in this ever-evolving discipline, I wanted to stand up and shout “Amen!” (Somehow,
however, I showed some restraint.) David is continuing his
research, and I cannot wait to hear more at successive conferences if given the chance.
Networking fun
The poster presentations this year were detailed and
innovative. Our CDI colleagues are doing great things,
making lasting contributions to our industry, and it shows.
I eagerly took home a copy of the handouts tied to each
presentation; as soon as I returned I scanned them and sent
them out to staff so they could help me see what opportunities we have and what lessons we can learn.
No conference commentary would be complete without
mentioning the awesome accommodations, scenery, and
people. The opportunity to casually converse and share
Networking with fellow CDI professionals is one of the perks of attending
the ACDIS Conference. Of course, the lovely weather and gorgeous views
of the San Diego harbor didn’t hurt either.
knowledge with CDI professionals from around the nation
was the highlight of my trip. If you took advantage of the
Thursday evening dinner cruise sponsored by CDI Search
Group, then you really got to enjoy the sights and sounds of
San Diego up close and personal. It was somewhat cold, at
least for this North Carolina native, but nobody cared—we
were having so much fun and enjoying fellowship, joined by
our common thread.
Networking is so important to be successful in this field.
When I entered the CDI profession four years ago after a good
many years already spent in healthcare, I was dumbfounded by
all there was to learn. I cautiously and ­incrementally climbed
to a plateau on a mountain of knowledge, only to realize that
the mountain would be insurmountable on my own. It is only
through dialogue and information exchange with colleagues that
I have even begun to skim the surface of this exciting realm of
healthcare and clinical expertise. If you have not attended the
ACDIS Conference in the past, I strongly urge you to make it
a priority. There is no better way to completely immerse yourself in CDI education than brainstorming with colleagues and
renewing your energy for the tough road ahead.
Editor’s note: Steelhammer is a CDI manager with Novant Health.
She is based in Charlotte, N.C., and was a member of the 2012
ACDIS Conference Committee. Contact her at absteelhammer@­
novanthealth.org.
Members of the California ACDIS chapter gather in the Top of the Hyatt”
restaurant atop the Manchester Grand Hyatt building for an event prior to
the start of the conference.
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July 2012
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2012 Vendors & Sponsors
With more than two dozen exhibitors featured at this year’s ACDIS Conference, attendees were able to meet with a variety of vendors
to discuss options and potential improvements at their facilities.
ACDIS Director Brian Murphy and Melinda Tully, MSN, CCDS, CDIP, vice
president of clinical services and education at J. A. Thomas & Associates,
share a laugh in the lobby of the Manchester Grand Hyatt in San Diego.
ACDIS participants enjoy the cruise sponsored by CDI Search Group.
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2012 Vendors & Sponsors
Changes
continued from p. 13
Deborah Hale and Susan Wallace of Administrative Consultant Services in
Shawnee, Okla., enjoy the San Diego sunshine.
ACDIS Advisory Board member Fran Jurcak, RN, MSN, CCDS, director of
CDI practice at Huron Healthcare, poses in the exhibit hall with her book
The CCDS Exam Study Guide.
MetaHealth representatives say a few words prior to the start of the local
chapter networking lunch, which they sponsored.
Members of the MedPartners CDI team get into the fun by dressing up as
characters from the San Diego–based movie Anchorman.
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2012 Networking Fun
Members of the North Carolina ACDIS Chapter gather for a photo opportunity during the networking lunch.
ACDIS Associate Director Melissa Varnavas bestows a CDI spirit award
on Fran Hudson for her purple and orange display of CDI pride.
At the registration booth, energized attendees fill out their early bird
registration forms for the 2013 conference in Nashville. If you look closely
you’ll notice their “Saints” shirts.
Conference speakers Jennifer Love and Janet Gentle, who spoke about
career advancement opportunities and how CDI managers can create ladders for professional growth within their facilities.
ACDIS participants get into the fun at the 5th annual event.
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2012 Networking Fun
Changes
2012 Conference Committee
continued from p. 13
Special thanks are due to the 2012 ACDIS Conference
Committee, whose duties include reviewing speaker applications,
interviewing potential speakers, reviewing nominations for CDI
Professional of the Year and Recognition of CDI Professional
Achievement awards, and helping with conference events
throughout the convention. This year’s committee included:
»» Christi Sarasin
»» Shelia Bullock
»» Judy Rochelle
»» Charrington Nicholl
»» Nita Seel
»» Eva Valles
»» Wendy DeVreugd
»» Abby Steelhammer
»» Susan McCoy
»» Michelle Limo
»» Sheri Blanchard
»» Ellen Chang
»» Kelly Sears
ACDIS Conference attendees really got into the spirit of documentation
improvement.
ACDIS attendees enjoy a gourmet buffet during the luncheon and awards banquet.
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July 2012
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