CDI Week 2021 Q&A: Managing your kitchen staff (staffing, professional development)
As a preview of the eleventh annual Clinical Documentation Integrity Week, ACDIS conducted a series of interviews with CDI professionals on a variety of emerging industry topics. These Q&As will continue throughout CDI Week, September 13-17 as well. Lashondra Tate, MSN, RN, MEDSURG-BC, CCDS, clinical documentation educator at the Birmingham Department of Veterans Affairs Health Care Center in Birmingham, Alabama, answered these questions. For questions about the committee or the Q&A, contact ACDIS Editor Carolyn Riel (criel@acdis.org).
Q: Most 2021 CDI Week Industry Survey respondents (47%) said they entered CDI because they wanted to grow professionally, and CDI offered them a chance to do so. What was your initial reason for entering CDI? What career growth opportunities have you had or seen since being involved in CDI?
A: Before entering into the CDI profession, I worked as a medical-surgical nurse for years. I absolutely enjoyed patient care, however, just like the 47% of respondents, I wanted to grow professionally. In 2015, the facility I was working called CDI professionals “chart reviewers”. When I saw that name, it immediately sparked interest in me.
Since being in the role of a CDI professional, I have grown tremendously within my career. I am now involved in several quality review initiatives at my facility. I’m involved with the Mortality/Morbidity team, Strategic Analytics for Improvement and Learning (SAIL)/complication team, and the Patient Safety Indicators (PSI) team. My involvement with the various groups helps with the overall documentation of hospital acquired complications (HACs) and PSIs. Patient care staff understanding quality metrics are pivotal in the performance and accurate documentation of quality care. I have communicated with nursing professionals on the importance of their documentation as it relates to quality metrics. CDI professionals within the organization have grown since 2015, now playing a major role on the front end of all these measures.
Q: According to the survey, 19% of respondents entered CDI because they were involved with a different department and were asked to fill a CDI role. Additionally, 36% said their CDI department includes those with an HIM/coding background in their department. Do you feel it is important to have people involved in CDI with a non-traditional background, such as coding? What potential opportunities do you think might be missed if CDI programs staff the department with only one background type (i.e., physicians, floor nurses, or inpatient coders only)?
A: I believe it would be beneficial for a CDI program to have a mixture of different backgrounds. CDI professionals with a coding background can bring their professional knowledge of coding concepts and guidelines for ICD-10-CM, ICD-10-PCS, and CPT coding. They are professionally trained and certified in those fields and are fluent in coding guidelines and know exactly how the documentation must read to code it accurately.
If CDI programs are only staffed with professionals from one background, I believe they will miss out on opportunities to improve and assist the program. For example, if a CDI department only consist of inpatient coders, the department would miss out on the clinical skills that a nurse or physician would assist with, along with quality metrics with which a clinical professional may be familiar. This scenario can also go the other way. If the CDI department only consisted of nurses and physicians, the department could miss out on the most current coding guidelines and the key words that may need to be documented by the physician to get the most accurate codes assigned.
Q: Most respondents (34%) said they have zero to five CDI specialists on staff at their organization. How many CDI professionals do you have on staff at your facility? How about systemwide? Does this feel like an appropriate number of staff for your organization’s needs?
A: We have a total of seven CDI professionals, including the CDI supervisor. Our facility is a level 1A acute tertiary medical and surgical care center with nine community-based outpatient clinics. The CDI department reviews all inpatient records and we have one CDI specialist dedicated to the outpatient setting. It would absolutely be beneficial to have more staff, especially to assist with reviewing all of the outpatient clinics.
Q: Just under 20% of survey respondents said their CDI program does not offer any professional development opportunities. Does your department offer professional development opportunities? If so, what are they? Which types of professional development opportunities have you found most beneficial personally?
A: Yes, my facility supports the growth and development of their staff by offering several professional development opportunities. Just to name a couple, we offer employees stipends for earning certifications. We also offer tuition reimbursement and scholarships for employees who wish to further their education. I have been fortunate enough to take advantage of both of these fantastic opportunities. I received my CCDS in 2018 and I just received my MSN in informatics in May 2021.
Q: In your opinion, what risks do CDI programs face in not offering staff development opportunities? What advice would you give to an organization with limited resources seeking to provide some type of professional advancement or development opportunity to its staff? What advice would you give to CDI specialists seeking professional development opportunities in an organization that does not offer them?
A: In my opinion, CDI programs who don’t offer staff development opportunities are in jeopardy for losing staff. There may be staff who want to grow professionally and if their program doesn’t support that, it could potentially be a problem. Without staff, there will be no program. My advice to organizations with limited resources would be to encourage them to reach out to other organizations who do have staff development opportunities. By networking with others, they can ask the necessary questions and provide different facilities input to their organization’s leaders.
Q: The majority of respondents (60%) noted that their department hired new staff in the last 12 months. In your opinion, what might be contributing to this growth? Should CDI departments always be looking to increase their staff, or is there ever a point where staffing needs should be met? Did your organization hire new CDI staff in the last 12 months? How has that affected your department’s focus, productivity, and program structure?
A: It has been proven that CDI specialist have a positive effect on a facility’s case mix index (CMI), reimbursement, regulatory and reporting requirements, and reflection of the level of care being provide. Just like our facility, I believe most facilities are expanding their CDI programs. We are venturing into the outpatient arena and of course more staff is needed to meet those needs. Increasing staff is important, but only when necessary. Healthcare is continuously evolving and as CDI continues to grow, the need for the CDI staff will continue to grow. If a CDI department is fully staffed and are affluent, there is no need to continue to hire.
In the past 12 months, my facility has hired two CDI specialists. One of our CDI specialists pulled away from the inpatient setting to focus solely on the outpatient setting. With the inpatient setting down one CDI professional and only one in the outpatient setting, hiring more CDI specialists would be advantageous. There has not been a negative impact on productivity, however, with such a significant shift, the department’s focus and structure has changed.
Q: Is there a relationship between the rate of new hires and the “new normal” effects of the COVID-19 pandemic, in your opinion? Do you believe that the CDI industry fared better than some other healthcare related fields in terms of maintaining program integrity? What are your own hopes related to CDI growth post-pandemic?
A: I believe some CDI programs found that staff are able to work remotely and be as efficient working from home as they are when reporting to the facility. I do believe that the CDI industry fared better than some other healthcare related fields. Because of the COVID-19 pandemic, a lot of organizations halted elective surgeries. This led to a decrease in the inpatient CDI reviews; however, telehealth increased drastically because it allowed patients to visit providers without the exposure. This increased the need for outpatient CDI. Our facility expanded to outpatient during this pandemic. I hope that post-pandemic CDI programs will continue to flourish to ensure patients’ records adequately represent the care provided.