Journal excerpt: Modifying CDI practices during COVID-19
While healthcare workers are busy dealing with the influx of COVID-19 patients, some CDI teams have been asked to modify their review and physician engagement practices to take any additional administrative burden off clinicians’ backs.
“I received a joint directive from our chief quality medical officer and associate chief quality medical officer, who is also our chief CDI physician advisor, to temporarily suspend query activity. This includes sending queries to providers, sending escalation communication on pending queries, and cancelling scheduled education meetings with providers in order to free up their time to focus on critical preparation and current patient care,” says Michelle Knuckles, RHIT, manager of inpatient coding and CDI at Utah Health in Salt Lake City. “In addition, as this crisis evolves, I’m told we may need to switch to short-form notes, which are part of crisis standards of care. This will change documentation as we know it now.”
While some organizations like OhioHealth in Columbus have altered some of their provider escalation practices during COVID-19 preparation and response to allow physicians to focus on patient care, others have requested their CDI teams lean into their record reviews and querying practices to shore up the organization’s bottom line. As non-emergency services were cancelled, high-weighted DRG cases also began evaporating, and some organizations have leaned on CDI to help ensure the hospital doors stay open during the crisis.
According to research published by Strata Decision Technology in late March, many hospitals face closure or extensive layoffs because of the decreased revenue associated with primarily caring for COVID-19 patients. While CDI professionals can’t change the patient mix coming into their organizations, they can ensure that those patient records are complete and accurate to receive the correct reimbursement, says Carrie Willmer, RN, CCDS, CDIP, CDI director at SCL Health in Denver, Colorado.
“We’ve actually been asked to ‘lean in’ on our query efforts from both a financial and acuity perspective,” she says. “Our care sites are looking for help to support the COVID response, but also to sustain support of resources to protect and care for our non-COVID patients. We have been encouraged to work remotely but encouraged to maintain our productivity to ensure we are set up to support coding to get accurate documentation to support accurate billing.”
The important thing, according to Robin Jones, RN, BSN, MHA/Ed, CCDS, division director of CDI at AdventHealth in Tampa, Florida, is to listen to the needs of your organization and adapt as they evolve. As with any sort of emergency scenario, things change quickly; communicate with your other department leaders—even if you’re remote—and offer help where you can.
“Our CDI program is business as usual. Our organization considers CDI essential staffing and part of the healthcare team. We have daily calls updating all department leaders about the virus,” she says.
“We have not been asked to suspend any specific CDI activities; however, as leaders, we are adjusting expectations of review/non-review activities,” agrees Mary Stroble, MSN, RN, director of CDI at BJC HealthCare in St. Louis, Missouri. “We will also continue to monitor capacity and evaluate daily, and even more frequently, as information evolves.”