Meet a member: Florida chapter president reflects on CDI experience
In the past 15 years at Sarasota Memorial Health Care System in Florida, there were two unsuccessful attempts to implement a CDI program. So when Joannie Crotts, RN, BSN, CPC, took on the project back in 2011, shortly after accepting her first CDI position, she had her hands full. Nearly four years later, the program still stands.
“As they say, the third time’s the charm!” says Crotts, who also served as president of the Florida ACDIS chapter in 2015.
When she’s not immersed in CDI, Crotts enjoys spending time with her family and friends, the great outdoors, and Friday pizza nights. Crotts has two children, a daughter and a son, but now she and her husband are “empty-nesters.” Crotts’ daughter graduated college this past spring and lives close by; her son lives in Nashville.
“I now appreciate the time we get to spend together more,” she says. “I am so thankful for my family.”
CDI Journal: How long have you been in the CDI field?
Crotts: I started out in CDI a little more than four years ago. Our team has grown since our inception in 2011 from four to 10 CDI specialists. I believe this is largely due to the dedicated staff who perform the CDI function, administrative support, and a well-rounded CDI team where each member brings with them unique talents and clinical expertise.
CDI Journal: What did you do before entering CDI?
Crotts: I worked as a revenue integrity analyst prior to my transition to CDI. My duties and responsibilities focused more on the outpatient side of healthcare; on current procedural terminology codes, ambulatory payment classifications, modifiers, and Recovery Audit Contractor denials. I had limited exposure to the inpatient side. I was interested in learning more about what drives a DRG, and the nuances of the inpatient perspective payment system, and my CDI experience has helped me achieve that goal.
CDI Journal: Why did you get into this line of work?
Crotts: My favorite subject in college was calculus. I love numbers, and solving problems, and puzzles. I was searching for a job where I could use both my clinical skills from my nursing background and my analytic skills. CDI and revenue integrity is a good fit for me.
CDI Journal: What has been your biggest challenge?
Crotts: I think the biggest challenge for most CDI teams is physician engagement. We constantly seek ways to engage our physicians. We have seen an increased interest in clinical documentation integrity from physicians, due to quality reporting requirements and the availability of the quality data on sites like Healthgrades, Hospital Compare, and Physician Compare. Physicians often say “but my patients are sicker” [than what the data shows]. We challenge them to show us that in their documentation.
CDI Journal: What has been your biggest reward?
Crotts: We collaborated with our clinical nutrition department to initiate a multidisciplinary approach to identify and diagnose malnutrition using best-practice, evidence-based criteria approved by our medical executive committee. One of our goals was early identification and intervention for patients with malnutrition. It has been rewarding for the CDI team to know our efforts with this initiative have a direct effect on our patients. An added bonus was the positive working relationships we established with our registered dietitian team.
CDI Journal: How has the field changed since you began working in CDI?
Crotts: CDI is not just about capturing CCs and MCCs anymore. It’s about ensuring the documentation paints an accurate picture of the patient and accurately reflects the patient’s severity of illness and risk of mortality. Our quality scores are driven by physician documentation. Like most programs, our focus is shifting to align with the ever-changing healthcare environment. This year, we decided to change our title from clinical documentation improvement to clinical documentation integrity to support our mission of accurate reflection of the patient’s story in the medical record documentation.
CDI Journal: Can you mention a few of the “gold nuggets” of information you’ve received from colleagues on “CDI Talk” or through ACDIS?
Crotts: Over four years ago, we explored the ACDIS website for information on CDI job descriptions and policies and procedures as we initiated our new program. As our program has matured, we have used ACDIS resources like “CDI Talk” and the Forms & Tools Library to keep up to date on CDI news and developments. Most recently, one of our CDI team members used the resources available through ACDIS to research clinical validation queries and found articles and sample queries to assist her.
CDI Journal: What advice would you offer a new CDI specialist?
Crotts: The CDI profession is growing and evolving. Due to healthcare changes such as new quality initiatives and the ICD-10 transition, the role of the CDI specialist is expanding. This is an exciting time to be involved in clinical documentation improvement. The opportunities are endless.
CDI Journal: If you could have any other job, what would it be?
Crotts: I enjoy my job, so this is a hard question for me. I think I would like to work as a preschool teacher. I love kids and watching them discover new things. They are little sponges, full of energy and life.
CDI Journal: What was your first job (what you did while in high school)?
Crotts: My first job was at Morrow’s Nut House at the mall when I was 16 years old. I hated telling people where I worked—the nut house! We sold candy and nuts, and I was required to wear a hair net.
CDI Journal: Tell us about a few of your favorite things:
- Vacation spots: Bar Harbor, Maine, and Napa Valley, California.
- Hobby: Reading, biking, hiking—anything outdoors.
- Non-alcoholic beverage: Diet Coke.
- Foods: Pizza! Friday night is pizza night in our household.
- Activity: Enjoying time with family and friends.
Editor’s note: CDI Journal introduces an ACDIS member in each issue. If you would like to be featured or would like to nominate someone who would, please email ACDIS Editor Katherine (Katy) Rushlau at krushlau@acdis.org.