Meet a Member: Participating on certification board one of her biggest rewards

Dorene B. Watson, MSN RN, CCDS, CDIP, ACHE, is the CDI director at Carolina Pines Regional Medical Center. She has served as a past-treasurer for the South Carolina ACDIS Chapter (2018-2019) and is a member of the CCDS Exam Committee. Previously, a neonatal nurse, she joined the CDI profession more than 13 years ago.

ACDIS: How did you come to the CDI field?
Watson: I tore both Achilles tendons while walking on a treadmill and needed a desk job because I was in and out of a “boot” for three years.

ACDIS: What was your biggest challenge in making the transition from neonatal patient care to CDI?
Watson:  Initially the challenge was to stop thinking like a nurse and start thinking like a coder/auditor. As a nurse we are trained to think clinically and interpret what is being said/meant by the physician’s documentation. I had to really focus on what was documented and follow the CDI/coding adage “if it is not documented then it is not done.” The change from the ICD-9-CM to ICD-10-CM/PCS code set in 2014 was also a big challenge due to the sheer number of new codes, codes being bundled together, eliminated, or changed, changes in CCs and MCCs. And of course, PCS-10 brought new characters and wording such as extirpation, too, that we needed to learn.

ACDIS: What was been your biggest reward?
Watson: Being accepted to volunteer on ACDIS’ Certified Clinical Documentation Specialist (CCDS) credential exam committee. For me, it means the respect of my peers. There were a lot of great applicants who volunteered for the committee and I was honored and humbled to have been chosen to serve.

ACDIS:How has the field changed since you began working in CDI?
Watson: Initially, the focus of most CDI efforts was on capturing diagnoses in the documentation which would lead to additional CC/MCCs on a medical record. Now, the focus changed to severity of illness and risk of mortality as well as a continued attention to MS-DRGs, quality of care delivered, quality of documentation provided, and prevention of denials and near misses for patients.

In the beginning, the focus was between you (CDI) and the physician. Now the CDI incorporates educating physicians and nurses on documentation. As a CDI director, I now assist physicians, nurses, quality and risk, revenue cycle team, and HIM/coders. I write denial appeal letters, review PEPPER (Program for Evaluating Payment Patterns Electronic Report) data for outliers and present this information at utilization meetings, hospitalist meetings, and surgical meetings. Physicians use to be able to write a diagnosis and it was accepted as “gold.” Now the physicians need to meet certain criteria in their documentation and document supporting evidence for the diagnosis. Their opinion is no longer accepted as “gold.” This is very difficult for physicians to understand and I’m not sure their schooling has changed to support this way of thought yet.

ACDIS: Can you mention a few of the “gold nuggets” of information you’ve received from colleagues on The Forum or through ACDIS?
Watson: There are so many to choose from. For example, I’ve been able to attend two ACDIS conferences. At one event in San Antonio, a speaker explained that CDI is not for the weak. It is time consuming, mental, and exasperating. Sometimes, it feels like we bang our heads into brick walls daily and come back for more the next day. They explained that we need to rejoice in the small accomplishments and felt like that was exactly what I felt and was able to take that home with me.

ACDIS: What piece of advice would you offer to a new CDI specialist?
Watson: Stop looking at a chart like a documenter and start looking at the chart as an auditor. Is all the information there? Are all the gaps bridged? Take a deep breath! You are doing a great job! Refocus, present education that is short and quick to the physicians. They are too busy to read long education materials. Take care of yourself. Don’t add extra pressure or feel like a failure. Each day brings new challenges. Forget yesterday, move forward. Keep a positive attitude and have a good sense of humor, because let’s face it, sometimes we read some pretty funny things written in the charts.

ACDIS: If you could have any other job, what would it be?
Watson: I really would like to be an ACDIS trainer/educator and help other CDI staff learn the trade or work in a corporate setting training CDI and helping them where they need it. Although, some days, I wish I worked on the denial end with insurance companies. I think I could deny everything and sit back and wait for the rebuttal/appeal letter from the organization to come back in. Just kidding.

ACDIS: What was your first job (what you did while in high school)?
Watson: My first job was at Wendy’s. I was horrible at remembering what people ordered on their sandwiches. We didn’t have electronic screens back then. You had to remember what the customer(s) said. One customer, I was okay with that, but a family comes in and and everyone places a different order and I would forget them all. Then I left and went to work in a Chinese restaurant washing dishes by hand. After a summer of that, I decided I was going to school. I received my bachelor’s degree in elementary education and then later went back for nursing and I’ve been moving forward ever since.

ACDIS: Can you tell us about a few of your favorite things?

• Vacation spots: Idaho (is gorgeous), mountains, and the beach.
• Hobbies: Sewing, painting pictures, making knit hats for our homeless veterans and cancer patients.
• Non-alcoholic beverage: Unsweet tea or water.
• Foods: Italian and Mexican.
• Activity: Bowling.

ACDIS: Tell us about your family and how you like to spend your time away from CDI:
Watson: I am divorced and have two children—a 19-year-old son who is attending Full Sail University and a 17-year-old daughter who is a terrific golfer! She is working on getting noticed for scholarships for college. We have two dogs and a cat. I am getting married this year (2020) to my high school sweetheart! It only took us 40 years of wondering in the dessert to find each other again.