Note from the ACDIS Director: CDI creativity in lean times

by Brian Murphy

When times get tough—and boy, they have been a bear these last few months—CDI professionals have a wonderful way of rising to the occasion. Our recent impact of COVID-19 on CDI departments survey demonstrated the willingness of these professionals to engage in tasks far removed from record review, right up to and including returning to the front lines. CDI staff pitched in with administering personal protective equipment and other life-saving equipment and supplies (10% of respondents), served on call center lines (15%), and even returned to the bedside to provide direct patient care (16%).

In a time when many healthcare organizations are laying off staff, CDI professionals are doubling down on demonstrating their value and staying employed. Recently I got to witness this flexibility and creativity first hand, during our recent virtual event Staying Engaged: ACDIS Presents Virtual Education and Community. I had the fortune of interviewing three CDI leaders from various parts of the country and learned the additional measures they performed to deliver a return on investment (ROI) to their organizations. From that interview:

• Orlando Health suffered a loss of elective surgeries and a corresponding downturn in census, but Sheri Blanchard, RN, MSN, FNP-BC, CCDS, CCS, corporate director of clinical documentation excellence, branched out her staff’s reach by implementing all-payer review, reviewing charts on evenings and weekends, and taking split shifts. Staff reviewed pre-bill COVID-19 cases, post-payment findings, performed DRG validation, and assisted with medical necessity reviews to make sure admissions remained denial resistant. “Really all with the focus of squeezing as many things out of the medical record, as compliantly as we could,” Blanchard said. These activities have been so successful Blanchard is planning to continue them post-COVID-19.
• Minnesota-based Essentia Health experienced redeployments and layoffs after elective surgeries ceased in March, but Tracy Boldt, RN, BSN, CCDS, CCDS-O, CDIP, manager of CDI, rolled with the punches. Two CDI specialists were redeployed to assist with telehealth encounters, triaging calls to get patients scheduled with practitioners but also assisting with documentation to support the telehealth visit and associated medications that needed to be ordered. Boldt also put together a special report showing how many cases its reduced CDI staff touched in the course of a day along with total hours worked and sent it to hospital leadership on a weekly basis. The report eventually helped get its staff restored.
• McLaren Health Care (Grand Blanc, Michigan) saw considerable variation in patient census across its 10 hospitals, which are situated in a widespread geographic area the state. In general, patient volumes fell and furloughs and pay reductions followed. But CDI Corporate Director Susan Fantin, MSA, BSN, RN, CCDS, CDIP, shifted focus to pre-bill COVID-19 reviews (all encounters including inpatient and observation), and also implemented a rigorous mortality review process to make sure all patient deaths were properly documented for severity of illness/risk of mortality. Fantin and her team then presented the mortality data to hospital administrators, building such a successful case that they were able bring all staff back on board by the beginning of May.

The CDI profession has always been flexible. From the early pursuit of DRG optimization and CC/MCC capture, it has evolved and broadened its focus. Today CDI professionals work to improve quality measures, perform clinical validation, review outpatient encounters, and foster connections to care through deep provider engagement. For all its disruptions and tragedies, COVID-19 has been yet another chance for CDI professionals to show their grit and innovation. I’m pleased to say that this great profession has once again met the challenge by rising to the occasion in the midst of the pandemic.

Stay with ACDIS as we hear more inspiring stories from CDI leaders working hard to get back to the hospital and ramp back up reviewing heavier patient volumes and the return of elective surgeries. Register for our free online summit on July 23. I hope to see you there.

Editor’s note: Murphy is the director for ACDIS. Contact him at bmurphy@acdis.org