A Note from the Instructors: One size does not fit all

by Sharme Brodie, RN, CCDS

I recently had the privilege of working with some pretty impressive people in our Boot Camp course, who happen to work for some critical access hospitals (CAH). They’re learning what they can do to improve documentation in the medical record, demonstrate the good quality of care provided to their patients, to increase severity of illness and risk of mortality (SOI/ROM) while improving profiles for their facilities and physicians, and, of course, to improve reimbursement.

One of the biggest differences between a CAH and an acute care facility is how personnel perform their jobs—wearing numerous hats is very common at a CAH, and often necessary for the facility. So, as nice as it may be to have a dedicated person to perform the duties of a CDI specialist, it probably is not going to happen in the CAH setting.

Their job descriptions look very different than the standard CDI position, too. They often perform the role of a CDI specialist and the coding staff for the facility. Sometimes they perform utilization review, discharge planning, and CDI roles. They often serve as staff educator. They are now even being asked to do some form of review while they are in the chart. More often than not, they accomplish all tasks without the advantage of software—they use old fashioned excel spreadsheets and (shudder to think!) a DRG Expert.

Clearly, the phrase “while you are in the chart” takes on a whole new meaning for these folks. And yet, it’s a major concern I hear voiced frequently by CDI specialists who worry that their traditional record review roles will become diluted as they incorporate additional job responsibilities. They worry that they simply will not have the traditional benefits many departments show. They worry that they’ll not be taken seriously by leadership without that proven “return of investment.”

For many CAH, and other CDI programs just starting out, the best so many of these smaller facilities have to start out small. We need to make sure that there are clear policies and guidelines for when CDI specialists are performing more than one job responsibility at the same time. The only alternative is not to do the reviews at all, which could lead to the facility possibly missing out on some huge benefits of good documentation in our patient’s medical records.

They are paid very differently than most facilities, so just teaching them how to maximize a DRG or increase SOI/ROM isn’t going to help.

One of the many things that makes me proud to belong to an organization like ACDIS is the realization that not everything has to be done one way—we do have a voice to share information and ask questions of each other when we find ourselves in new territory. Not every CDI department is going to flourish using the same model as another facility. There are too many variables that we cannot always control, and we often have to change our plans. Some of the best advice I ever received was, “have a plan and don’t be surprised when it blows up.” Be creative, go back to basics start with smaller goals, and work your way up from there.

Editor’s note: Brodie is a CDI education specialist for HCPro in Middleton, Massachusetts. Contact
her at sbrodie@hcpro.com. For information regarding CDI Boot Camps offered by HCPro, visit www.hcprobootcamps.com.