Q&A: Filling a CDI lead position
Q: Is the terminology, “A bachelor’s degree in nursing or a related field,” sufficient to allow application by foreign-trained physician candidates?
Dawn Valdez, RN, LNC, CDIP, CCDS: If you add “or a related field,” that should be adequate, but I recommend that you run the specific verbiage by your human resources (HR) team to see if they agree or have other suggestions. The verbiage of “or a related field” leaves it open to discretion, which is what you want if you are considering a foreign-trained physician as a candidate.
Kim Conner, BSN, CCDS, CCDS-O: A CDI lead position should require at least three to five years of experience in the CDI industry (chart reviews, query compliance, working with coding, understanding coding guidance and staying current, as well as CDI/provider education). A CDI lead position is an individual that understands the nuance of CDI work. That comes with practice and experience in the field.
If physicians are applying for a position like this, they should have the same CDI experience as other applicants. Just because they have an MD after their name doesn't mean they have the necessary experience to lead a CDI team.
Laurie Prescott, MSN, RN, CCDS, CCDS-O, CDIP, CRC: With foreign-trained medical graduates, one important consideration is their experience within the United States (related to reimbursement methodologies, quality reporting, etc.). Many do not have the knowledge related to these concepts to successfully lead in CDI work. Have they ever worked in a hospital in the United States? Do they understand standard practice, communication patterns, treatment protocols, etc.? Did they ever work as a physician? What was their specialty or patient population focus? How many years did they practice? What types of leadership positions have they held?
Any applicant should be evaluated for their ability to audit, review, and communicate with staff and physicians. Other skills to require, depending upon the job description, would be the ability to create, deliver, and provide professional presentations, the ability to gather and interpret data, and the ability to work with technology. Look at your job description and then think of the skills required for the position. That should determine who you hire, not the specific credentials.
Sharme Brodie, RN, CCDS, CCDS-O: I really appreciate all the recommendations everyone has offered and agree with their points of view. I will add that when you’re hiring a candidate whose credentials suggest they have clinical experience, make sure they have actual experience caring for patients at the bedside. Having a degree, regardless of what it is in, does not substitute for this type of training. Unfortunately, most of the time we hire based on credentials assuming that the experience is there, but sometimes this is not the case.
Q: How would you suggest addressing licensing requirements?
Valdez: I recommend checking with your compliance and/or HR department. They will know the bylaws in your state and can give you more insight if a provider chooses to seek employment in CDI, as they will not be acting as treating providers. However, there may be some caveats that the leadership team should be aware of.
Conner: While level of education is important, it has been my experience that experience in the field trumps how many letters are after your name. I do think the applicants should be CCDS or CDIP certified, however, as that shows someone who has expertise and is vested in their profession.
Prescott: I agree with the previous comments but would like to add that an individual coming from an HIM background may be suitable as well if they demonstrate they have worked in the field and are credentialed. I would also remind anyone requiring credentials that the CCDS requires at least two years of work in the CDI field, but the CDIP does not. An individual can sit for the CDIP without ever having worked as a CDI specialist.
Q: Are there any additional minimum qualifications (outside of CDI experience and credentialing) you would recommend?
Prescott: Here are some other considerations: does the individual’s personality fit your departmental culture? Will they be a positive addition to your staff and departmental interactions? Do they communicate respectfully? Are they open to lead and mentor? Are they a team player? What are their long-term goals (i.e., are they worth your investment)?
Valdez: Talk to your HR department and see if a pre-knowledge entrance test is acceptable in your state for those you are considering as candidates. If HR agrees, then I would develop a test to determine their clinical knowledge base and other areas that are important to your organization. Using a pre-entrance test that all candidates must take is a great way to separate out those that are a good fit.
If a test is not advisable by your HR department and they don’t have pre-determined questions that are used in your organization’s interview process, then I would design interview questions to be open-ended so the candidate can tell you what they know about various subjects that are important to your CDI department. For example, what would you look for in the documentation that demonstrates a patient is in acute congestive heart failure? Then let them fill in what they know. I would design questions around the problem diagnoses such as sepsis, respiratory failure, encephalopathy, malnutrition, acute kidney injury, complex pneumonia, patient safety indicators, hospital-acquired conditions, etc.
Another aspect to consider is the working DRG component. How familiar with the coding process are they? What other duties have they performed in the CDI industry? Open-ended interview questions can draw out someone’s knowledge base when questions are prepared in that manner.
Then there are the most important job duties of a CDI lead position. As stated above, clinical knowledge is of the upmost importance, but are they detail-oriented? Ongoing CDI audits are essential for the continual growth of the team, so a lead position should be able to excel at detailed-oriented tasks to uncover the issues. The audits are only as good as the auditor, so you may want to consider that if your new hire will be expected to perform that task.
If training is within the scope of duties, I would have a question or two designed so the candidate teaches you about a subject matter that you would expect a lead to teach often, whether it is to CDI specialists or providers. How do they relate personally with people? Can they communicate effectively to guide the CDI staff? If a candidate passes the initial interview, you could also set up another interview for a CDI specialist on your team to interview the candidate, if you feel comfortable doing that.
Another suggestion is to consider asking the candidate if they would be willing to shadow a manager or another CDI lead for a day. That way, you can draw out questions that the candidate may have. If you have a physician advisor, they may be a good person to shadow with as well, as there may be conversations MD to MD that wouldn’t otherwise occur. Of course, I would run this by the HR team if you haven’t done anything like that before.
Editor’s note: Laurie Prescott, MSN, RN, CCDS, CCDS-O, CDIP, CRC, is the interim director and CDI education director, and Sharme Brodie, RN, CCDS, CCDS-O, Kim Conner, BSN, CCDS, CCDS-O, and Dawn Valdez, RN, LNC, CDIP, CCDS, are all CDI education specialists for ACDIS, which is based in Middleton, Massachusetts. Contact them at firstname.lastname@example.org, email@example.com, firstname.lastname@example.org, and email@example.com.