Radio Recap: Tips to engage the chief medical officer

Catholic Health Services of Long Island (CHS) started its CDI program at St. Francis Hospital in Roslyn, New York, back in 2006. For anyone who’s met the dynamic director who started the program back then, it may come as little surprise that Adelaide La Rosa, RN, BSN, CCDS, since expanded the from program from two full time positions to more than two dozen, from one hospital to six, and has expanded the CDI focus to include all payers, as well as risk of mortality, severity of illness, and medical necessity reviews.

That kind of growth requires support from the system chief medical officer (CMO), La Rosa says, something she set out to earn in the early days of her program’s inception.

“One of the most important things to do when you’re starting a program is get the physicians to see the ripple effect of their documentation, to help them understand how that documentation helps us charge for their services, and the long-term financial viability for our facilities, for the care physicians are providing,” she says.

She not only convinced her CMO but eventually shifted the program to report to system CMO. Each facility has its own CMO who meet with the CDI staff monthly. Part of the CMO’s role is to support the CDI staff and act as a champion for the team, addressing any recalcitrant physicians, and helping CDI specialists with any difficult cases. They also help the team think strategically about how to advance CDI efforts to meet the changing needs of the healthcare system in the light of healthcare reform and other initiatives.

While many CDI programs shy away from frank discussions regarding their financial effect on their facilities, La Rosa embraced the idea.

“If the facility is successful, the physician is successful,” she says. “If we understand the population of care that we are providing, we can make the argument that we need a specific procedure, staff, or equipment. So if the physicians come looking for a new type of equipment that money will be there,” as long as the documentation supports the codes and procedures billed.

Like many CDI programs La Rosa’s early successes stemmed from CC/MCC capture rates, improvement in the facility’s case mix index, and MS-DRG accuracy. Successes which earned her support from the chief financial officer (CFO) who supported her suggestion to move the CDI team under the CMO.

“The [CFO] is looking at the overall finance of the institution. Engage him or her to help you and show how you can help them in return,” she says. “Use metrics to prove that documentation improvement and cooperation leads to an improvement in overall reporting.”

Although La Rosa’s often the first to point to her CDI program’s return on investment for Catholic Health System, her real passion stems from the positive effect physician documentation has on patient care and outcomes reporting. It’s one of the reasons she earned ACDIS’ Recognition of CDI Professional Achievement Award in 2010.

“Adelaide anticipates the needs of her fellow colleagues and the medical staff,” said Jack Soterakis, MD, FACP, FACG, Vice President Medical Affairs, Medical Director at St. Francis Hospital in La Rosa’s nomination form at the time. “She is constantly developing innovative methods to increase provider engagement.”

“CDI plays a big role in pulling all the pieces together to tell the patient’s story,” La Rosa says. “To me, you have to keep the patient at the center of everything you do. That’s what this is all about. The rest will follow.”

Editor’s Note: La Rosa was featured on the March 4, 2015, ACDIS Radio program. ACDIS Radio is a by-monthly web-based discussion with industry experts, featuring stories from practicing clinical documentation improvement specialists working in the field. For more information, visit www.acdis.org/radio.cfm.