2022 CDI Week bonus Q&A: Staff engagement in the remote setting

As part of the twelfth annual Clinical Documentation Integrity Week, ACDIS conducted a series of interviews with CDI professionals on a variety of industry topics. Alyce Reavis, RN, MSN, CCDS, CDI auditing coordinator at Evangelical Community Hospital in Lewisburg, Pennsylvania, answered these questions. She is a member of the Central Pennsylvania ACDIS chapter and the 2022 ACDIS Furthering Education Committee. She was a recipient of the 2021 ACDIS CDI Scholarship. For questions about the committee or the Q&A, contact ACDIS Associate Editor Jess Fluegel (jfluegel@acdis.org).

Q: According to the survey results, only 13.43% of respondents were 100% remote prior to the pandemic, but during the pandemic the percentage jumped to 77.68%. Currently, 61.90% are still 100% remote and another 32.15% said they have a hybrid program of some sort, leaving less than 6% as fully on-site. Are you still remote? If a CDI program wants to move to remote work, what do they need to consider?  

A: Our CDI team is currently hybrid but will likely become entirely remote. CDI work can be successful remote. It’s very important, however, to designate communication methods between providers and CDI. We have morning rounds via Teams^® and use a secure texting platform. Additionally, management should be available to communicate regularly with the team to help stave off any issues.

Q: More than 33% of respondents said their staff engagement has actually increased since moving to a remote structure, and nearly 52% said their engagement has remained the same. For the roughly 15% who said their engagement decreased, what methods or activities do you suggest to help increase staff engagement?

A: We have regular CDI team meetings biweekly via Teams, which helps to provide education and departmental updates. There is always a designated time for the team to bring up and discuss anything they like as well. We also occasionally meet in person, often at like a park pavilion and have pizza to touch base and maintain a personal connection.

Q: Most 2022 CDI Week Industry Survey respondents (44.72%) said they entered CDI because they wanted to grow professionally and CDI offered them a chance to do so. What was your initial reason for entering CDI? What career growth opportunities have you had or seen since being involved in CDI?

A: I more or less fell into CDI by luck. Prior to entering CDI, I had been a care coordinator for seven outpatient providers. When I relocated, I found a position at Evangelical and was very intrigued by the job description. I have never looked back. CDI has become an important part of Evangelical where we are a small community hospital. I was moved to an auditor position, which is a new program, and we are now working on a proposal for an additional full-time equivalent for CDI Auditor. I was also supported with the opportunity to present at the ACDIS national convention in 2022.

Q: We know from previous surveys that there’s a high number of organizations currently hiring for CDI roles, yet nearly 70% of respondents to the CDI Week Industry Survey said they don’t anticipate seeking out a new position at a different organization. Has your department recently hired staff?

A: We have not recently hired staff but will soon be involved in this process. I think that CDI is not always well understood for someone who is looking for a change, particularly moving from a patient-facing role. I think that actively communicating with folks looking for a new opportunity about how patient care and outcomes are affected by CDI work will make this favorable. I also feel that shadowing with a CDI professional will help show what the role involves.

Q: Is there a relationship between the rate of new hires and the “new normal” effects of the COVID-19 pandemic, in your opinion? (In other words, with the country returning to normal, have CDI programs returned to normal, too?) Do you believe that the CDI industry fared better than some other healthcare-related fields in terms of maintaining program integrity (i.e., keeping staff employed and growing during the pandemic)? What are your own hopes related to CDI growth post-pandemic?

A: I do feel like CDI fared well overall in the pandemic. When scheduled surgeries were cancelled at our facility, CDI became critical to help maintain financial stability, quality metrics, and medical necessity for the admissions that came through the ED. We maintained all our FTEs and added an auditing coordinator. I hope that hospitals and health systems will continue to expand their CDI forces and explore the multitude of ways that CDI staff can help in keeping operations going and hospital doors open for the communities they serve.

Q: The number one reported reason respondents said they would consider leaving their current role was management failure (91.27%), followed by lack of raises/low compensation (90.45%). When it comes to leaving the profession, the most impactful reason was burnout generally (52.19%), followed by required overtime (51.43%). What do you think these concerns say about the state of CDI? How can leaders protect against these risks?

A: I think leaders need to advocate and constantly communicate and demonstrate the benefits of CDI to senior administration. There are many options for those with CDI experience to assume other roles with payers or auditing companies. These companies offer CDI staff what they feel they can’t refuse compared to what a small hospital can offer. Managing CDI staff with trust and professionalism in addition to advocating for the great work they do can help with retention.

Q: The top staff engagement method was to offer regular virtual team meetings (84.60%), followed by instant messaging throughout the day (74.05%) and flexible schedules (62.32%). How do your department leaders engage their staff members? What methods have you found to be the most effective?

A: I have found it effective and beneficial to have regularly scheduled CDI team meetings. Our team also reaches out via Teams with questions or with a call to discuss a case freely during the workday. We do allow a flexible start and stop time (start 7:30–8:30 a.m. and stop 4:30–5:30 p.m.). We also allow “flexing” of hours for personal appointments to avoid using PTO. We do have one rotating CDI staff work on Sunday who is then given Friday off the next week.

Q: In your opinion, what risks do CDI programs face in not offering staff development opportunities? What advice would you give to an organization with limited resources seeking to provide some type of professional advancement or development opportunity to its staff? What advice would you give to CDI specialists seeking professional development opportunities in an organization that does not offer them?

A: Staff development and education is an important part of a CDI program as our profession is a world of constant change. I try to be proactive in creating educational material for each of our team meetings and encourage team members to share and teach about interesting cases. We also meet regularly with our coding team to discuss trends and cases. We do reimburse our CDI team for ACDIS membership and for CCDS certification as well. This is not a large cost and allows them to keep themselves up to date on their down time.