ACDIS update: CDI industry changes over 15 years of ACDIS, according to members
ACDIS is about to turn 15 on October 1, 2022, and we’re all feeling a bit nostalgic. Hindsight brings a lot of things into perspective, including just how far the CDI profession has come since the association’s beginnings. For years, we have been asking members about their experiences in the CDI field, including how each person has seen it evolve.
In our time-honored tradition of interviewing CDI professionals for “Meet a Member” articles (email ACDIS Editor Jess Fluegel if you’d like to be featured!), we’ve regularly asked how working in CDI has changed over the years. Though the answers have varied, they are certainly unanimous on one truth: the CDI profession has seen considerable development and expansion over the years, and that’s unlikely to change anytime soon.
Here are a few notable member answers we’ve received over the years to the following question: “How has the field changed since you began working in CDI?”:
2017: “When I started, there was a limited CDI involvement with focus on chart reviews, simply capturing CC/MCC diagnoses and querying physicians. The CDI specialist scope of practice has now expanded—serving as a more in-depth physician CDI education resource. There is also increasing coordination between the CDI, HIM, Case Management, and Quality departments to support compliance and hospital quality improvement initiatives.”—Alma Yap, RN, BSN, CCDS, CDIP
2019: “We went from a seven-day a week schedule, printing a daily hospital census sheet to search for our patient population (Medicare only) to review, and standing with our laptops at the counter at the nurses’ station (because there was no room to sit) to hunt for and review each hard copy record. We would type up a worksheet and queries for each patient that we printed and placed on the chart, all while watching for those specific physicians to provide documentation pearls and discuss queries as they passed through trying to avoid us. We had to forge a new relationship with coders while reconciling every record. All the while, there was a feeling of isolation; we didn’t have any contact with peers out there, except from our consultant firm—a group of suits that trained us, audited us, and provided feedback comparing us to those “peers” somewhere out there, which always seemed competitive and punitive.
“Now, we have a Monday through Friday schedule. We’re remote three days a week to review completely electronic records, and we’re on campus one or two days per week (provided we maintain our productivity statistics). There are still a few difficulties with level loading patient assignments, but we have increased our reviews to almost all payers. We have a daily CDI huddle, with those who are remote Skyping in. On-campus days involve a trip to our assigned nursing units to post education on our CDI board and check in with the medical staff who are on the floors for interdisciplinary team rounds. We notify the hospitalist by secure text to give them a heads up when we have sent them an electronic query. Coders send any DRG mismatches to our queue for our input before billing. Query reconciliation is much easier, although there is still room for improvement—assigning the correct physician response and impact can still be tricky. We now have many CCDS holders on our team and we make time to be a part of the ACDIS community. We can now compare ourselves and relate to our peers out there. We are not alone!”—Bettina Sonen, RN, CCDS
2020: “At first CDI was more about working collaboratively with physicians to capture appropriate diagnoses in the chart for additional reimbursement for the resources consumed to care for the patient. Now as a CDI specialist, we work collaboratively with the physicians to have a positive impact on the quality of their documentation and care management of the patients.” —Trish Endress, RN, BSN, CCDS
2021: “In 2015, the CDI program and roles were less understood by the acute care teams. We had plenty of room for increased physician engagement. The sense at that time was that CDI would probably ‘go away’ and many physicians listened politely while considering the program temporary. Fast forward to 2020 and we are highly connected and part of the treatment team. Collaboration through video chat is the norm. There has been a significant shift into more data analysis and better education design and content planning. Education foundations like learner motivation and increased learning transfer are rising to the top to make every interaction count. Careful planning is important and having an educator and/or education focused program is essential to success. One example of this is reduced turnover. Since 2016, we have added seven full-time employees with 100% retention. I believe that speaks directly to the thoughtful education support, roles, and training as planned by our program director.”—Elisa Sninchak, M.Ed, BSN, RN, CCDS, CDIP, CCS
2022: “The biggest change I’ve seen is that physicians have now begun to understand the value of CDI. Now, I even see practicing physicians also working as CDI specialists!”—Rabia Jalal, MBBS, MSHIM, CCS, CDIP, CCDS, RHIA
Over the coming month, the ACDIS team would love to hear from you about how you’ve seen the CDI world change! Shoot us an email and make sure to stay tuned all month to hear about what we have planned for to celebrate ACDIS’ birthday!
Want to hear more reflections on the state of CDI? Check out the September 28, 2022, episode of the ACDIS Podcast which featured an overview of the fiscal year 2023 Inpatient Prospective Payment System final rule changes (which take effect on October 1) and a discussion with one of ACDIS’ first board members about the changes in the industry!