2025 CDI Week Q&A throwback: Provider & staff engagement
As part of the fifteenth annual Clinical Documentation Integrity Week, which took place last week (September 15-19, 2025), ACDIS conducted a series of interviews with CDI professionals on a variety of emerging industry topics. Debbie Breton, BSN, RN, CCDS, a CDI educator at Providence Health & Services – Oregon Region, and Patricia King-Musser, DNP, RN, CCDS, the senior director of CDI at Geisinger Health System in Pennsylvania, answered these questions. Both are members of the ACDIS Furthering Education Committee, and Breton is a member of the Florida ACDIS chapter. For questions about the committee or the Q&A, contact ACDIS Editor Jess Fluegel (jess.fluegel@hcpro.com).
Q: According to the 2025 CDI Week Industry Survey results, 32.19% of respondents reported that their medical staff is “very” engaged in CDI, meaning they understand the importance of CDI and actively participate in documentation integrity efforts. Another 57.12% reported they are “somewhat” engaged, meaning they understand CDI concepts but inconsistently put them into practice or do so incorrectly. What is the engagement like at your organization, and what advice do you have to help CDI professionals move the needle from having “somewhat” to “very” engaged medical staff?
Breton: At Providence, our CDI leadership collaborates closely with our physician advisor to keep documentation front and center. Education happens in real time, often sparked by identified issues, and we use targeted tip sheets to address specific needs. Over time, this approach has helped providers better understand CDI concepts.
To boost engagement from “somewhat” to “very” engaged, my advice is to make CDI education ongoing, specific, and timely. Providing quick, targeted feedback and demonstrating the “why” behind documentation changes helps providers see CDI as a partner in patient care rather than just another task.
King-Musser: The medical staff engagement at the Geisinger organization is very strong. This is primarily attributed to longevity and face time. Geisinger residents who stayed on as attending physicians “grew up” with our CDI team and their support, and because the CDI team is actively involved in rounds, the providers know who we are and we have established a mutual respect. Rounds are a platform for dual transfer of knowledge and information to occur real time. This real-time sharing of the why, the how, and the impact supports the provider’s need for relevance to patient care and quality outcomes.
But as with anything, it is not that simple. The CDI specialist has a responsibility in engagement to demonstrate knowledge, preparation, and availability. Even the best CDI specialist cannot navigate an obstinate or curmudgeon personality alone, however. To support the frontline effort, we have structured tiers of responsibility and accountability within the divisions and service lines.
Reality has yet to meet an ideal state, but the established structure includes the site-specific chief medical officers (CMO) and each service line lead, who own accountability for the attendings under their direction. The facilitating catalysts for engagement are our physician advisors and results reporting. Program results and opportunities are shared at various executive and site-specific meetings that include the aforementioned leaders, correlating impact to quality, reimbursement, safety, compliance, etc. Our physician advisors are also CMOs, so they support through direct communication with physician groups at all levels and in platforms in which I do not participate. Of course, new providers entering the system may be unfamiliar with Geisinger’s model and “Rules of Engagement,” so ongoing attention and adjustment to our strategy is required.
Q: When asked how frequently they conduct physician education sessions, almost 36% of respondents reported that they do so monthly, an increase from last year (30.05%), while 21.15% said they do so “as needed,” a drop from last year (26.86%). Together, those results indicate more organizations are settling into a rhythm. How often does your CDI program conduct such sessions, and what advice do you have to make the most of these educational opportunities? What advice would you give CDI professionals on how to educate outside of formal sessions as well?
Breton: While we typically provide education as needed, it’s recently become more frequent—closer to monthly—due to our focus on query response timeliness and clinical validation. Our physician advisor plays a key role, engaging in regular, in-person conversations with attendings and specialists. Outside of formal sessions, I find that informal touchpoints (e.g., quick huddles, one-on-one chats, and concise tip sheets) are just as impactful. These brief interactions reinforce key concepts without overwhelming providers.
King-Musser: Formal physician education is an area of desired enhancement. In our current state, we meet with all new hospitalists across the system to introduce them to CDI, sharing the “why,” the “how,” and the relevance as a provider to patient care. We have a monthly audience with the hospitalist service line to review common documentation pain points, the resolution, and the impact using real case examples. The specialty services are harder to establish a cadence for, but annual interaction and quarterly education occur. We rely heavily on our advisors and the front-line team for their in-the-moment education, which helps keep up engagement. To grow and improve, however, we need to increase the support and enhance structured opportunities.
If resources are limited, I suggest the utilization of everyone! I have engaged with the Geisinger School of Medicine to introduce the concept of CDI and the importance of documentation, and made connections with other ancillary services such as anesthesia, clinical nutrition, respiratory therapy, wound care, and nursing to educate and review opportunities to support the capture of conditions and mitigate denials. At present this occurs on an ad-hoc basis, but would be even more beneficial as scheduled routine meetings. Engagement with ancillary services who comprehend the power of their documentation has created unofficial champions for overall documentation improvement. They give valuable support through the alignment of diagnostic criteria, template standardization, points of capture, smart phrases, and other electronic health record automation. They also educate and act as the CDI voice in meetings that I do not have awareness of or capacity to attend.
Q: According to the survey results, 71.22% of respondents have a full-time or part-time physician advisor, a notable increase from about 61% in 2024. The percentage of respondents with a physician champion also increased from 36.7% in 2024 to 44.37% in 2025. Of respondents with a physician advisor or champion, 63.33% reported sharing them with another department, a small increase from 2024 as well (59.19%). Does your CDI program have a physician advisor or champion, and if so, in what capacity do they assist your CDI efforts? What benefits and/or challenges have you noticed in working with (or without) one?
Breton: Our dedicated physician advisor has been instrumental in improving provider response rates. As part of our escalation policy, they step in for real-time interventions, especially with less responsive providers. The peer-to-peer nature of these conversations adds credibility and often leads to immediate improvement.
King-Musser: Geisinger is comprised of 10 hospital campuses. The CDI program has two part-time physician advisors who collectively account for a 0.5 FTE. There is an obvious mismatch in coverage need and time allocation. They both have multiple obligations from frontline patient care to CMO responsibilities. Still, the benefits we realize from our advisors are numerous and it’s difficult to document them all. They support the program through educating providers and connecting the results of the daily CDI work with the organization’s goals. They act as liaisons between providers, CDI, coding, quality, and utilization review. We also meet three times a week to review escalations and discuss next steps and strategies. All this for only 0.25 FTE each? Yes! But we all realize we are only touching on the basics of our capabilities and desires for the program.
A potential advantage of not having an advisor is that no one is better than the wrong one. In the past, we worked with an advisor whose perspective and motivations were misaligned with CDI. The result was detrimental, and it took a lot of energy to build what was lost after their departure. Prior to an advisor, we developed close and direct contact with each service line through an identified champion. Although this was nice in theory, the champions were often “voluntold” and had little knowledge of the CDI concept. It was a cursory relationship and saw little benefit from the mandatory query response enforcement they put on their peers. With no CDI advocate for the providers from one of their own, responses were a struggle; service line education only happened with forced entry into a meeting and had to be done in five minutes or less. I am very thankful for our current advisors and the attention and support they provide.
Q: When asked how they measure the effectiveness of their CDI provider education program, the most common measurement selected was improvement in CDI metrics (79.59%), followed by feedback from providers (53.45%) and reduction in documentation errors (35.39%). How does your organization measure its CDI provider education? What advice do you have to help CDI programs track their success in this area?
Breton: We track CDI metrics such as provider response rates, which we aim for a 98% rate or higher. When we notice gaps—especially in “no response” queries—our physician advisor addresses them directly. Monitoring these trends over time helps us see where education is working and where we need to adjust.
King-Musser: Measurement is important to demonstrate value and impact. It is hard to directly correlate CDI effort into results, as we are one step in a complex process and many common measures are influenced by factors outside of CDI work. Still, we try to capture impact by utilization of both broad and focused metrics. I recommend having short- and long-term measures so you can demonstrate movement in the right direction and ensure more complex, long-term improvement. I suggest avoiding focus on case mix index, as the association to CDI improvement and education alone is very loose.
We utilize similar measures to those listed above, but as we are still working on a formal consistent education rollout, the measurements may vary depending on request from the audience. Our scheduled annual education is structured and based on service line opportunity research. In those situations, we demonstrate the broad impact of optimized documentation. We review the change in severity of illness/rate of mortality and increase in relative weight which adds to a longer length of stay attribution. Although it is hard to capture a monthly total of “days added to provide care,” we will review this metric in individual case discussions.
A meaningful measure that many providers understand is the O: E ratio, which we commonly use to monitor the impact of education and improvement in results. We are working to connect CDI efforts to Vizient quality measures. We compare cohort capture of certain variables and review common metrics that impact multiple patient populations or DRGs. We include this information in both CDI staff and provider education. These are more compelling to providers than direct focus on reimbursement capture, though we do monitor the latter in the background.
Many of the quality metrics have delayed results, so we have to wait a significant amount of time to see impact. In order to supplement and have more concurrent measures, we also look for aspects that can be measured concurrently with education rollout. One example is a decrease in the rate of common queries and/or documentation errors. It’s a quick check, but should be monitored long-term to ensure sustainability.
Though standard measures are important, allowing benchmarking and comparison, do not be afraid to be creative. When we receive outreach, for instance, we often customize the information and education based on the request of the service line leader to align with and support their internal initiatives.
Q: Do you provide formal education to your providers, and if so, how (e.g., one-on-one, group presentations by service line, informal coaching, tip sheets, newsletters, etc.)? How is education content decided (e.g., based on hospital standards, individual provider needs, etc.)? How have your provider education/engagement models changed over the last few years?
Breton: Our education strategy is tailored and flexible. We use tip sheets, one-on-one coaching, service line group sessions, and direct feedback from our physician advisor. Topics are selected based on documentation gaps, coding updates, or trends from quality reviews. Over time, our model has become more individualized and responsive, with a strong focus on just-in-time education.
King-Musser: I am a big proponent of education and will take advantage of any moment to learn and share information. We provide education in any way and at any time possible, including all of the methods I’ve mentioned above. The content is modified based on the audience and the need, but the information is consistent.
We provide formalized education to service lines and the executive leaders in scheduled meetings, and this education has a stronger focus on the hospital standards and goals, whereas informal education is geared toward the provider’s needs. Our CDI staff do specific one-on-one education with their providers when rounding and use this opportunity to provide tip sheets for new attending physicians and residents. Similarly, the advisors frequently coach the providers when navigating escalated or outstanding queries, along with some specific diagnosis education. Group presentations are the middle ground between formal and one-on-one education and are a good platform for non-Geisinger providers or a team of onboarding attendings. It is also ideal for working sessions or when a discussion is desired.
We also have an internal CDI department newsletter that supports the education and knowledge of the CDI team. The expectation is that team members internalize the information and apply it with their provider groups through enhanced queries or in-the-moment education.
Q: Almost 83% of respondents either agreed or strongly agreed with the statement “I feel valued and respected by my manager,” and nearly 79% agreed or strongly agreed that “I have received sufficient materials/training to perform my job well.” How important is CDI staff engagement, in your opinion, to the success of a CDI program, and why? What advice do you have for CDI leaders to better engage their staff, and/or for CDI staff to advocate for a better work environment?
Breton: Engaged CDI staff are essential—they’re the frontline experts ensuring documentation accuracy. We involve them in identifying educational needs, whether it’s new technology, coding changes, or complex clinical topics like hepatorenal syndrome. I also conduct regular quality reviews and provide follow-up education based on team-wide trends.
King-Musser: The high results are encouraging. Respect is interesting, as it must be given and earned to be received, and engagement needs constant attention. In the hierarchy of organizations, if someone at one level does not feel valued or respected, it can impact their interactions with and perception of others and their actions. Navigating this can be challenging for a CDI leader, as they work with many characters through their organizational obligations. Managers should have an established tolerance but also need to have cues that identify when to take a pause and separate the outside troubles from the internal team needs. Taking care of yourself will ensure capacity to care for others. Even the airline industry touts this message: “Put on your oxygen mask first before you help others.”
It is paramount to individual and departmental success to always treat others the way you wish to be treated. This demonstrates respect and also establishes acceptable behaviors. Respect and engagement are dependent on each other and are critical factors to foster a highly functioning and engaged CDI team.
Engagement is also enhanced by having a sense of ownership and value. To promote ownership, allow opportunities for staff input and feedback on work processes and implement suggestions when you’re able. Do not offer opportunities in non-negotiable situations, however, as it only leads to frustration. Be honest and clear on what is mandatory and what is negotiable. Results and data are powerful tools to promote change, so always share the rationale and supporting information when making a proposal. Talk through it and respectfully come to an agreement. Sounds easy right? We are all human, of course, and passion is a strong catalyst. But if you use enthusiasm respectfully and for the right reasons, it can create a better environment for all.
Q: Almost 26% of respondents either disagreed or strongly disagreed with the statement “My CDI team is adequately staffed for the workload we have,” though this was a small decrease from the last time the question was asked in 2023 (30.33%). Have you noticed a trend of CDI programs taking on more staff in recent years? In your experience, what types of issues can arise from a staffing shortage, and how can CDI professionals and/or leaders realistically address them?
Breton: Despite rising patient volumes, our CDI staffing has remained steady. To manage this, we prioritize high-impact reviews and rely on software tools to help us focus on cases with the greatest CDI opportunity. It’s about making the most of the resources we have.
King-Musser: My definition of a staffing shortage is not having enough staff to perform the current work. But programs may also not have enough staff specifically for their expanding scope. If the program is foundational and the scope is focused on CDI reviews and MCC/CC capture only, that requires a different staffing model than a comprehensive program that includes quality, appeals, and education. I see most programs growing toward the comprehensive model, but not simultaneously being afforded the staff to accomplish these additional responsibilities. It is usually a “do it” and “prove it” before investment in staff is approved. In these scenarios, something is sacrificed and it’s either coverage or the quality of work, and a decline in performance can translate to increased scrutiny and decreased trust in the program.
To address the need, information and data is beneficial. Research other programs, models, staffing, and scopes of work. Compare your program to the program you are working toward and identify the differences and needs. Demonstrate the results of the program historically, currently, as well as the projected benefit. Identify the right number of staff needed that will still provide a reasonable net value for the organization before you propose and request the positions.
Of course, that is the easy piece. How do you solicit staff in a profession that is experiencing a shortage? Promoting the positives of the CDI work life can be a great marketing tool. We currently have an RN model, so we emphasize the Monday to Friday work week with no mandatory holidays or call time, which can be very enticing. Investing in onboarding staff new to CDI is expensive and extensive, but it is one method. The other option is to recruit from other programs. Knowledge of what CDI staff look for in an organization and the CDI program they work for can help you adjust your program and make it a more desirable place to work—more desirable than your competitors!
There are always numerous contract companies soliciting their availability and willingness to support staffing needs as well. This can be a reasonable temporary bridge, but expensive if utilized long-term.
Q: When asked how their organization offers assistance for staff looking to earn CEUs for professional development, the most common way was by offering access to a platform with CEU-approved education (55.07%), followed by educational opportunities provided by the organization (43.61%). About 20% of respondents said they receive no assistance or financial support at all. What benefits are there for an organization that provides assistance in earning CEUs vs. an organization that provides none? What advice do you have for CDI professionals struggling to find educational opportunities?
Breton: We’re fortunate to have CEU-approved education built into our CDI platform, supporting both nursing licensure and CCDS recertification. I also send out weekly “Free Friday Education” emails with CEU opportunities from vendors, ACDIS, and other professional resources. For those without employer support, I recommend tapping into free webinars, podcasts, journals, and staying active in CDI networks—there’s a wealth of accessible education out there.
King-Musser: It can be expensive to obtain or maintain licenses and certifications with many hours invested to acquire the necessary CEUs. Staff appreciate organizations that provide CEU opportunities, especially at no cost, and it can be a deciding factor in which organization is chosen for employment. Providing opportunities is a small investment for an organization that yields a high return, attracting new staff, knowledgeable employees, innovative care, and satisfied current staff, to name a few.
Not all organizations can or choose to offer CEU opportunities. For those looking elsewhere, it can be a challenge to find credible sources. My suggestions are to reach out to professional organizations such as the American Nurses Association or ACDIS. Reach out and join your local ACDIS chapter, as this is another good source of information, learning, and free CEUs.
Many CDI programs have consulting groups or vendors that provide programs to support CDI work. These sources often offer professional or industry-wide training that translates to CEUs. Tap into your partner departments such as coding or quality and join any of the CEU opportunities they participate in or have available. This not only increases your knowledge but broadens your perspective while awarding CEUs. The last alternative is to search for internet resources. There are known names or companies that work with or support the CDI industry. They often offer free learning opportunities to introduce their brand or entice new customers. Always ensure the source is legitimate and relevant. Once you find these sources, save them for easy retrieval when needed.
If your organization does not offer CEUs, consider reaching out to leadership and make the request. Better yet, get a group together to show the need and the demand. It is possible that no one asked, or they were not aware of how broad the need is. They may say no, but they may say yes!