Symposium Speaker Highlight: Prescott searches for Waldo
Editor’s note: As we did with the 10th annual ACDIS conference in May, we’ll take some time leading up to the first ever ACDIS Symposium: Outpatient CDI to meet a few of the speakers. The event takes place September 18-19 at the Hilton Oak Brook Resort & Conference Center in Oak Brook, Illinois. Today, we talked with Laurie L. Prescott, MSN, RN, CCDS, CDIP, CRC, who will be presenting “Risk Adjustment: Where’s Waldo? Common Diagnoses Often Missed in Outpatient Documentation,” on Day 1 of the event. Prescott is the CDI education director with ACDIS and HCPro. She serves as a full-time instructor for the CDI Boot Camps as well as a subject matter expert for ACDIS.
Q: You always have such interesting and fun presentations—the Family Feud coding versus clinical language session earlier this year at ACDIS and the boxing-themed session the year before. How did you come up with the idea for “Where’s Waldo”-type presentation?
A: The outpatient setting offers a much more condensed patient encounter. There’s little time to focus on improving the documentation and capturing those vague or missing diagnoses that will influence risk adjustment. Often, very significant diagnoses are missed—just like Waldo. His striped hat may be right in front of you, but you don’t see him.
Q: What are some of the overlapping areas/diagnoses of documentation concern between inpatient and outpatient efforts?
A: This is a great question. As I increase my knowledge related to the areas of risk adjustment and quality measures, the same diagnoses continue to appear. For example, the diagnosis of malnutrition is traditionally a focus for inpatient CDIs as it offers a CC or MCC, depending upon severity. It also affects risk adjustment within the CMS Hierarchical Condition Category (HCC) methodology, and its presence as a secondary diagnosis can impact CMS quality measures. In my Boot Camps, I teach that if we strive to obtain the most specific diagnoses possible and work to obtain all reportable diagnoses, we will succeed no matter the setting in which we work or the mission we’re handed.
Q: It seems like different CDI programs define outpatient documentation improvement differently—how would you define it?
A: I tend to over simplify: outpatient documentation improvement is any effort to obtain improved documentation in any healthcare setting that is not inpatient. Depending upon that setting, the goal of this improved documentation could be aimed at any number of areas to include: risk adjustment, professional billing, medical necessity of care, severity of illness, quality measures, etc., etc.
Q: What do you think is the most important thing to focus on for those looking to expand into outpatient CDI?
A: The first and most important question to ask is why? Why are we considering expansion—what do you wish to gain? If you are not sure, then perhaps you need to take time to inventory the problems and locate the area where you can provide the largest impact. Start there and perhaps then you can expand as you are able. This requires education related to reimbursement issues, code sets, quality monitors, denials, etc. Each organization will have different needs. You need to seek out the priorities within your own organization and identify the area(s) or focus you have the ability to impact.
Q: What’s your favorite thing to do when you’re in the Chicago area?
A: I’ve never been to downtown Chicago—you tell me!