CDI Specialists Must Creatively Train Physicians for ICD-10
Clinical documentation improvement (CDI) goes far beyond the detail and specificity requirements of ICD-10, but HIM professionals who are scrambling to get their organizations in shape for the big switch on October 1, 2015 have just twelve months to instill adequate documentation habits in their physicians. While training seminars, online modules, and reference books are the tools of the trade for coders who want to be well-versed in the new terminology in order to keep their jobs, training a physician requires a different approach. At the 2014 AHIMA Convention on Tuesday, Vickie Monteith, RN, MBA, and Cheryl Golden, CPA, MHA, CHC, PCP-A, CHRC, both of Deloitte & Touche LLP, explained the importance of CDI to the ICD-10 transition and how to achieve an effective and thorough training program for clinicians.
A successful CDI program has to appeal to the more selfish side of human nature, Monteith and Golden said. Whether it’s convincing an executive board that hiring a CDI specialist will save money in the long run or appealing to a physicians’ competitive urges, framing clinical documentation improvement as a tool for achieving a desirable goal instead of piling it on top of more and more cumbersome mandates with little benefit, can make the difference.
“I can’t tell you how many providers want to hire a CDI specialist, and the CFO says, ‘show me the money,’” Golden said. “We want to show providers what the opportunity is. If you can move your case index mix a couple of points, that’s really significant for an organization. Having metrics that you can share will show that accurate documentation really does make a difference for reimbursement.”
“If you’re not doing any sort of CDI scorecard on your physicians, you should be,” Monteith added. “Make sure you give them the data and tell them where their peers are at least once a month. That’s how you’re going to win them over. They’re competitive. They want data. You’re not necessarily going to win them over from the payment standpoint, but it can be beneficial to use benchmarking so they understand where they are compared to the rest of their peers. Make sure you have that for them.”
Monteith suggests using real charts as examples when educating physicians so that they have a point of reference they clearly understand. Dividing education into smaller chunks can also ensure that nothing slips past a flagging attention span. If you can get a physician for 15, 30 minutes, you’re actually doing really well,” she said. “Prioritize what you’re working with.”
A comprehensive CDI program should include education for residents, as well. Monteith noted that some of her clients had designed tests for trainee physicians as they move through their different rotations, requiring a high passing grade in order for them to continue through their modules. “If we can build that into our resident programs, then the residents that become our attendings will be better equipped to pass on good habits themselves and produce quality documentation.”
While the one-year delay may have derailed certain ICD-10 projects, and many organizations have pushed back education in order to ensure that the knowledge is fresh in the minds of their clinical and coding staff members by the time 2015 rolls around, the time to ramp up those efforts once again is already upon us, the presenters reminded the audience.
“We’re sitting in a compressed time frame here,” Monteith warned. “We’re at October 1. If you haven’t started training, if you haven’t built your education for your residents or trained your physicians, you have a pretty small time line. Can you do it? Yes.”
But if you have documentation that’s not cutting it in ICD-9, and you’re translating that into ICD-10 and you’re sending that out to the payers, guess what? You’re getting data that might not be relevant when you get in ICD-10 properly. Instead, if you get people trained and have good documentation that works, you can code and send those out for testing. You’re going to get back a much more realistic picture. If you have started training, good for you. If you haven’t, you really need to be working to figure out when you’re going to start testing and how you’re going to work those claims.”
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