Guest Post: After the consultants leave...what now?

by Lynne Spryszak, RN, CCDS, CPC

Hey, you CDS with new programs out there! How’s it going? Are you sailing along on the smooth seas of phenomenal MCC capture rates or are you stalled in the doldrums? Are you asking yourself the following question: “What do I do now that the consultants are gone?

Been there. Done that …twice, in fact! Are you finding that the people at your hospital who decided that a CDI program was a good idea are now saying things like “the CMI doesn’t seem much different” or “where’s the money they promised us”?

Don’t feel bad. You didn’t do anything wrong. You’re just feeling the pangs of aftermath: the training and support is over and now you’re alone and administration doesn’t even know what you do, exactly.

First, who do you report to? Someone who actually knows from a hole in the ground, or someone who wouldn’t know an MCC if it bit them? This isn’t a silly question. If the person making the decisions doesn’t know what you’re REALLY there for, it’s going to be hard to succeed and grow your program. So, invite this person to come to your team meetings and be sure to share your successes and tell him/her how much more you can do with their active support.

Consultants are expensive (and we all know that), the organization has already spent lots of money on training and start-up costs, and salaries aren’t going down. BUT… these costs aren’t going up nearly as fast as Medicare’s reimbursement rate is going down! It’s in everyone’s best interests to have the best-trained, most prepared CDIS at your facility. And that takes continuous learning and growth.

Second, in order to stay on top of the latest developments and have advance notice of what may lie ahead it’s important to subscribe to newsletters, newsgroups and industry publications. Several resources are available through HCPro but there are also resources that are free to individual subscribers.

I found that it was important to find whatever free resources I could since our department budget was in an iron lung once we’d paid the consulting fees. I felt fully prepared when I started but as the next October loomed closer and closer I had no idea where I was going to get my new information, or how I’d identify the new opportunities.

One of the first things I did was to register for free notices at the CMS website. I receive several weekly e-mails and updates from CMS. This is how you get the first news of changes and rulings regarding the IPPS (inpatient prospective payment system).

If you need POA information go here. You’ll get direct links to the web page so you can download bulletins and lists.

You can subscribe to Advance for Health Information Professionals, another free subscription. For example, the June 30th issue contains a very well-written Letter to the Editor regarding AHIMA’s recent decision to revise the physician query practice brief. This magazine is written for HIM professionals so it’s chock-full of useful information. The current cover story talks about Physician Liaisons, something no CDI program can afford to be without.

Are you a member of one of the professional organizations that are related to what we do? The AAPC (American Academy of Professional Coders) provides support and information to coding professionals and much of this information is helpful to CDIS. Here you can subscribe to EdgeBlast, a free online newsletter that you can receive via e-mail or blog (RSS) feed-reader. This type of newsletter is great for discovering tips that will help you in your job.

The AHIMA Web site has many free resources as well under the “HIM Resources” tab.

Third, what is your team doing to make sure that communication between the coding staff and CDIS staff (coders/nurses) is clear and timely? If you haven’t already developed a written-down version of your processes, don’t waste another minute!

One of the biggest issues our team had was poor communication patterns. People would say “Oh, I didn’t know we had to do that every time” or “Why do we need to call you when the DRG is different? We’ve already dropped the bill”.

Or, one coder would communicate with the CDIS when they had a question, and another would just confer with a coding colleague, leaving the CDIS entirely out of the loop. Two-way communication keeps everyone in the loop, promotes learning (especially for the CDIS) and decreases the amount of contentious behavior: “But I’m the coder.” “But I’m the one who spoke to the doctor”. You know how it goes.

Every CDI team needs a step-by-step flowchart of who does what when. We escalate our open post-discharge queries to the next administrative level based on how much money is involved. For example, if the DRG difference is less than $500, the coder completes the record and no phone call is needed.

If an open query was answered and an affirmative reply would result in more than $500 than after an unsuccessful phone or fax attempt to obtain a response, we refer the case to our Physician Advisor (PA) who personally contacts the MD in question. Have you ever noticed how much more effectively a physician can get through the phone/office red tape when he’s making the call? He’s usually put right through to the other physician with no waiting. Then it’s usually “Hi Bob, it’s Ted. We have a question here. Blah, blah, blah. You will? Great.” It never fails.

One of the many benefits of our Physician Advisor is that our coders know that he’s always willing to discuss a case by phone or come in the next day to review a record. In our part of the country the professional going rate is about $150.00/hour for physicians in this role. When you consider that one query may result in additional revenue of $5000 (or more), if your PA is working 20 hours/month he’s already recouped his salary and more. And that’s for only ONE query. Bring this information to your administration if you haven’t already.

Even when questions don’t result in additional revenue, a PA’s availability will reduce your turnaround time for the complex cases. Often a query isn’t needed, just clinical interpretation. Our PA is very effective in this role.

Last, how many other hospitals are in your area? Take some time to develop a network of CDIS in your area. Our regional group meets quarterly and we take turns hosting the event. Our first meeting drew about 35 people and the next one, planned for next week, expects even greater attendance.

This is the place where you can network with others, discuss burning issues, exchange query forms, information and success stories. Why spend all that time and effort working on an issue when someone else can give you the down-and-dirty? I foresee this group hosting our own local conferences – and why not? With a little effort we can be our own consultants!

Editor's note: Spryszak, at the time of this article's release, was an independent HIM consultant based in Roselle, IL. Her areas of expertise include clinical documentation and coding compliance, quality improvement, physician education, leadership and program development.