Meet a Member: Leveraging nursing, case management, and insurance experience for the good of CDI

December Douglas, RN, CCDS, is a clinical documentation integrity specialist at Memorial Hermann Hospital, Texas Medical Center, in Houston, Texas.

ACDIS Blog: How long have you been in the CDI field?
Douglas: I’ve been in CDI for 14 years now.

ACDIS Blog: What did you do before entering CDI?
Douglas: My nursing career started in 1992 at St. Luke's Hospital in Houston. I was chosen to be a part of the new nurse graduate resident program. This program allowed me to experience the different areas of nursing throughout the hospital; it was a great experience. After completing the program, I worked in medicine and later got accepted into their operating room program.

After I left St. Luke’s Hospital, I worked in home healthcare for many years, which I enjoyed tremendously. I enjoyed working with wounds and learning how to provide wound care to some very large wounds and to see where the wound started and how it healed. It was very fulfilling for the patient and myself.

My next career challenge was working for a Medicaid insurance company as a case manager. This gave me insight on how insurance companies use grids according to the diagnosis to approve treatment. That job also gave me the opportunity to advocate for patients that I’d never met.

Then, in 2000, I became a part of the world renowned Memorial Hermann Trauma Center in the case management department. My experience working for an insurance company helped me to know exactly what the insurance company wanted to know and hear concerning the patient’s progress in order to get approval for continued hospital stay.

The biggest reward I can remember was having a patient in the hospital who I’d encountered during my time at the insurance company and she remembered me. I remembered her and she was grateful to have me as her case manager again. That let me know that I had done a great job in assisting in her care. As a nurse, I have to do my best job for my patients at all times, no matter what company or position I hold.

In 2004, I transitioned from case management to the CDI program.

ACDIS Blog: Why did you get into this line of work?
Douglas: One of my closest friends whom I worked and shared an office with in case management transferred to CDI and she looked very happy. She explained the job of CDI and, because she knew me well and it just happened to be an opening, she encouraged me to apply. The rest is history.

ACDIS Blog: What has been your biggest challenge?
Douglas: My biggest challenge has been getting the surgeons that I work with to be compliant to answer queries.

ACDIS Blog: What has been your biggest reward?
Douglas: My biggest reward is, after many years of working with surgeons, the majority of them have finally realized that answering queries is a win-win for them and the hospital.

ACDIS Blog: How has the field changed since you began working in CDI?
Douglas: When I started CDI, there were only comorbid or complicating conditions (CC), now there are CCs and major CCs (MCC) and Medicaid APR grouper. Additionally, there’s more of a focus on quality and severity of illness/risk of mortality reviews.

ACDIS Blog: Can you mention a few of the "gold nuggets" of information you've received from colleagues on the Forum or through ACDIS?
Douglas: Don’t get discouraged, remember that, if you are a nurse, you have clinical skills, and even though you have just switched positions, the RN knowledge is the same. Take advantage of webinars, articles, and don’t be afraid to talk to your doctors, nurse practitioners (NP), physician assistants (PA), and coders for education. And, most of all, make Google your friend.

ACDIS Blog: If you have attended, how many ACDIS conferences have you been to? What are your favorite memories?
Douglas: I have attended three conferences. My favorite memory was getting to meet the staff of ACDIS, seeing how the conference has grown from when I first attended in 2009 and when my name was called for winning a prize.

ACDIS Blog: What piece of advice would you offer to a new CDI specialist?
Douglas: Learn your AHA Coding Clinic, use your CDI Pocket Guide. And, don’t be afraid to ask your coworkers questions and for help.

ACDIS Blog: If you could have any other job, what would it be?
Douglas: A wedding planner. I would love to work with couples in making their special day become all that they have dreamed and envisioned it would be. From the smallest to the largest budget, it can happen.

ACDIS Blog: What was your first job?
Douglas: I was in health occupation as a senior in high school and, to get my additional credit and earn my grade, I worked four hours at a medical clinic.

I had the opportunity to have hands on experience in various roles with supervision of the staff, including experience with medical assistance, lab technician, X-ray technician, EKGs, ultrasounds, and assisting the physician with various procedures. Working there helped me to know that nursing was the correct career path for me. I learned a lot working there. I was able to continue working there during the summer after graduation.

ACDIS Blog: Tell us about your family and how you like to spend your time away from CDI.
Douglas: I love my family dearly. I have four sisters and two brothers, along with sister and brother-in-laws, nieces, a great niece, nephews, and great nephews. When we all get together, we have a blast. We go for birthday gatherings, sisters’ shopping getaways, going to each other house to relax, eat, and have fun. Our biggest times together are Thanksgiving and Christmas. I love having alone time to read magazines on the latest fashions, and spending time growing in the word of God.

ACDIS Blog: Can you tell us about a few of your favorite things?

• Vacation spots: Italy, France, Spain, London, Hawaii, Aruba, Jamaica, mostly all of the western and eastern Caribbean, and Puerto Rico. Disneyworld as an adult was mega fun!
• Hobby: Gardening, picking plants that will make the yard look fabulous
• Non-alcoholic beverage: Sunkist Orange
• Foods: Fish, Mexican authentic, BBQ, T-bone steak, carrot cake
• Activities: Serving at my church, shopping, playing with my dog (Black Diamond), bowling, concerts, dinners, going to basketball and football games (especially for my favorite teams the San Antonio Spurs and Pittsburgh Steelers), and traveling (especially cruises)  

ACDIS Blog: Is there anything else you'd like to add?
Douglas: CDI is growing and more hospitals are now adding a CDI program. Doctors are also very interested in how they look compared to their peers too. With “customers” (the patients) able to look at HealthGrades scores and compare hospitals and doctors to each other, institutions want to be rated the highest they can be in their field.