Note from the Associate Editorial Director: Spending a week with PROPELCDI clients

by Melissa Varnavas

The first week of the month is typically the time when ACDIS CDI Education Director Laurie Prescott and I spend with our PROPELCDI clients during their regular educational calls. It’s always heartwarming when an attendee expresses gratitude for the session as one PROPELCDI member did recently stating, “I just want to say how valuable these education calls are. Even though I’ve been doing this job for a long time, I think it’s great to learn something new, refresh my awareness, and have everyone on the team be able to get on the same page.”

PROPELCDI members receive a collection of customized educational calls in addition to regular, members-only recaps of Coding Clinic releases and updates related to annual changes to the inpatient prospective payment system. In addition, they get access to a library of training solutions including book excerpts, articles, and online tools target to their team’s educational needs and CDI development strategies.

When we hold these calls, we build in an extra 30 minutes into each (about 15 minutes both prior and post the educational presentation) to allow folks to dial into the call, get themselves situated, and to ask any questions they may have.

Often these conversations lead everyone to a greater insight into the challenges around their chosen topics, but they also afford us an opportunity to get to know one another better as individuals. One recent pre-call included conversations about groundhog nesting practices, tips on how high to hang a bird feeder to keep it out of a deer's reach, and how to spot poison ivy.

The actual education provided during these sessions runs the gamut from CDI practice concerns such as clinical validation, physician buy-in, and compliant query creation, to clinical concentrations from sepsis to encephalopathy, trauma to transplants, and spinal procedures to surgical complications. We’ve covered quality topics, too, such as patient safety indicators, observed to expected mortality, and readmission reduction. 

During a call this week about clinical validation, Prescott explained the ongoing importance of such reviews. “Back in the day,” she said, “nobody looked over your shoulder. The doctor wrote it. We coded it. They reimbursed for it.”

The introduction of Recovery Auditors changed that. Now those working in CDI to expand their reviews beyond simple DRG capture. The term “clinical validation,” Prescott explained as defined by the Pocket Glossary of Health Information Management and Technology, Fifth Edition, is “[t]he process of validating each diagnosis or procedure documented within the health record, ensuring it is supported by clinical evidence.”

For physicians, Prescott explained, “this is difficult piece for providers to document. This is the invisible piece.” Their medical decision-making thought process is like driving home from work. “These decisions are automatic in nature and your brain performs the tasks. The provider is constantly reviewing the patient’s presentation, diagnostics, medication lists, present conditions, etc. But they don’t necessarily know how to commit this process to paper because it is sort of invisible to them.”

Just this analogy, we hope, helped our PROPELCDI clients wrap their minds around a potential physician engagement element and open their thoughts to additional approaches to clinical validation. Coming off a week of similarly inspiring sessions, I continue to be impressed by our instructors’ efforts as they provide innovative education and our clients for their energetic desire to constantly engage in their professional development.

Editor’s note: Varnavas is the associate editorial director for ACDIS overseeing its main conference, outpatient CDI Symposium, local chapters, and PROPELCDI educational content. Contact her at mvarnavas@acdis.org. Want to learn more about PROPELCDI? Visit https://acdis.org/cdi-advisory-services.