Q&A: Career Advancement
As part of the annual CDI Week celebration, ACDIS conducts several interviews with industry experts surrounding topics covered in the CDI Week Industry Survey. James Wall, RN-TN, BSN, MBA, the senior director of clinical documentation improvement at LifePoint Health in Brentwood, Tennessee, and a member of the 2017 CDI Week Committee, answered these questions on CDI and career advancement. Contact him at james.wall@lpnt.net. If you're interested in volunteering for the 2018 CDI Week planning committee, please contact ACDIS Editor Linnea Archibald at larchibald@acdis.org. This year's week of recognition takes place September 17-21.
Q: What, in your mind, does the "typical" CDI specialist role entail?
A: It’s really a combination of several attributes. It’s a role that requires the CDI specialist to be a mentor to the coders and the physicians. It is about public relations. I coach the local CDI managers, when looking for CDI specialist candidates, to ask if the applicant has any sales experience. It makes all the difference if a CDI specialist can establish a rapport with the provider. Of course, it also requires knowledge of pathophysiology and treatment modalities and how these are coded. But the most important thing the CDI specialist must possess is critical thinking skills. Without this, they will not succeed.
Q: As CDI programs advance, they begin to branch out into other review areas. What areas do you think programs should move into first?
A: I am always cautious when it comes to CDI mission creep, meaning other assigned duties that have no bearing on the core mission of CDI. That said, I recognize the need to collaborate with other departments. I believe there is a role for CDI in hospital-acquired condition querying. This does not mean CDI should assume quality’s grunt work—it means the areas that can be gleaned from the legal medical record in the course of the CDI specialist’s daily workflow. The most notable example is present on admission status.
Q: What is the most important thing a healthcare professional should do to further their career as a CDI specialist, either in CDI or elsewhere in healthcare?
A: Continual education is the key. If the CDI specialist is interested in career advancement, they should seek an advanced degree. I believe corporate leadership requires an MBA more so than an MSN.
Q: Do you think CDI specialists are compensated adequately for the work they do? Why or why not?
A: From my review of the 2016 ACDIS salary poll, there are drastic differences in pay from region to region. When you consider a single CDI specialist can create $500,000 per year in revenue recovery, they are worth perhaps $85,000. CDI needs to demonstrate its worth. In my experience talking with my colleagues at the ACDIS Conference, no one is looking at return on investment (ROI): That means the revenue recovered minus the software fee plus educational fee plus salary and benefits. What is left is the ROI.
Q: It seems like the most typical career ladders for CDI fall into two categories: the step category, in which individuals advance based on education, time on the job, and certification; and the expertise category, in which individuals advance based on their demonstrated capabilities and task sets such as CDI physician educator, quality reviewer, or data analyst. Can you talk about some of the pros and cons of these categories? What does your facility have in place?
A: Typically, our facilities (62 programs to date) are community hospitals with between one to three staff members per facility. There is the typical length of service/time in position, etc. Some of our facilities have a CDI manager who is a CDI specialist too. We may consider a step that recognizes CDI expertise that can be rewarded without the CDI specialist assuming direct reports.
Q: How important do you think it is to develop career ladders of some sort to ensure CDI retention?
A: I think it depends on the facility, but that idea really has merit.
Q: What type of salary structure do you think career ladders might employ (e.g., 5% salary increase per year or bonus structure)? Why?
A: Since our health system covers 22 states, this is very difficult to answer.
Q: How different will CDI look as a profession 10 years from now?
A: The CDI team will continue to be an indispensable part of any hospital or hospital system. The shift to outpatient and ambulatory environments will continue. Our system is exploring physician service CDI to serve the needs of the physician practices. With the reimbursement scheme changing from fee-for-service to quality, CDI will be the provider’s best friend.