Symposium spotlight: Baptist Health System’s CDI specialists are all on the same team—both inpatient and outpatient

Editor’s note: Jennifer Boles, CPC, CRC, Lori Ganote, MSN, RN, CCDS, and Caryl Liptak, MSHAI, RHIA, will present “Joining Forces: How Ambulatory CDI Can Collaborate with Inpatient CDI Staff” on Day 1 of the ACDIS Symposium: Outpatient CDI, which takes place November 14-15 at the Hyatt Regency in Austin, Texas. Boles is the system manager of ambulatory CDI, Ganote is the system manager of CDI, and Liptak is the system director of CDI at Baptist Health System in Kentucky/Indiana.

ACDIS Blog: What was the first step you took when rolling out the ambulatory program at Baptist Health? How did you determine that was the step to take?
Liptak: Our first work with ambulatory CDI was in partnership with some of the payers. The payers had access to patient hierarchical condition category (HCC) data and risk scores per Baptist Health provider/practices. From this, we were able to pinpoint our providers or practices with the largest number of patients and the lowest risk scores. Those were the practices we focused on in the beginning. We chose this step first because of the data being readily available and the payer asking for our help.

Boles: Personally, the first step was creating an HCC report that allowed for tracking and prioritizing HCC capture. I believe in order to create buy-in and understanding, you need data to show leadership and providers that there is a need for an ambulatory CDI program.

Ganote: The inpatient CDI program was a primary resource for our ambulatory CDI team. Our inpatient team had been established for roughly 20 years prior to discussion of starting an ambulatory program. Because it had such a long history, our inpatient program was very robust, well-known, had a good reputation, and so it served as a blueprint when we looked to expand.

ACDIS Blog: What’s the best way to get the inpatient and ambulatory CDI teams on the same page?
Liptak: I think our biggest success with making this a team approach is the fact that we all work out of the same office, have shared leadership, and know each other well.

Boles: Those looking to move into ambulatory/physician practice settings need to foster a close working relationship between the program leaders and the system administrators as well as between the inpatient and outpatient CDI teams. They should plan on conducting lots of communication and sharing via meetings, initiatives, and education.

Ganote: Start from the beginning. Establishing roles and responsibilities, setting parameters for the positions, is very important. Then work on developing a shared, consistent, educational platform. It’s important to establish which team should present what education. Determine who the subject matter expert is on each topic and how you can educate one another before educating the providers. Also, discuss what past, present, and current efforts each team is working on to determine if there’s an opportunity to co-present.  

ACDIS Blog: With such a large health system, is it difficult to ensure the educational message going out to physicians is consistent across the organization? How have you managed that challenge?
Liptak: We share any proposed education with both teams and get their buy-in prior to providing the education to the physicians.

Boles: Once the educational message is agreed upon, it’s important to invite multiple departments and anyone interested to the educational meetings. The more representation at each session you have, the more everyone understands that the education applies to the whole system. Having both CDI managers on the same page educating their teams and providers the same way helps immensely.

ACDIS Blog: What metrics do you use to monitor the success of the ambulatory CDI program? Are they the same or different for those you use on the inpatient side?
Liptak: We monitor the improvement in risk adjustment factor (RAF) scores. We use different metrics on the inpatient side, such as MCC and CC capture, improvement in risk of mortality and severity of illness, concurrent query rates higher than retrospective, etc.

Boles: On the ambulatory side, since the software is limited, we use payer risk score information and provider documentation chart review scores. We track user activity through the EHR data to understand which tools are being used successfully. Otherwise, all productivity is tracked manually through spreadsheets. I would say they are different on the inpatient side since the inpatient side has a more advanced software to track their metrics.

Ganote: The biggest challenge with selecting metrics is understanding the priorities for each team and how we can intertwine our needs into collaborative educational moments/opportunities. Our system is spread throughout the state of Kentucky, into Indiana for inpatient services, expands into Illinois. I think we see things differently on a regulatory perspective. Meaning that we understand each other’s limitations and respect regulatory stipulations and benefits for one another. Understanding this helps us to know when and where documentation is relevant and best practices for capturing opportunities. 

ACDIS Blog: What’s the biggest challenge with inpatient and ambulatory CDI teams collaborating? How do they see things differently?
Liptak: I think the hardest part is that ambulatory CDI does not have the same software for tracking and reporting their work. It’s hard to speak the same language at times. Each area is focusing on different aspects of CDI. Where we do try to collaborate is in asking for improvement in documentation specificity at every patient encounter.

Boles: The different guidelines create some challenges on how to educate the different teams on documentation and coding. My outpatient team currently has more of a coding background, so they understand the physician billing guidelines, but need to work more on clinical indicators. The inpatient CDI specialists are RNs and clinically strong, so we help them with the coding verbiage while they help us with clinical indicators. Often, I believe the system forgets that the physician practice side is part of the system and can play a vital role in value-based purchasing.

Ganote: Support from upper echelon leadership can be a challenge still. Our leaders understand the importance of our roles and that to better achieve a compliant, appropriate, and high-quality document requires teamwork. You have to break down the silos. 

ACDIS Blog: What, in your experience, has been the most successful team building tactic to bring the teams together?
Liptak: Having a shared office location and meeting regularly. Also, having both teams at our facility CDI steering committees and both teams at our system meetings.

Boles: We have a “Meeting of the Minds” meeting each month where both ambulatory CDI/coding and hospital CDI meet to discuss projects and updates.

ACDIS Blog: If you could have any other job besides CDI, what would you do and why?
Liptak: Rescuing and rehabilitating all types of animals. I would love to be in a job at either the state or national forests in order to enjoy the great outdoors. Another interest of mine is helping those with disabilities maneuver the various systems they encounter to attain the services and benefits they deserve, i.e. school system, vocational rehab, and social security.

Boles: Ride and rescue horses. I like to work with animals and be outside (when the weather is good).

Ganote: Stay at home grandma! I have five beautiful grandbabies and they are the best in the history of ever!