Guest post: COVID-19 frontline worker insight on CDI

by Rabia Jalal, MBBS, CCS, CDIP, CCDS, RHIA

The last time I wrote for ACDIS, it was early March for the ACDIS California local chapter’s April newsletter and COVID-19 was starting to be recognized as a dangerous pandemic. As I write this, it is now mid-May, and we are at a staggering 5,931,112 cases and 357,781 deaths globally; over 101,000 of those deaths are here in the United States. Unfortunately, these statistics will be higher by the time we go to publication. It has been an overwhelming time for our frontline workers who are battling this deadly virus with limited resources. Hospitals have been hit hard, with COVID-19 bleeding resources, and sadly even losing healthcare workers.

The CDI community realizes this plight and in lieu of these unprecedent times, organizations have requested that CDI staff only query physicians “if there is a change in DRG, SOI/ROM, or if the diagnosis is listed in the 2020 ACDIS Pocket Guide comorbidity list.” CMS has also recommended that documentation requirements be relaxed.

I reached out to an old medical school friend, Dr. Ahmer Rehman, MD, a critical care and nephrology physician working in Wayne, Canton, and Livonia, Michigan. He is a frontline worker heavily impacted by this pandemic and has been working with COVID-19 patients since this public health crisis began. Dr. Rehman works in two hospitals, has his own private practice, and works in a dialysis unit. He does all his own billing for his practice.

Following is a transcript of our conversation. Please note that it has been lightly edited for clarity and style.

Jalal: How many COVID-19 patients are you seeing on average on a daily basis?

Dr. Rehman: It depends on where I am working. Since we have peaked about 10 days ago, in the ICU I have an average of 10-25 patients per day, in my nephrology practice about 10-15 patients per day. Before the peak I would about see around five nephrology patients.

Jalal: How long does it take you to do your documentation on such patients?

Dr. Rehman: I spend 60%-80% of my time doing this. On ICU days I have my residents assist me with documentation.

Jalal: Does your facility have a CDI department? If yes, do you receive queries from the CDI department to clarify COVID-19 diagnoses?

Dr. Rehman: Yes, we do have a CDI program. Before the pandemic, I would receive a lot of queries, but since the pandemic has started, I have not been getting any. I did receive a couple, but before I could answer them, my facility, Beaumont Hospital, shut down. The queries had to be a no response.

Jalal: What are the clinical criteria you use to diagnose a patient with COVID-19?

Dr. Rehman: PCR positive, viral pneumonia, acute respiratory failure, renal failure, sepsis, and septic shock.

Jalal: What are some of the treatments you and your colleagues use to treat COVID-19 patients?

Dr. Rehman: In the ICU most of the patients are vented, in my nephrology practice a third of them are on dialysis. My colleagues use mostly Plaquenil, Azithromycin, Plasma, Steroids.

Jalal: Do you think clinical documentation requirements are difficult in times like this when faced with a pandemic and overwhelmed hospital?

Dr. Rehman: In times like this, two thirds of my time is spent documenting and dealing with regulations from quality organizations, which go way too far, and my patients do not get enough time.

Jalal: And finally, is there anything you would like to share with clinical documentation professionals? Suggestions?

Dr. Rehman: I would like to reiterate that 60%-80% of my time is spent documenting, and as physicians, we did not sign up for this. My nurses, residents, and respiratory therapists are also doing this. The system needs to change. I do however appreciate you helping physicians like me, and I consider you an essential worker as well.

Editor’s note: Please note that due to the ever-changing nature of the pandemic, the numbers and statistics in this article reflect those that were available at the time of publication and are subject to change. Jalal is a CDI specialist/senior clinical analyst with Optum360 at Marian Regional Medical Center in Santa Maria, California. Opinions are those of the author and do not necessarily reflect those of ACDIS, HCPro, or any of its subsidiaries. To read ACDIS’ coverage of the COVID-19 pandemic, click here.