Guest Post: The (CDI) importance of serving others

by Kelli Estes, RN, CCDS

Any leadership book you read will quickly point out the importance of serving others! Who can we include as likely candidates for the CDI Team to serve? All healthcare providers: Physicians, nurse practitioners, physician assistants, coders, any variety of others.

Unfortunately, the idea of going above and beyond the proverbial call of duty to serve providers is often lost. I have worked in numerous hospitals where the CDI team exhibits heightened frustration over the lack of provider participation in the CDI program, and over the continued poor documentation that results. CDI team feels forced to find a way to work around this group of difficult providers in order to obtain the improved documentation, in the end, from another provider on the case. This tends to give a “pass” to certain providers who have the tendency to discount the importance of  CDI compliance.  sually this results in an incessant flow of behind closed door mouthing without ever obtaining a workable solution for the future. Sadly, this only sets the table for a negative attitude toward the group of difficult providers.

So what is the CDI Team to do? First, maintain the proper perspective!

Any well-oiled machine has all the moving parts working together at the appropriate time. CDI can be a very complex process that involves input from several different parties to get it all right. Undeniably, everyone has to own their part, but it would behoove any CDI team to provide whatever is necessary to encourage the providers to incorporate CDI into their busy and demanding schedules.

Before you “boo” this entire idea, think about those providers who require repeated queries for the same things, over and over. Most often when I ask CDI specialists if these providers answer their queries, the answer is yes. I remind them that this is still a “win” for the CDI team. Remember why the CDI team is in place. Undoubtedly, the vast majority of providers will begin to document certain conditions unprompted; however, don’t become discouraged when some providers require ongoing CDI queries; that is precisely why CDI is so valuable to the overall continuity of improved documentation.

Secondly, talk to the providers! Taking the initiative to set up a time to talk with difficult providers and explain the “why” behind your need for clarifying queries is a necessary step to facilitate CDI participation. Physicians often get saturated with a great deal of information when CDI programs are first implemented then fail to hear much else beyond that point. Ask providers how you can better serve them in future CDI efforts. Do everything you can to help them realize that you are there to help and be a credible resource for their future documentation improvement needs. Express your willingness to cater to their individual requests within reason. This will allow the difficult providers to recognize that the CDI team can help improve their documentation without completely disrupting their day.

Nevertheless, you may continue to face some barriers such as:

• The CDI specialist (or team) does not understand a disease process well enough to discuss the need for clarification with confidence.
• There is a lack of administrative support for fostering a collaborative relationship between the CDI program and providers regarding CDI initiatives.
• There is no CDI physician liaison in place.

If any of these are the case at your facility, consider the following:

• Employ the CDI team member most knowledgeable about a particular disease process when discussing with a provider.  Allow a newer CDI staff to come along for the conversation and be mentored.
• Provide case studies to administration that demonstrate the positive effects of provider participation.
• Provide other case studies that support the need for a physician liaison. In the meantime, use physicians with whom the CDI staff have a great relationship to discuss difficult cases prior to approaching providers.

Despite our best efforts, we will never completely rid ourselves of those challenges presented by difficult providers, but maintaining an attitude of serving the providers will always prove to be a successful approach to gaining a win for the CDI program.

Editor’s Note: Estes, at the time of this article's original release, was a CDI consultant with DCBA Inc., in Atlanta.