Lessons Learned from ACDIS

Lessons Learned from ACDIS

Today and in two weeks, I am going to share some tips I picked up at the ACDIS National Conference in Chicago, May 9 through11. I want to thank those of you who approached me to tell me how much you enjoy Talk Ten Tuesdays and took selfies with me.

It was a very well attended conference in my old stomping grounds (I trained in Chicago). There were five tracks, and I often had trouble choosing. In fact, there was a session I clicked to attend and then realized it was during the time slot when I was presenting!

The first keynote was presented by Brian Murphy, the prior director of ACDIS. He paid tribute to Melissa Varnavas, a beautiful person whose role was Editorial Director, Events and Education, who was taken away from us far too young from breast cancer. The lesson she taught Brian, the staff at ACDIS, and all the rest of us was to be your authentic self. He encouraged us to harness our passions and to foster others allowing their passions to bloom, too. The theme of ACDIS was FLOURISH in honor of Melissa’s love of flowers.

Teri Rice, a regulatory instructor for HCPro, spoke on the collaboration between Utilization Review and CDI. She discussed five types of communication and how they may need to be approached differently:

  • Intrapersonal – what you tell yourself
  • Interpersonal – communication between you and your colleagues
  • Small group – which we often do with service lines or in other meetings
  • Public speaking – like when we give presentations to large groups,
  • And mass communication which is exemplified by sending out educational emails.

Some of her recommendations were to consider daily rounds where you break down walls and create teams, improving communication. You should avoid an “us versus them” mentality. She noted that we have some aligned goals: preventing medical necessity denials, improving coding accuracy, encouraging documentation integrity, improving quality metrics, assuring correct DRG assignment, and meeting value-based care goals. Some of the methods she promulgated were having educational sessions together, like lunch and learns, having face-to-face conversations or phone calls and secure texting.

The next talk I attended was by Fran Jurcak called “What’s in a Review?” She posited that the goal of a CDI program is to achieve accurate and thorough medical record documentation.  Providers need to understand that accuracy is imperative for ensuring that the patient looks as sick and complex in the record as they do in real life. In fact, she showed a set of pictures similar to an exercise I do where one set of codes from suboptimal documentation make the patient look smiling and well whereas coding from ideal documentation paints a picture of a moribund, intubated ICU patient.

I was under the impression that remote work increased productivity, and that may be true for certain kinds of work. However, Fran cited a Forbes article which stated that, although short-term productivity may increase, long-term productivity, quality, collaboration, and innovation may decrease. One of the most important points was that a great deal of CDI review time doesn’t yield query opportunity and that identifying the right cases to review can minimize wasted effort.

A very innovative suggestion is that reviews be done in reverse chronological order, especially for long length of stays. Fran looks at the most recent progress note and then works back to the history and physical to see what’s missing. She also recommended abandoning the copious note-taking that many of us do and instead observe what’s missing. She advises ditching the pen and taking notes electronically. She also strongly suggested that you limit the time you spend on each review. Her experience was, with these process changes, folks got through more records and had an increased query volume and rate and increased MCC capture rate.

I think one of the most provocative things she said was, “Are we waiting for them to get it wrong or are we prompting them to get it right?”

Next time, I will share some more nuggets from ACDIS with you. Until then…have a meaningful Memorial Day.

Programming note: Listen Dr. Erica Remer every Tuesday on Talk Ten Tuesdays when she cohosts the long-running broadcast with Chuck Buck.


Erica E. Remer, MD, CCDS

Erica Remer, MD, FACEP, CCDS, has a unique perspective as a practicing emergency physician for 25 years, with extensive coding, CDI, and ICD-10 expertise. As physician advisor for University Hospitals Health System in Cleveland, Ohio for four years, she trained 2,700 providers in ICD-10, closed hundreds of queries, fought numerous DRG clinical determination and medical necessity denials, and educated CDI specialists and healthcare providers with engaging, case-based presentations. She transitioned to independent consulting in July 2016. Dr. Remer is a member of the ICD10monitor editorial board and is the co-host on the popular Talk Ten Tuesdays weekly, live Internet radio broadcasts.

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