Case Management

Mentor moment: Offer physicians insight, not just 'education'

Case Management Weekly, October 20, 2010

Editor's Note: The following blog post originally appeared on the Association of Clinical Documentation Improvement Specialists (ACDIS) blog site.

I recently received a fortune cookie from a colleague. After reading the fortune several times, I realized the hidden message certainly has direct relevance to clinical documentation improvement (CDI) efforts affecting overall change in patterns of physician documentation. It read:

“Anyone can memorize things, but the important thing is to understand it.”

Most people remember reading college textbooks, listening to professorial lectures, taking notes, and regurgitating the information we supposedly learned on tests and final exams, as part of our endeavors of higher learning. We always seemed to ask ourselves why we were “learning” the majority of that rote information, anyway. It was difficult to appreciate and understand its practicality and usefulness.

Now, let’s look at CDI training and education.  The majority of training, education, and CDI programs center around:

  • understanding the MS-DRG system
  • learning what a MCC/CC is
  • gaining a practical sense and understanding of coding rules and policies governing principal and secondary condition selection/assignment
  • learning how to review the record
  • learning how to identify opportunities to improve clinical documentation and financial reimbursement

Finally, we learn how to enter the data into the tracking software for reporting purposes. If we’re lucky, we learn to track

  • how many queries were left
  • how many were responded to
  • how many contained a positive response
  • how often records were reviewed
  • how much of a financial impact CDI has on hospital’s bottom line

The entire process is similar to the college experience in the sense that we “memorize” the steps of CDI, apply its principles consistently, and ensure we review the standard number of records each day in the name of that learning. Although I am not fundamentally against established “quotas” for record review, I do advocate for quality of chart reviews. These chart reviews work in tandem with CDI efforts to educate physicians, particularly to the extent that we are not repeatedly leaving the same queries day in and day out to determine the likes of acute blood loss anemia or the type of congestive heart failure.

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