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Strategy: Provide proper training for case management, other embedded CDI staff

CDI Strategies, December 13, 2007

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Strive to blend utilization management with CDI functions

It's not easy to implement a successful clinical documentation improvement (CDI) program when the documentation specialists' role is embedded in case management, HIM/coding, or other job functions. But with the right training it's possible to expand the roles of embedded staff to include CDI, says Wendy De Vreugd, RN, FNP, senior director of case management for the West Group of Kindred Healthcare, Hospital Division, in Orange County, CA.

"It can prove difficult to effectively push consistent outcomes when utilization management and discharge planning are also embedded in case management roles and other functions, such as risk management, quality improvement, infection control, and interdisciplinary planning," she says. "Immediate priorities and patient care-related functions may sometimes take precedence over CDI."

To ensure that case managers keep up with CDI efforts, De Vreugd suggests blending utilization review and CDI, and fostering partnerships with the coding department. For example, Kindred's long-term acute care (LTAC) facilities (which comprise a large segment of Kindred' s healthcare system) provide their physicians and case managers with up to eight hours of training in CDI, and interface information technology systems to ensure communication between case management and coding.

Kindred's CDI training is optimized to the top 15 LTAC DRGs. CDI training also includes establishing competencies and workflows for case managers related to CDI.

"Most importantly, case managers must be trained to 'think critically' when reviewing a record," De Vreugd says. "When they do their utilization management review, they have to do it with two sets of eyes--case management and CDI."

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