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Tip: Consider this top 10 list when training embedded case management staff as clinical documentation improvement specialists

CDI Strategies, December 27, 2007

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As noted in the December 13 issue of CDI Strategies, it's not easy to implement a successful CDI program when the documentation specialists' role includes case management, communication with coding staff, and other time-consuming roles.

Below, Wendy De Vreugd, RN, FNP, senior director of case management for the West Group of Kindred Healthcare, Hospital Division, in Orange County, CA, suggests a top 10 list of steps you should consider when cross-training embedded case managers or other staff in CDI. These include:

1. Physician education and a "physician champion" to maintain the dialogue with the medical staff
2. Monitoring timely physician history and physical documentation within 24 hours of admission to ensure compliance
3. Encouraging timely physician discharge summary dictation at the point of care to facilitate final coding
4. Ongoing case manager CDI training, job descriptions, competencies, and measurements
5. Interdisciplinary training (e.g., nurses, physical therapists, respiratory therapists, etc.) on basic DRG concepts
6. Concurrent review of both clinical documentation and coding, and implementation of an effective communication and feedback process between the two departments
7. Legible physician documentation, as well as education and feedback on concepts for appropriate documentation
8. Information technology, fax, and scanning equipment support
9. Working DRG and final DRG comparison review, as well as performing analyses of top 10-15 DRGs
10. Administrative knowledge and support for adequate case management staffing to support the CDI functions and deliver the outcomes and return on investment within the case management team. 

"In addition, tools must be established which facilitate the workflows necessary to combine the concepts of CDI, physician queries and education, and the recognition of DRG principles, such as identification of comorbid conditions and medically-complex conditions," De Vreugd says. "Encouraging clear, concise, and specific physician documentation of complex patient care is necessary to adequately reflect the 'thrust of care,' patient severity, and appropriate length of stay and revenue."

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