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Ask yourself: Could your CDI program work at home?

Association of Clinical Documentation Improvement Specialists, May 1, 2015

It’s no question that CDI specialists have made a big difference while working in hospitals. But a question asked more and more among CDI teams is can the job be done from home?

Charlene Barnes, RN, CCDS, a CDI specialist at Hardin Memorial Hospital in Elizabethtown, Kentucky asked that question in one recent discussion on CDI Talk. Her CDI team is currently weighing their options for accommodating a workfrom-home program.

In a recent poll conducted on ACDIS Radio, listeners were asked to respond to this question: “Do you have a remote component to your CDI program?”

  • 6% of the respondents answered yes, our CDI specialists are 100% remote
  • 24% answered yes, we have a mix of remote and onsite staff
  • 16% answered no, but we are considering it
  • 47% answered no, our hospital does not permit this option
  • 7% answered don’t know/not applicable

What is the appeal?

Convenience and flexibility, for one, answers Juli Bovard RN, CCDS, a CDI specialist at Rapid City (South Dakota) Regional Hospital. Bovard always liked the idea of working remotely, and thinks it would allow her to be more productive with fewer interruptions.

The biggest benefit is flexibility, says Katy Good, RN, BSN, CCDS, CCS, CDI Program Coordinator at Flagstaff (Arizona) Medical Center, who currently works from home with a CDI team onsite at her facility.

“I have three small children and the last [few] years have been very demanding career-wise for my husband and me,” she says. “This arrangement allows for an incredible amount of work-life balance.”

The benefits of working from home may be innumerable for the employee, but Good feels employers benefit as well. Having a work-fromhome option increases productivity, she says. For one, she doesn’t have to take sick days when she needs to stay home.

She doesn’t have to worry about being late because of traffic. And she doesn’t have to rush out at the end of the day to pick up her kids. Working without the distractions of an office allows her to schedule and prioritize her time, and complete tasks more efficiently.

Remote options work especially well in regions where it is a challenge to fill positions, and find experienced staff—a problem Good often runs into at her facility. The flexibility allows the organization to hire and retain staff members regardless of location.  

Organizations should embrace the work-from-home option, says Paul Evans, RHIA, CCS, CCS-P, CCDS, manager of Regional Clinical Documentation and Coding Integrity at Sutter West Bay in San Francisco, California. New technologies, such as electronic health records (EHR) and coding software, and more reliable home internet access, allow CDI staff to review all aspects of a case and issue queries from any location.

CDI managers can also plan ahead, and schedule on-site days where staff come in for team meetings, educational sessions, and present educational materials to physicians.

“If one is strategic,” Evans says, “it may be feasible for a CDI program to be home-based.”

The Mayo Clinic’s CDI program is almost entirely home-based, according to CDI specialist Timothy Weiser, RN, MSN, CCDS. Staff has the option to work from home five days a week.

They use a company-developed EHR system. Queries are done by email and CDI and coding staff interact through email and a company message board. Staff meets online daily at 11 a.m., with occasional meetings at the hospital, Weiser says.

The facility assigns each CDI specialist a primary and secondary focus for cases, says Teresa Hegard, BSN, RN, CDI at the Mayo Clinic. For example, her primary focus is cardiology, and her secondary focus is psychiatry. Cases are filtered into the EHR system based on the CDI specialists’ focus.

Hegard starts by reviewing cardiology cases. If she finishes all cardiology cases, or if none are listed, she reviews psychiatry cases. CDI staff know their responsibilities and are able to go to work without instruction.

Some CDI staff prefer to work in the office, though everyone has the option to work remotely, Weiser says. They also have an onsite staff for education and training, and for chart reviews and clarifications that must be done in person.

Since implementing the remote program at the Mayo Clinic, Weiser says the number of cases reviewed per day has gone up from an average of 18 to an average of 25-26.

What are the cons?

Remote CDI limits interactions with providers and other CDI staff, Bovard says. Her team bounces ideas and questions off one another throughout the day, which would be difficult if they worked remotely. CDI staff also already struggle with physician engagement, and effectively communicating and educating physicians could prove challenging, Bovard says.

Working remotely could lead physicians to take CDI less seriously. Remote CDI specialists face a number of personal challenges, too, Good says. Working from home can be isolating and requires a hefty dose of self-motivation. Setting personal and professional boundaries represents another challenge. At-home CDI staff may find it difficult to stop working at the end of the day, and to focus on work despite distractions at home. Those who work remotely also tend to go overboard and work longer hours to prove they can manage tasks at home.

“When your office is at home, it’s easy to feel like you are always working,” says Good. “I have to force myself to turn off the computer and phone after I am done for the day, or I will be answering emails at 11 p.m.”

Is it possible for a CDI team to work remotely?

The answer falls somewhere between yes and no. The key is finding a balance. Let’s take a look at a few facilities that have successfully integrated working remotely into their programs.

Martin Conroy, RHIA, CPC, director of coding education and clinical documentation improvement at an academic medical center in the northeast (Conroy requested the facility remain anonymous) says his program has two CDI teams. One works remotely, and the other works onsite. Each team has distinct roles, and very different job descriptions.

The onsite staff is all former patient care nurses from within the facility. They know and have established relationships with the physicians, nurse managers, staff nurses, and most of the ancillary staff.

The remote staff functions as a hybrid coding and CDI team, coding cases and offering suggestions for queries to the onsite staff. The teams are assigned by units and work closely together.

There needs to be someone onsite for a CDI program to be successful, Conroy says. “The physicians and hospital leadership want more face-to-face interaction,” says Conroy. “Someone needs to be in-house to train the physicians and answer questions. But, ultimately, it is important for each facility to find what works best for them and their staff.”

Linda Rhodes RN, BSN, CCDS, CDI manager at New Hanover Regional Medical Center in Wilmington, North Carolina, helped implement a work-from-home program at her facility. Their eight-person CDI staff works from home two days a week and onsite at the hospital for three.

This allows them to maintain connections and interact with providers. Their staff is divided into service line teams, and rotates who works from home and when. At least one CDI from each service line is expected to be onsite each day.

The only issues they experienced were technical, Rhodes says. They stick to a strict, pre-developed set of guidelines.

For example, the staff is expected to meet certain productivity standards, and their duties remain the same whether in the hospital or at home.

By implementing the workfrom-home program, staff productivity, teamwork, and employee satisfaction improved, she says.

“Working from home should still be a work environment,” says Rhodes. “I hold the staff equally accountable for their work, but ultimately the [productivity] has improved.”

Overall, find the right balance of working from home and engaging with physicians that suits your program.

Whether hiring two teams, allowing staff to work from home part-time, or transitioning to a completely remote CDI program, the focus should remain on improving documentation and strengthening CDI efforts.

“It’s important to be honest with yourself about what works for you,” says Good. “The decision should be what is best for both the staff and the facility.”