Shawn-Marie Herring

AI’s Impact on CDI A recent ACDIS Survey of ACDIS members gauging impact of AI on CDI processes and the CDI profession revealed some interesting points and sentiments towards AI. The most common impacts from the implementation of CDI technology are increases in remote work and in productivity (cited by 67% each), followed by identifying “low-hanging fruit” queries (65%) and improving documentation issues with high-volume DRG groups (54%). Additional responses appear in Table 4 below. Remote work is not conducive to effectively providing sustainable measurable physician documentation educational training. One-on-One training or small group training is most effective in ultimately changing overall physician behavioral patterns of documentation. Often, the best form of training is small bit size nuggets provided in a quick conversation specific to a case on the floor. Productivity is not a valid and reliable measure of CDI performance. The mere fact that the CDIS reviewed a record does not necessarily equate to achieved improvement/integrity of the record. Identifying low hanging fruit diagnoses through queries implies CDI has room for improvement in physician documentation education through reinforcement that improves physician's muscle memory of better documentation practices. Electronic querying serves to mechanize the query process and is no substitute for physician documentation training and knowledge sharing. Physicians do not want more queries, they prefer to document right the first time versus more repetitive transactional reactive queries. AI definitely can assist and serve as an effective tool in CDI activity. However, it must be considered as a tool and not a crutch. There simply is no substitute for good old fashioned CDI boots on the ground, helping physicians achieve clinical documentation excellence through documentation training with reinforcement and guidance. AI is the panacea for improving documentation. #AI, #documentationimprovment, #notapanacea

40

13 Comments

Introducing CDIQ Consulting - Education Empowering Healthcare Our services empower allied healthcare professionals and the organizations they serve to achieve excellence in patient care and operational performance. We specialize in transforming clinical documentation integrity (CDI) into actionable strategies that enhance severity reporting, risk adjustment, and quality metrics. Under the leadership of Tarman Aziz, MD, CCDS, our CEO, and Anna Rusinowski, our COO, we deliver innovative solutions grounded in expertise and a commitment to elevating healthcare standards. Together, they guide a team dedicated to operationalizing intelligent insights into documentation accuracy, financial outcomes, quality metrics, and career excellence. Our Physician Advisor Solutions focus on training Documentation Champions to more comprehensively prevent DRG downgrade denials, mentoring custom strategies that sustainably improve provider assessment documentation. The Comprehensive CDI Apprenticeship Program builds future CDI specialists using real-world practical training, preparing them for faster onboarding to readily exceed management expectations. HIM and CDI leaders leverage our CDI training modules to enrich their programs with enhanced team productivity and query scope. We design middle revenue cycle consulting initiatives featuring both efficient assessments and immediate solutions strengthened by policy creation to optimize CMI and risk adjustment metrics. For professionals pursuing CCDS certification, our CCDS Exam Preparation course offers a custom curriculum to each enrollee, based on a diagnostic assessment. Our hourly and subscription-based Professional Coaching sessions deliver personalized support to foster leadership skills, professional growth, and adaptability to industry trends. Discover how we can transform your plans into positive outcomes! Empower your success by visiting cdiqconsulting.com today. #EducationEmpoweringHealthcare #ClinicalDocumentation #CDI #RiskAdjustment #HealthcareConsulting #CDIQ

7

Are you inundating your patients with messages❓ Are they receiving the right information at the right time❓ Download "Your Guide to Governance," a comprehensive resource designed to help you effectively manage your patient communications strategy enterprise-wide. 𝐓𝐡𝐢𝐬 𝐠𝐮𝐢𝐝𝐞 𝐢𝐧𝐜𝐥𝐮𝐝𝐞𝐬 𝟓 𝐛𝐞𝐬𝐭 𝐩𝐫𝐚𝐜𝐭𝐢𝐜𝐞𝐬 𝐭𝐨 𝐡𝐞𝐥𝐩 𝐲𝐨𝐮: ✅ Understand the risks of over-messaging and digital fatigue ✅ Break down silos and establish a governance committee ✅ Measure, iterate, and improve your enterprise-wide communication strategy ➡️ Download the full governance guide and workbook here » https://lnkd.in/gGHjjExa #healthcare #patientexperience #digitalhealth #medtech #healthtech

14

I would venture to say that our Clinical Documentation Integrity (CDI) team at Pediatric Resource Group (PRG) has more collective years of pediatric CDI experience than all other CDI consulting firms combined. 110 years amongst us and we are not done growing our team. If we include my physician advisor consultants that support peds CDI, the years of experience goes beyond 150. It's not just experience. Our team is full of national CDI leaders who speak at conferences regularly as well as CDI and coding leaders at major children's hospitals. We bring that expertise to our clients to assess, develop or optimize pediatric and neonatal CDI programs around the country. Peds is different from a care, culture, and reimbursement perspective. Your CDI consulting partner needs to understand all the nuances associated with this unique patient population. Hospital leaders, let's connect to see how PRG can help you optimize or cover peds/NICU CDI. CDI consultants, let's partner on peds clients. Amy Bush, BS, RN, MJ, CCDS, CCS, Kristen Johnston Jorde Spitler MHA BSN RN CCDS, Ashley Ezell, Kristin K., Kesia St Romain, Amy Philen, BSN, RN, CCDS, Jeff Morris, BSN, RN, CCDS, CCS, Jessica Audino-Iwuji #pediatricCDI #clinicaldocumentation #peds

60

4 Comments

Experience firsthand what a mature management system, built on the foundation of organizational excellence, looks like in a healthcare organization through our site visits: https://ow.ly/oLBJ50U7pTX

3

Join Kina L. White, DrPH, MHSA, FACHE, and me next Thursday, November 7, for a webinar, Getting Ready for the CMS Age-Friendly Measure. The #webinar is free for Mississippi Hospital Association members and $100 for non-members. We will crosswalk the requirements for becoming an #AgeFriendly Health System with the requirements of the new CMS structural measure that goes into effect on January 1, 2025. The Age-Friendly Hospital Measure assesses a hospital's commitment to providing age-friendly care. It consists of five domains: - Eliciting Patient Healthcare Goals - Responsible Medication Management - Frailty Screening and Intervention (Mobility, Mentation, and Malnutrition) - Social Vulnerability (Social Isolation, Economic Insecurity, Ageism, Limited Access to Healthcare, Caregiver Stress, Elder Abuse) - Addressing Hospital Culture and Leadership for Age-Friendly Care Hospitals receive one point for each domain they meet, with a total score ranging from zero to five. We will also cover how to incorporate age-friendly care into your #healthequity work. In addition to those over 65 being a group that experiences health disparities, there are also more disparities within that larger group. For example, Black and Hispanic older adults are more likely to report wanting their healthcare providers to spend more time discussing what matters to their health and well-being. And rural older adults often face challenges in accessing specialized geriatric services. We will share tools and resources available in Mississippi and nationally. For those registered, a recording and the slide deck will be shared. I hope to see you there! Register here: https://lnkd.in/g8j64XZb

7

Sharing key takeaways on the CMS Hospital Inpatient Quality Reporting program for FY2025. - Seven new measures are added (which are welcome, with the caveat of let's see how they work out) -> Patient Safety Structural Measure beginning CY 2025 with payment determination in FY 2027 -> Age Friendly Hospital CY 2025/FY 2027 -> Catheter-Associated Urinary Tract Infection Standardized Infection Ratio Stratified for Oncology Locations (CAUTI- Onc) CY 2026/FY 2028 -> Central Line-Associated Bloodstream Infection Standardized Infection Ratio Stratified for Oncology Locations (CLABSI-Onc) CY 2026/FY 2028 -> Hospital Harm – Falls with Injury (eCQM) CY 2026/FY 2028 -> Hospital Harm – Postoperative Respiratory Failure (eCQM) CY 2026/FY 2028 -> Thirty-day Risk-Standardized Death Rate Among Surgical Inpatients with Complications July 1, 2023–June 30, 2025/ FY 2027 - Five existing measures are removed (which is a breath of fresh air) - the unpopular PSI-04, and measures related to 30-day episode payments for acute myocardial infarction, pneumonia, total hip/ knee arthroplasty, heart failure - Two existing measures are modified (Global malnutrition composite score expanded from seniors over 65 to anyone older than 18 - this is very positive; and Refined HCAHPS measure - will post details on this next week.)

2

Experience firsthand what a mature management system, built on the foundation of organizational excellence, looks like in a healthcare organization through our site visits: https://ow.ly/9HJL50Upibx

8

The Association of Healthcare Value Analysis Professionals (AHVAP) celebrates Elizabeth Eisenberg, MSN, RN, CVAHP from Scripps Health for commitment to excellence in the specialty of healthcare value analysis! Liz has signified this commitment by signing the official Association of Healthcare Value Analysis Professionals (AHVAP) healthcare value analysis pledge. To learn more about the Association of Healthcare Value Analysis Professionals (AHVAP) Commitment pledge: https://lnkd.in/gqEWPBue. #AHVAP #valuebasedcare #excellenceincare #valueanalysis

7

𝗕𝘆𝗹𝗮𝘄𝘀 𝗥𝗲𝘃𝗶𝘀𝗶𝘁𝗲𝗱: 𝗔 𝗗𝗲𝘁𝗮𝗶𝗹𝗲𝗱 𝗔𝗽𝗽𝗿𝗼𝗮𝗰𝗵 𝘁𝗼 𝗥𝗲𝗳𝗶𝗻𝗶𝗻𝗴 𝗚𝗼𝘃𝗲𝗿𝗻𝗮𝗻𝗰𝗲 𝗗𝗼𝗰𝘂𝗺𝗲𝗻𝘁𝘀 📝 Revising hospital bylaws is critical for aligning with current practices and regulations, and it’s important to realize that much of the work centers around a few customizable sections. These key areas can be tailored to reflect the specific operational and governance needs of your organization, making the task more manageable. 🗝️ Listen in while I breakdown each of those areas and important points to consider when making changes. ➖➖➖ Over the last 25+ years as an MD with an MBA and MPH, I have worked with 3 Multi-Million dollar Hospital organizations serving as VPMA and CMO saving millions of dollars and improving quality. I went on to serve as Chief Physician Executive for BDO USA, the fifth-largest professional services firm in the United States. The key to my clients' success has been my proprietary ACCESS Methodology: Assess Coach Consult Execute Strategize Simplify Today, I run my own organization helping hospital executives solve their “Burning Issues”. For a limited time, get my newest ebook for free: "Caught in the Crossfire: The 5 Executive Errors That Ignite Corporate Crises in Hospitals”. Quickly learn 5 critical hospital mistakes and how to fix them. ***** 👉 Type “PDF” in the COMMENTS, and I will send you a FREE PDF copy. #leadership #management #strategy #personaldevelopment #healthcare #healthcareleadership

146

43 Comments

Key Strategic Insights = A Successful OP CDI Program The challenge of value-based care starts with a collaborative approach, when launching an Outpatient Clinical Documentation Integrity (OP CDI) program. Here are some key strategic insights to success: 1. Engage with Population Health Understand Pain Points: Begin by understanding the specific challenges faced. This fosters collaboration. Tailored Questions: Use customized questions to facilitate productive discussions and ensure alignment with needs. 2. Effective Software Implementation Manage Patient (Pt.) Volumes: Implement software solutions to efficiently handle pt. volumes. OP CDI Calculator: Utilize a calculator to determine Full-Time Equivalent (FTE) needs. Data Analytics and Reporting: Emphasize the importance of continuous improvement via data analytics. 3. Workflow Creation Establish Robust Workflows: Create strong workflows before integrating reviewers. 4. Collaboration & Communication Promote Strong Collaboration: Encourage robust communication between key stakeholders. Leverage Software: Use technology to reduce physician burnout & streamline communication. 5. Patient-Centered Approach Address social determinants of health (SDOH) & ensure accurate documentation of conditions and care plans. Patient Outcomes: Keep patient care at the center of all doc. & workflow processes. 6. Regulatory Compliance Adhere to Guidelines: Follow regulatory requirements such as CMS guidelines on Hierarchical Condition Categories (HCC) coding to avoid penalties and enhance credibility. 7. Measurable Outcomes Set Clear Goals: Aim for measurable outcomes like improved HCC recapture rates, enhanced RAF scores, better HEDIS measures, and addressing SDOH needs. 8. Stakeholder Engagement Involve All Stakeholders: Ensure that executives, clinicians, and other relevant parties are involved in planning and implementation process. Success Stories Recently, I helped several CDI directors validate their cases for OP CDI programs within Accountable Care Organizations (ACOs). By engaging with population health leadership, we identified key issues such as RAF gaps and HEDIS measures, and tailored processes to address them. For instance, a CDI director I guided successfully identified HCC and HEDIS recapture as their biggest pain points. With strategic solutions in place, they are now ready to implement the project for the 2025 budget yr., aiming to improve their HCC recapture rate by 20%, leveraging data analytics for outcomes and improvement needs. Benefits of Implementing These Strategies Align Risk Stratification: Properly align risk stratification with chronic conditions and healthcare needs. Quality Measures: Improve quality measures and address SDOH. Collaborative Team: Ensure success with a collaborative team supported by technology. Overall, these strategic actions will enhance patient care and operational efficiency. #Healthcare #Leadership #CDI #PatientCare #ValueBasedCare #HealthcareInnovation

22

9 Comments

Read this special report that provides a detailed review & validation process for the appropriate use of discharge status code 06 and Condition Codes 42 & 43 in claims involving home health services post-hospital discharge. Download your copy now: https://gag.gl/kkTLyy #TransferDRG #ConditionCodes

1

So this gem 💎 by Susan Walberg JD arrived in the mail.... If you are a decision maker at a health tech companies or care provider who has to navigate regulatory and legal requirements related to healthcare and technology 😫 this is a fantastic resource that is super user friendly! 😅 Key elements include:  -HIPAA and The Cures Act -Fraud and Abuse -The FDA and Safety Standards -FTC Laws and Enforcement -Compliance Guidance for Building a Telehealth Practice "Whether you are the CEO of a healthtech start-up, a physician building a telehealth practice, a compliance officer, or a developer working on the next great AI tool, this book is a must-read." If you want a copy, link is in the comments. #Healthcare #Technology #Law #Compliance #healthcareinnovation

44

7 Comments

CCBHCs and aspiring CCBHCs can drive value contracting to other service areas by building a quality reporting and quality improvement program that not only achieves the aims of the CCBHC program, but also demonstrates your value to other payers to achieve health and quality outcomes. Building a meaningful quality program positions your organization to participate in additional value contracting arrangements that diversify and grow your revenue. Your quality program should identify your core competencies and report on your performance in ways that allow you the confidence to enter value agreements and define better terms, because you are confident in your ability to perform. Curious how? Reach out. I love talking healthcare quality.

24

System modernization isn't just a trend, it's a necessity. Let's talk about the people side of change! 💡 🔶 Needs analysis 🔶 Readiness assessment 🔶 Communication planning 🔶 Stakeholder management #BrilliantPossibilities #ChangeManagement #HealthIT #Medicaid

4

Recent regulatory changes provide hospitals a unique opportunity to reassess their reimbursement practices and strategy, showing the value of completing three reporting types in tandem rather than one at a time. By understanding how reimbursement programs like Medicare DSH, Worksheet S-10 Uncompensated Care, and Medicare bad debts are related, hospitals can save time, alleviate strain on their IT departments, free up staff to focus on high-priority work, and potentially improve their financial health. Learn more in this Moss Adams article by Heather Keser, Jonathan Mason, Jesse Vo and Josh Stewart.

2