Off the Record with Brian Murphy
By Brian Murphy
Off the Record with Brian MurphyOct 05, 2022
The art of defense: Legal lessons from an OIG audit of severe malnutrition
Off the Record recently featured a wide-ranging conversation with Vaughn Matacale, physician advisor for Vidant Health (now ECU Health), an organization that found itself on the receiving end of an OIG audit of severe malnutrition claims.
On this episode I’m pleased to bring you a continuation of that story from the legal team that helped the organization win the case and strike a blow for clinical truth.
It’s not every day you get to hear a lawyer’s perspective on coding and documentation. But this episode is a double-dose, featuring Anderson Shackelford and Susan Hackney with North Carolina-based K&L Gates LLP.
On this show we cover:
• Vidant case details, and fighting an uphill battle against a formidable foe
• Weaknesses exposed in the OIG’s independent audit team and lack of consistent clinical review criteria
• Broad takeaways from the case, including best practices for making your organization a harder target
• Other legal liabilities related to documentation and coding you might not be aware of
• Open discussion: Should CDI programs be worried about being “better” than their peers at capturing certain diagnoses?
Link to OIG audit report “Vidant Medical Center Incorrectly Billed Medicare Inpatient Claims with Severe Malnutrition”: https://oig.hhs.gov/oas/reports/region3/31500011.asp
Breathing life into pediatric CDI: Meet Sandra Love
As a non-clinician I can think of few things more terrifying than having responsibility for the life of a fragile newborn in your hands, and your hands alone.
Welcome to the early nursing career of Sandra Love.
Sandra served a labor and delivery nurse in rural North Carolina and survived some harrowing experiences that continue to inform her work today as Director of Solutions for Norwood. Sandra learned that infants are not just small adults—they have their own unique clinical profiles.
That same axiom holds true for documentation and coding, too, which is often why pediatric CDI programs fail. But there are some very real opportunities that you’re leaving on the table without a pediatric focus.
We talk about all of that on this episode Off the Record. If you have a pediatric CDI program or are thinking expanding into one, this is a show you’ll want to listen to.
• Sandra’s early experiences working in a level 2 nursery with specialty support a long way away
• Transition into adult medicine and eventually CDI at Wake Forest
• Why most hospitals are off the mark with pediatric CDI
• Documentation clarification opportunities in the pediatric space
• Suggestions for engaging pediatric providers and obtaining buy-in
• And of course, the latest addition to the Off the Record Spotify playlist
A clinical vision of risk adjustment: Meet Katie McLaughlin
It’s often said that to be a good CDI or coding professional you have to roll up your sleeves and get clinical. If you code just what is explicitly documented you will miss opportunities; if you don’t understand A&P and pathophysiology, you will make mistakes.
But what about those who take the opposite path?
Katie McLaughlin became a registered nurse at age 23, then went back to school to earn her doctorates before becoming a nurse practitioner in 2007.
Today—at least until very recently, when her organization opted to discontinue accepting Medicare Advantage patients and shuttered its risk adjustment program—she became Population Health Clinical Advisor: Clinical Documentation Integrity, Risk Adjustment, and Epic Informatics, for Scripps Health.
A clinical path, to coding and CDI.
Today she is looking for the next opportunity. But given her clinical foundation, coding expertise, EHR savvy, and above all, passion and vision, she will be landing very well, and very shortly.
Katie joined me for this week’s episode of Off the Record, where we discuss:
• Her path into nursing, clinical medicine, and ultimately risk adjustment
• Prospective chart reviews—a 2 a.m. vision, and implementation
• Leveraging Medicare annual wellness visits
• Scaling risk capture by customizing EPIC
• Building dedicated Internal Wellness Clinics focused on screening and risk capture
• Unexpected free time and plans for her next career move
A win for clinical truth: How Vaughn Matacale and Vidant prevailed against the OIG
Severe malnutrition is a major predictor of mortality/morbidity.
In a five-year observational study cited by the National Institutes of Health, malnourished patients showed an eight times greater risk of harmful falls during hospitalization as compared to well-nourished patients. Further, malnutrition is associated with increased risk for septic shock, acute kidney injury, stroke, and intubation.
So it’s important to get severe malnutrition documented and coded. Unfortunately, doing so thoroughly and systematically can also make you an audit target.
Vidant Health—now part of ECU Health—found that out the hard way in January 2017, when it was the target of a high-profile audit by the Office of Inspector General (OIG). The report was scathing and seemed to indicate that Vidant had major problems reporting the condition.
What the OIG didn’t know was that Vidant had Dr. Vaughn Matacale.
Vidant fought back. And ultimately prevailed. It was not just a major win for the hospital, but for clinical integrity and autonomy of hospitals nationwide.
We talk all about this landmark case on this episode of Off the Record. And get caught up on what’s new with Vaughn, including his well-stocked beer cellar and a rock band recommendation for the OTR Spotify playlist I’ve never heard of before. How is that possible?
Tune in and listen as we cover:
• The initial OIG records request and onsite visit
• Reading the initial painful audit report with its 89% error rate: https://oig.hhs.gov/oas/reports/region3/31500011.pdf
• Fighting back: An extraordinary response letter and building a case
• Courtroom culmination (and celebration)
• Advice for other hospitals: Shoring up severe malnutrition claims from audit and denial
• Some broad discussion on the OIG and its work
• Fun stuff including beer and music
Don’t hate on hospitals: Navigating the complexities of healthcare reimbursement with Jugna Shah, MPH
Stop hating on hospitals. It’s a sentiment most Off the Record podcast listeners would probably agree with. But not everyone.
Hospitals are under assault in some corners, including the media and in the halls of government. We need a villain and hospitals often find themselves playing the role of fall guy. For example, many blame them for out-of-control healthcare costs, citing a lack of cost transparency and exorbitant charging practices.
Jugna Shah, MPH, founder and president of Nimitt Consulting, Inc. pushes back on these assertions, making a compelling case that a broken system is to blame. Hospitals own a piece of the problem, but by and large are doing their best to navigate inadequate and complex rules and opaque payer requirements. Many of the gotcha soundbites on Twitter, especially ones that place full blame on hospitals, are misguided, she says.
On this show we cover:
• Jugna’s unique path into healthcare and hospital advocacy
• Pricing transparency: The problem with posting prices, and the real reason why outrageous hospital charges exist
• Why and how hospitals must charge to get adequately reimbursed for CAR-T and other expensive therapies, drugs, and services
• Site neutral payments. Why should hospitals be paid multiples of the same procedure done at an ASC down the street? There are reasons…
• Fighting back against payer denials of packaged/bundled services
• Best practices for commenting to CMS and making your voice heard
Finding your Ikigai: Nicole Fox on the art of balance amidst trauma
During my last conference as ACDIS Director in Oct. 2021 I had the pleasure of introducing Dr. Nicole Fox as our opening keynote. Nicole is not a professional lecturer but delivered one of the most impactful and inspiring speeches I’ve seen, covering her work as a pediatric trauma surgeon and her challenges as a single mother raising four children.
Understatement: Nicole is an impressive human being. In addition to a heavy clinical rotation, she’s the Associate Chief Medical Officer, Associate Professor of Surgery, and the Medical Director of pediatric trauma for Cooper University Hospital, a level 1 trauma facility in Camden, NJ.
Oh, and she also serves as Medical Director for the hospital’s CDI program.
Nicole is recently back from a World Trauma Congress in Tokyo and was married this year. We get caught up on all of this on this episode of Off the Record. We cover:
• Advances in trauma treatment and insights into Japanese culture and the philosophy of Ikigai
• A “typical” day in pediatric trauma—instructive for any CDI professionals who might be grumbling why queries aren’t always answered timely
• Nicole’s inauspicious path to CDI (she was one of the worst documenting physicians in her organization, with a number of outstanding charts so large you have to listen to believe) and unlikely path to medical director of CDI
• Vendor shortcomings—overpromise and under-delivery
• Mortality reviews—getting started, common clarification opportunities, and the delicate dance of querying a physician to provide further detail on an expired patient
• Recent domestic changes
• Her favorite song for the OTR Spotify playlist, and our personal encounters with Steven Tyler of Aerosmith (hers is much, much cooler than mine)
Books mentioned on the show include:
• Ikigai: The Japanese Secret to a Long and Happy Life, Hector Garcia and Francesc Miralles
• Ichigo Ichie (same authors)
• Wabi Sabi, Beth Kempton
The obstacle is the way: The art of overcoming challenges with WVU’s Dawn Diven
It’s not easy moving into Clinical Documentation Integrity as a new nurse or coding professional.
But now imagine what it’s like if you’re from Maryland. And it’s 2006.
These were pre-ACDIS days, in a state which used APR-DRGs.
In other words, no best practice, little information, and no real community.
But Dawn Diven, Enterprise System Director of Clinical Documentation Improvement for WVU Medicine, is used to taking on difficult challenges—and overcoming them. And she’s got a track record to prove it.
Which you’d never know because she’s also humble and down to earth as they come.
On this episode we discuss:
- How one survived (and thrived!) in CDI in the stone age that was 2006, in Maryland of all places. Hint: Networking is key.
- Dawn’s career progression and leap into leadership in 2016
- The lay of the land at an ever-changing WVU program: Implementing assistive software (a two-year process from approval to adoption!) and a CDI career latter
- The struggles of being an early adopter of outpatient CDI
- How to build a business case: Where to start, how to do it, and Dawn’s secret sauce for 100% success rate, to date
- A revealing look at some of her struggles and failures
- The difficult reality and compromises inherent in leading a team
- A classic rock hit that I can’t believe didn’t make the OTR Spotify playlist ... until now.
Remote but closer to home than ever: Kim Higgins on the rewards of at-home CDI work
Most people envision and expect careers to follow a straight line, gently upwards and to the right, in one direction. Once you’ve found the type of work you want to do you get promoted as high as fortune and talents will take you, until the day you retire.
Kim Higgins is an exception to this rule.
A year ago Kim was serving as the interim CDI director for AdventHealth West Florida Division, a massive health system (West Florida has 13 hospitals alone). Her responsibilities included day-to-day management but also helping build a case for new staff, demonstrating ROI, and growing the department.
That was in 2022, not so very long ago.
Today you’ll find her working as a remote CDI specialist reviewer for Valley Medical Center, a small, standalone acute care hospital located in Washington State.
And she couldn’t be happier, because it was the right move for her.
We get into the reasons why and much more on this episode of Off the Record.
On this show we cover:
- Her motivations and reasons for leaving leadership
- A day in the life of a remote CDI professional
- Impacts on her personal and professional life, pro and con
- West coast vs. Southeast chart reviews—there is a difference
- Kim’s non-traditional career path into CDI (Cub Cadet?)
- Discovering what really matters in work, and life
Walking the leadership tightrope: Meet Sheri Blanchard, Senior Director CDE, Orlando Health
To be an effective leader you have to have a vision and be willing to implement changes that disrupt the status quo.
But you also have to involve your team, and use diplomacy to obtain buy-in. In short, be a team player with a little bit of swagger.
It's a delicate dance, but it describes the tightrope Sheri Blanchard, Senior Director of Clinical Documentation Excellence and Revenue Management, had to walk.
And she did so skillfully. After taking over the Clinical Documentation Excellence program at Orlando Health in 2018 as a new leader Blanchard put her own unique stamp on the program--all the while recognizing her team is everything, and involving them at each step.
On this show we cover:
• The Clinical Documentation Excellence (CDE) program at Orlando Health.
• Arriving at the organization as a new face in 2018, seeking to make change
• A day in the life of a busy senior CDI director covering 11 facilities
• Orlando Health’s unique DRG reconciliation process, which includes a dedicated resource and final assignment authority given to CDI
• Out of the box CDI work including monitoring long LOS patients and patients that flip to observation
• Advice for new CDI leaders
• The most metal entries on the OTR playlist to date (Sheri likes AC/DC, GNR, etc., which automatically makes her cool in my book)
A first year for the record books: Catching up with Wellstar’s new Executive Director of CDI
Few CDI professionals are rising as fast as Faisal Hussain, Executive Director of CDI at Wellstar Health System in Georgia.
Fewer still have come as far as he has, both literally and figuratively. A foreign medical graduate and native of Pakistan, Hussain has risen up through the ranks in a remarkable career in healthcare.
In his current role he is responsible for overseeing the CDI strategy and operations for the entire Wellstar health system, comprised of nine hospitals and more than 300 medical offices, as well as cancer centers, rehabilitation centers, hospice facilities, and urgent care locations.
It’s a huge task and he recently completed a firehose of a first year with the organization.
But in case that didn’t keep him busy enough, Hussain this year also ran for and was elected to the ACDIS advisory board, in addition to serving as a member of the ACDIS leadership council and the ACDIS regulatory committee. And he’s done it all with kindness and humility while raising a young family.
On this show we cover:
• A day in the life of Faisal Hussain, Executive Director of CDI
• WellStar’s CDI strategy and metrics for success, including a focus on chart touches that matter and a proactive rather than reactive approach to chart review
• Recent wins (build and pilot of a promising homegrown EHR documentation tool) and struggles as a new leader and new(ish) dad seeking better work-life balance
• An unlikely and winding path from graduate of Aga Khan University in Karachi, Pakistan, to MD, and finally to CDI
• Winning the organizational Diversity in CDI award at the 2023 ACDIS conference, and his own prior experience with discrimination
• His favorite classic pop or rock song (because, it’s Off the Record, duh). I refused to bend on “Baby Shark.”
Lighting a CDI fire with Tom Brazelton, CDI medical director UW Health
News flash: Many (most?) physicians aren’t on board with CDI initiatives and coding practice. It’s understandable; they’re busy with patient care, and in their remaining hours are swamped with chart completion. Answering clinical queries and documenting with greater specificity is either seen as a chore or falls by the wayside entirely.
Sometimes it takes real-world impact to make the lightbulb go off and touch a match to tinder.
Tom Brazelton, MD is a practicing pediatrician and the CDI medical director for UW Health in Madison, Wisconsin. His passion for CDI was ignited by seeing how documentation and coded data was reflecting on organizational quality (and not in a good way).
So, he decided to get involved.
Brazelton helped a fledgling program comprised of four CDI professionals grow to more than 35 FTE across four hospitals, all while achieving a 98% physician response rate. His story of how achieving buy-in looked in a long-ago orthopedic surgery meeting is worth listening to alone.
Today CDI is in his blood. Brazelton was recently given an organizational award, “Superheroes in Scrubs,” for his efforts, and he now makes the ACDIS conference a regular stop.
On this program we cover:
- Dr. Brazelton’s journey into clinical medicine, a day in the life of a PICU physician, and his path into CDI
- The UW CDI/coding program today, including staffing and metrics, successes, and ongoing challenges
- A counter-narrative to the belief documentation leads to provider burnout
- A compelling vision for the CDI professionals of tomorrow
- And of course, his top classic rock hit
Antarctic Anecdotes: The real-life adventure of ex-CDI physician advisor Howard Rodenberg
There comes a point in our life when we all need to take an adventure. For most that means a vacation to an exotic faraway continent. For others, that might mean taking a new job, or changing careers altogether. Or starting a family.
All of these are adventures of one sort or another. All are wonderful.
But then there is Howard Rodenberg.
Howard decided at age 60 to take a real-life adventure. To the South Pole, where today he is serving as a physician at the Amundsen-Scott South Pole Station with the U.S. Antarctic Program.
Prior to this monumental decision Howard served as a physician advisor to the CDI program at Baptist Health in Jacksonville, FL, and chaired the ACDIS regulatory committee. And took adventures of the mind playing the fantasy role playing game Dungeons and Dragons. All of which immediately endeared me to him and led to this interview.
On this episode (conducted tenuously via satellite link) we cover:
• Why do this? What did your family think?
• What does an average day look like? Have you had any medical emergencies?
• Do you spend much time outside? Can you?
• What’s the hardest part about life in the South Pole and what don’t most people understand about the conditions and isolation?
• Do you have to document and code your work?
• What have you learned about yourself?
• What’s the first thing you’re planning to do upon your return?
While there is not as much CDI, coding, and health records management talk as you’d find on an ordinary episode of OTR (although we do get into this, and CDI may be part of Howard’s future plans), I guarantee you’ll be inspired by his story. And possibly find the courage to take an adventure of your own. Even if it doesn’t lead to the South Pole.
Back from ACDIS, talking value-based care and outpatient CDI with Jason Jobes
After a short break that was not really a break because we were on the road at ACDIS 2023 we're back with another episode of Off the Record.
Today I’m joined by fellow conference-goer, presenter, and colleague Jason Jobes, senior vice president of solutions at Norwood.
On this show we dive into the recently concluded ACDIS 2023 national conference in Chicago, which was my 15th (yes, I’ve been to every single one from 2008-present, not including the virtual event of 2020, and I think I’m the only person on the planet who can say this) and Jason’s first. We had a blast, learned a lot, and came back recharged and optimistic for the future of the CDI profession. I also had the honor of remembering my colleague Melissa Varnavas with a Day 1 keynote.
We then switch gears to outpatient CDI and the ongoing transition to value-based reimbursement with a focus on Jason’s session from the ACDIS Outpatient Symposium, entitled The Importance of Risk Adjustment in Value Based Settings.
We cover the following topics:
- Payer relationships, and how CDI and coding leaders and their respective organizations should approach payers with whom they have had (and likely still have) an adversarial relationship, but now find themselves in a shared savings agreement that rewards cooperation.
- The importance of patient scheduling, including leveraging your case managers, social workers, and population health team to get patients in to be seen. Both to manage their health in less expensive settings but also to capture risk. Annual Wellness Visits can play a large role here.
- What if you don’t have an OP CDI program? How to figure out where your opportunities lie and where to start. Hint: It’s about understanding and seeing your patients, knowing what risk program they are in and what clinical conditions they have, and seeing them at least annually. And monitoring process and outcome metrics to ensure that patient complexity is fully captured.
- The Medicare Advantage 2024 Advance Notice final rule and the anticipated impact of the transition from V24 to V28 of CMS-HCCs over three years (2024-2026).
- The current landscape of intense regulatory scrutiny, and the corresponding shift from revenue maximization/capture to compliance and revenue protection. We discuss Jason’s recent series on LinkedIn analyzing the seemingly endless stream of OIG audits of Medicare Advantage payers on presumed overcoding, including ongoing patterns of (likely) error.
And of course, we discuss Jason’s top 90s rock/pop hit. He's a little younger than me so I let him get into the music of his youth, rather than mine—the 80s. Against my better judgement.
Payer perspective: A conversation with Colleen Gianatasio
CDI and coding professionals typically recoil from the dreaded word, “payer.” After all, provider-payer relationships are often adversarial at best, hostile at worst. Clarify the diagnosis or procedure with the physician, apply the medical code … only to have the payer downcode or outright deny the claim.
My guest on today’s podcast understands the frustration because she once worked in the hospital setting. Today she works on the payer side.
But here’s where things get interesting.
New hospital-insurance plan arrangements, often in the context of Medicare Advantage contracts, require partnership rather than combat. And if all goes well, the beneficiary is the patient.
At least, that is the belief of Colleen Gianatasio. Colleen is the Director of CDI and Coding for Capital District Physician’s Health Plan. On the show we discuss:
- The changing landscape of healthcare reimbursement, from fee-for-service to capitated, pay-for-performance models
- The intersection of coding and CDI with quality, and how the work of CDI professionals can improve star ratings
- Today’s highly charged regulatory environment of OIG Medicare Advantage audits and CMS enforcement: How did we get here, and digging out for a better tomorrow
- Common compliance vulnerabilities from the perspective of a payer
- Provider education strategies
CDI-ing like its 1999: A conversation with Atrium Health Wake Forest Baptist director Tamara Hicks
How long have you been in CDI, oh listener?
Three years, five, 10? Maybe as many as 16, if you started back when CMS adopted MS-DRGs and ACDIS began, in the hazy, pre-Tik-Tok days of 2007?
My most recent guest on Off the Record has been in CDI for 24 years, starting in 1999. Longer than she served at the bedside as a nurse. It’s possible some of my listeners are 24.
She’s been there, done that, but still driving her program forward, never settling.
Tamara Hicks is the Director of Clinical Documentation Excellence at Atrium Health Wake Forest Baptist in Winston-Salem, North Carolina. She's a two-time member of the ACDIS advisory board, served on the ACDIS CCDS certification committee, and in 2019 won CDI professional of the year from that organization.
She's also acquired the nickname Grandmother of CDI. So it behooves us to listen to her wisdom.
We get into that deep pool of wisdom on this episode of Off the Record, covering the following topics:
- What was life like for a CDI professional in the 20th century?
- A day in the life of Tamara Hicks and the Atrium Health Wake Forest CDI department
- Is there such a thing as “advanced CDI”? If so how do you define that, and practice it?
- Career ladders for staff retention
- What is the ideal CDI candidate (if you could clone one, who would they be)?
- Much more, including Tamara’s family of dogs, cruise obsession, and favorite classic rock hit
Legal eagle: Healthcare denials through the eyes of Sarah Mendiola
Denials are a reality of life in the mid-revenue cycle. And they're not going anywhere. As Medicare Advantage (MA) grows—MA Organizations statistically deny more care than traditional Medicare—the volume of denied claims will only keep growing.
I wanted to talk about this subject with someone who not only understands the current mine-filled landscape, but knows how to overturn a denial like a lawyer—because she happens to be one.
Sarah Mendiola is the senior vice president of denials management for CloudMed. She is an attorney admitted to the Maryland State Bar and a former attorney for Washington and West, LLC. Her background includes a 10-year stint as an LPN for Mercy Medical Center in Baltimore. She also served in the U.S. Army.
Coupled with coding and compliance credentials, Sarah brings a unique clinical/coding/legal perspective to the subject. One I think you’ll find compelling.
How many of you have had the opportunity to see inside an Administrative Law Judge (ALJ) hearing? Sarah has. We get into this and much more on the podcast, including:
- The secret to a great denials management strategy
- Current “soft targets” for auditors
- Preventing denials with proactive documentation strategies
Banner Health’s Jami Woebkenberg: Managing the constant changes of modern healthcare delivery
“The pessimist complains about the wind. The optimist expects it to change. The leader adjusts the sails.” – John C. Maxwell
It’s been said that there is no constant in life except for change. Jami Woebkenberg is proof.
Jami is the Senior Director of HIM operations at Banner Health. Or at least, that’s her title now. She has had a few twists and turns over 19 years at the organization, which recently acquired a couple hospitals and clinics and added them to the system’s EMR last September.
Banner is HUGE. Headquartered in Phoenix, AZ, today it operates in six different states and employs more than 52,000 team members across a dizzying array of services including insurance, ambulatory health centers, urgent care, acute care including three academic hospitals, behavioral health, children’s post-acute services, pharmacy, labs, telehealth, and more.
It also employs 3,300 staff in revenue cycle alone, of which some 400 ultimately report up through Jami.
To put this all in perspective, when she started 19 years ago Banner had one hospital implementing one EMR.
“Banner is a constant state of growth,” she says, which means a lot of change and a daily dose of the unexpected. For example, Banner recently re-orged, splitting up coding, CDI, and HIM operations into three separate verticals, which changed her job completely.
Jami is now knee-deep in records management, release of information, records storage, and EMR management including data integrity audits, information blocking, SDOH, privacy and security.
She’s survived it all with a great attitude and a mindset shift, which we get into on this episode of Off the Record. We cover Jami’s strategies for change management at a basic blocking/tackling level, including establishing a change management team and communicating changes to impacted stakeholders including physicians.
We also cover her helpful personal routines (morning walks), tips and tricks like calendar blocking and meeting free times, managing life-work (not work-life) balance, and strategies for introverts in leadership positions (introverts unite!). Jami recently served on the Board of Directors at AHIMA and is a past-president of AZHIMA, which meant she had to get comfortable speaking in front of crowds, in a hurry.
Enjoy the episode.
What Would Nick Do? On building relationships and rebuilding a life, with Mike Behringer
When I started Off the Record, I wanted to launch a program that served the broader industry that serves the health record.
That means, most of my guests work in the HIM/coding, CDI, case management, and trauma/oncology registry fields. But I also host folks who support the mid-revenue cycle—consulting, staffing, sales, legal, tech, and from time-to-time, members of my own company. And share their personal stories, too.
On the latest episode of OTR Mike Behringer and I start with his unique take on “sales.” I put that in quotes because it’s a word he doesn’t care for all that much, at least in the context of his work.
Sales is a transaction where a product is exchanged; what Mike does is foster partnerships, with humor and personality.
There is something to learn from his approach, whether or not you’re in “sales.” We’re all in the business of building relationships and forging partnerships.
We then switch to a very different, more painful, and personal subject—the tragic death of his son, Nick, age 21, in 2016.
If you follow Mike you know he drops the acronym WWND—What Would Nick Do—into his regular rotation of posts. But if you’re like me, you also never heard what happened that terrible night that stretched into long unknown hours, ending in the worst possible outcome. Or how Mike has rebuilt his life over the last seven years.
We get into this on the show.
I found myself at a loss for words, but was also inspired by how Mike has shown tremendous resiliency and continues to keep his son’s name and spirit alive in his work today.
I think you’ll find something in this episode that resonates.
Boston strong: Climbing the U.S. News and World Report Best Hospitals rankings with CDI Director Deb Jones
Since taking on the CDI director role at Brigham at Women’s Hospital in October 2017, Deb Jones has made big changes with big impact. These include:
- A deep focus on risk adjustment and mortality reviews. Boston is an incredibly competitive healthcare environment with 25 hospitals operating within the city. Patients have a choice of where to shop for care, which makes rankings in the likes of U.S. News and World Report absolutely critical for survival. In a 2022, Brigham made the honor roll by grabbing the no. 14 spot in the country on that list.
- Doubling the number of her staff, to 20 CDI professionals between Brigham and Women’s and affiliated Faulkner Hospital. And then retaining them… forever. Jones has yet to lose a single staff member (two that did leave have since returned).
- Getting after it in general, with provider education, new CDI software, and an engaged team that issues 2,000 queries a month.
Deb is a success (in my opinion) because of her positive, engaged, and friendly managerial style, coupled with her close connections to the c-suite, including the CFO, and her ability to tell the right story with the right metrics. If you’re a leader in this space, or an aspiring HIM or CDI professional looking to learn from someone with a track record of success, she’s worth listening to.
We get into all of this—risk adjustment, metrics and reporting strategies, staff retention, leadership, and relationship building—on the latest episode of Off the Record.
We also use the word “synergy” a bit too much for either of our liking. But, we recover with some good talk about the Boston restaurant scene, the importance of happy hours (yes, I invited myself on air—awkward), and music too, including her son’s music career after graduating from the Berklee College of Music.
Always learning, always growing: Meet Keisha Downes, CDI Director, Tufts Medicine
CDI Director for Tufts Medicine.
Recently went back to school to earn her MBA.
Contributor to, and co-author of, the latest ACDIS-AHIMA physician query practice brief.
Speaker at the upcoming ACDIS conference.
And all-around cool person.
Keisha Downes, BSN, RN, CCDS, CCS, joined me recently to talk about her impressive career in healthcare, a path that started from humble beginnings at Wal-Mart, then to nursing, travel nursing, and finally CDI, which took her from her home state of Virginia to my home state of Massachusetts.
Today Downes serves as CDI director over a 3-hospital system and a staff of 21. She constantly challenges herself to learn and do new things, and is constantly learning and growing as a result.
We get a bit into her ACDIS session, CDI Mortality Reviews: Going Beyond SOI/ROM, as well as Tufts’ metrics for success and mortality review process. And a little bit about a session I plan to deliver at ACDIS about my former colleague, the late Melissa Varnavas.
We happen to share a similar love of 80s hard rock, which was an unexpected surprise. Downes’ CDI oversight includes Melrose-Wakefield Hospital, the place where I was born—another surprise. Which often occurs when speaking with my guests.
Come to think of it, I wonder if my mom’s admission and my delivery was given a proper CDI review—probably not, this was 1973. Pre-DRGs, pre-EHR, almost pre-electricity.
An EPIC discussion with Chris Petrilli, MD: Talking CDI, COVID, AI, and more
Chris Petrilli is the Medical Director of Strategic Initiatives and Operations at NYU Langone Health. He’s an Associate Professor of Medicine at the NYU Grossman School of Medicine.
… and he happens to have been a one-time stand-up comedian, whose gift for gab and comedic timing I can attest to. And may have been on the butt end of, a time or two.
We get into all of this on a memorable episode of Off the Record.
One of the reasons I started this podcast was to bring more people, personality, and color into an industry dominated by sober and serious discussions on clinical and coding and compliance concerns. As it should … but behind the numbers are people, too.
Chris is a hospitalist who administered live-saving care at the height of the COVID-19 pandemic, at the epicenter of the outbreak in New York City in the spring of 2020. We talk about his experiences during that scary, wild time.
The NYU Grossman School of Medicine is one of the most heartwarming and uplifting healthcare stories of which I’m aware, offering full-tuition scholarship to all current and entering students in its MD degree program. We talk about his experiences teaching young residents in this incredible environment.
And of course, we talk CDI and coding. Chris spearheaded a project to modify EPIC to capture diagnoses at the point of documentation, bypassing the need to invest in expensive CDI software. His lessons on maximizing the tools you might not realize you already have at your disposal are worth listening to.
We discuss what a CDI professional of the future looks like, what skills they will need to succeed, and why AI still greatly lags human intuition.
Since this is OTR we wrap up with some classic rock talk. And Moonwalking. Seriously (or not so seriously).
I’m a believer in authenticity at work and Chris brings that, and more. Enjoy!
“You need to have a vision”: A conversation with Adelaide LaRosa, VP of HIM, CDI, EMPI, and DRG Appeals, Catholic Health
You’ll find few CDI/coding personalities as big and colorful as Adelaide LaRosa—and fewer still with a broader and bolder vision for what mid-revenue cycle professionals can do, and should do, to improve the quality and financial health of their organizations.
Catholic Health’s VP of HIM, CDI, EMPI, and DRG Appeals reordered the entire heart of coding, compliance, and reimbursement at the six-hospital system in New York, consolidating HIM and CDI into a seamless team led by three system director positions that, at the time, did not exist.
On this show we discuss:
- The all-encompassing role of CDI professionals at Catholic Health, whose responsibilities include concurrent review, concurrent coding, charge capture, and more
- The Enterprise Master Patient Index and why it’s so important
- Organizational restructuring and securing corporate buy-in—how Adelaide transformed her system with a bold vision, married with bold questions, curiosity, and diplomacy
- Warm inheritance, and why I’m going to eventually do the same with my kids
- 2023 goals, and her favorite late 70s hit song (hint: it's about survival)
Today at 60 LaRosa remains as vibrant and passionate about her career as ever, but with an eye on succession planning and preparing the next generation of leaders, to whom she wants to not only pass on the proverbial torch, but like her, be prepared for bold action and realizing colorful visions of their own.
Enjoy the episode!
2022 in review, 2023 look ahead—and a whole lot in between
For our final episode of 2022 we’re going off the record (even for Off the Record) with a couple interesting guests you may recognize from Brian’s home base at Norwood.
This week we’re joined by CEO and Founder Justin Satterfield, and VP of Consulting Jason Jobes.
As you might expect at the holidays the conversation is reflective, expansive, and personal. We look back at some of the common themes shared by Brian’s guests, including the importance of mentorship, discussing mentors who have made a difference in our own lines. Our conversation includes a look inside the inner workings of a company striving to make a name for itself in the mid-revenue cycle by doing things differently. Learn what we’ve been up to in 2022 and what we’ve got planned for next year.
Personal stories, startling admissions, hard-earned life lessons, trials and rewards of entrepreneurship, struggles of maintaining work-life balance—you’ll get it all on this special year-end episode. Join us as we put a cap on season one of Off the Record.
Enjoy the listen, and the holidays!
Little-known profession, big organizational impact: Ren Garcia on the ins-and-outs of a career in cancer registry
What the heck is a cancer registry professional?
How can they impact quality (and even revenue, indirectly) in your hospital?
And why do Harley Davidson and Indian owners despise each other (and is it possible to like both brands)?
If you’re at all curious about these incongruous questions, the latest episode of Off the Record has answers.
This week I’m joined by the one and only Ren Garcia, Oncology Data Manager and Registry Quality Analyst for Norwood. We cover:
Why your hospital needs oncology and trauma registry professionals
The CTR (Certified Tumor Registrar) credentialing exam—what it is, what the test is comprised of, and why this profession might be a calling for you
Why Maine is such a great state (beer and lobsters? Enough said.)
Motorcycles and the motorcycle lifestyle
This is probably the most fun I’ve had hosting an episode of Off the Record, and is definitely the most I’ve learned while conducting an interview (I knew nothing about the cancer or trauma registry professions prior; now I do, and I’m a fan). Ren has an infectiously likeable personality: Warm, talkative, curious, and above all, interesting, with an utterly unique origin story. When Ren’s father suffered a debilitating injury she found herself needing to step in and run his fencing company, a young woman with no management experience in a male-dominated industry.
Not easy, but that experience helped shape who she is today.
We cover all of these stops, spanning an interesting career with many unexpected detours and turns. Eventually leading to a career that seems tailor-made for Ren Garcia: One you can’t imagine her not doing.
So, listen in. Learn something new, have some fun. This episode goes off the record, even for Off the Record. Then get your motor running, and head out on the highway. Just maybe not to Maine this time of year though, a bit cold for that.
RN and HIM can get along, after all: Meet Rebecca McDade and Andrea Smith
HIM professionals and nurses can get along, after all.
There has long been a divide in the clinical documentation integrity (CDI) profession over who can/should serve in the CDI role. Though it has lessened with the passing of years, that divide still exists today.
Recent ACDIS survey data shows that 72% of CDI professionals are nurses. Nothing wrong with that; nurses make wonderful CDI professionals. But I know of many fine CDI professionals with HIM/coding backgrounds who have also succeeded in the role. As well as MDs, even the occasional respiratory tech or CPHQ.
With this episode of Off the Record I wanted to prove that an RN and an RHIA can not only exist side-by-side, but get along, quite amicably. As friends, even.
Turns out I did not have to look far or dig too deeply.
At a reception at the ACDIS national conference earlier this year I ran into Andrea Smith and Rebecca McDade. I made my way over to their table, and a half hour of conversation (and a bit of wine) later, invited them on to a podcast that did not yet exist, except in my mind. What struck me was that they were friends, despite their very different backgrounds.
Five months later I had them on Off the Record. And can now bring you this show, and revive a part of the conversation we had that evening at ACDIS.
Andrea is the CDI Director at Washington Regional Medical Center in Fayetteville, Arkansas, a nurse who moved into CDI eight years ago. Rebecca meanwhile is Director of Revenue Cycle Integrity for the same organization, and an RHIA. Despite their differences they work very well together, complimenting each other’s unique strengths and skills in adjacent roles (note: Rebecca is not directly in CDI but works closely with that department).
We cover the lay of the land at Washington Regional Medical Center, including the staffing of its CDI and coding programs, metrics for success, and assistive software. Then a day in a life of each, their roles and responsibilities, and respective origin stories.
Things get interesting when we talk about the historical RN/HIM divide, how they’ve bridged that gap, and the unique strengths each profession brings to the table (this starts at about the 37-minute mark of the show).
Hosting this conversion reinforced that we can get along, at least some and perhaps most of the time, if we’re willing to acknowledge differences and be generous. Andrea and Rebecca are proof.
Hospitalist, family man, CDI guru of MedTwitter... Meet Robert Oubre, MD
Twitter is an … interesting place right now, due to the purchase of the platform by the lightning rod known as Elon Musk.
Love or hate the platform, there is some great content being produced in some corners. Light, rather than heat. Which speaks to me.
One such lantern-bearer in the storm is Dr. Robert Oubre, my guest on this week’s episode of Off the Record.
Dr. Oubre is a hospitalist and part-time CDI medical director for 280-bed St. Tammany Parish Hospital in Covington, LA. He’s up to his neck in patient care, and to a lesser degree CDI and coding issues.
But what really makes Dr. Oubre unique is the social media following he’s built. And not through Tik Tok dance videos or cutting memes, but sharp, well-written threads on Twitter. Material that includes 3 tips for writing a better SOAP note, which as of today has received over 5,000 likes. Bulletproofing your respiratory failure diagnosis. And simple, effective strategies for combatting denials.
Mixed in among the education are fun and revealing personal posts about family (Oubre is a father of two, and a third child on the way), work-life balance, burnout, self-development and more. Which makes it all feel real and personal, and well-rounded.
As a result of his generosity and ability, this “CDI guru of MedTwitter” caught my attention. As it turns out he was a terrific podcast guest as well. And accommodating. He’s a busy dude, with a full patient caseload, a family, and a growing online presence. When I needed to reschedule our first recording after experiencing my first case of COVID (whose aftereffects I’m still battling) Dr. Oubre made it happen.
If you’re looking to build a brand, publish good content, and explore a side-hustle, this episode has all that in it, too.
I think it was worth the wait. I’ll let you decide. Subscribe and listen on your favorite podcast player (Spotify, Apple Podcasts, Amazon Music).
Follow Dr. Oubre on Twitter: https://twitter.com/Dr_Oubre
A football mindset, delivered with a nurses’ caring: Meet Robin Jones, Executive Director of Clinical Excellence, AdventHealth
What prompts a nurse working at the bedside to get into clinical documentation integrity (CDI)? Long, draining shifts, and burnout, are among a few that I’ve heard. Others include a desire to put their clinical acumen and physician communication skills to work in a different, less physically demanding capacity, but one that still engages the intellect.
Robin Jones’ origin story is one worth hearing. It’s powerful, the most moving I’ve heard of to date on Off the Record. I won’t spoil it any further, you’ll have to listen yourself.
This was a great interview. I’ve known Robin for many years, and we get into some good topics and conversation.
While the move these days is toward 100% remote CDI and coding, Jones, Executive Director of Clinical Excellence for the 13 hospitals in the West Florida Division of AdventHealth, spearheads a quality-focused program, one that places a particular focus on Leapfrog and other quality measures. To help with these intensive initiatives, its CDI program is hybrid and maintains an onsite/physician-facing component.
Although she’s left the bedside behind Jones has not abandoned nursing—far from it. In fact, she oversees all clinical education in the organization’s West Florida division, including its graduate nurse residency program. She is actively giving back to the next generation of caregivers.
We cover her decision to pack up and move halfway across the country, from Ohio to Florida. That decision meant a minor recent brush with Hurricane Ian. We discuss introversion vs. extroversion (introverts—shout out!) and empty nesting.
Finally, Jones is a massive Cincinnati Bengals fan, who may or may not think Joe Burrow may be our nation’s president one day. Or maybe that was the host egging her on. I don’t recall.
What’s most interesting about Jones’ football obsession is not the Xs and Os, or painted game face, but the fact that she uses this great game to teach lessons and lead a diverse group of people. She offers up some great advice on leadership, giving me three bullets with practiced ease that each have a lot behind them.
Give episode 5 of Off the Record a listen, and please let me know what you think of this episode and the podcast in general. Guest ideas and other suggestions welcomed.
"I like unique. Tell me something I don't know." Meet Tracy Boldt, director of CDI and UM at Essentia Health
“I like unique. Tell me something I don’t know.”
That certainly describes this week’s guest.
Tracy Boldt is the Director of CDI and Utilization Management at Essentia Health in Minnesota.
Since September 2016 Boldt’s role has included providing leadership, direction and support in the development and management of CDI and UM at multiple Essentia Health sites. In this role Boldt collaborates closely with the utilization team, physician partners, and coding manager system wide.
Recently she helped implement a successful outpatient clinical documentation improvement program with an emphasis on Accountable Care Organization (ACO) partnership, risk adjustment, and population health.
Tracy’s path into healthcare did not follow a straight line. Admittedly she was not the most dedicated student. She started as a hairdresser before she got (mostly) serious, and healthcare became a calling.
We review Tracy’s career stops in nursing, CDI, a detour into consulting (for a firm, and then launching her own personal company), and her current entry into Essentia.
Tracy also has a rich personal life. I’ll go ahead and plug Cedar Point Resort and Campground, not only because I’m hoping I can parlay some free advertising into a discounted cabin, but it’s also an incredibly interesting chapter in her life that has broader applicability to effective project management and staff leadership.
If you want to learn how to succeed in a challenging role, listen to people that struggled and overcame adversity. And then, having succeeded, have refused to settle, but continue to seek out new ways to create impact.
That certainly describes Tracy.
Oh, and we discuss KISS. Everyone’s favorite face-painted 70s rockers. Talk about unique.
From meeting planner to medical coder ... meet UC Davis' star director of CDI and coding, Tami McMasters Gomez
Tami McMasters-Gomez, BS, CCS-P, CDIP, CCDS, (MHL), is the Director of CDI and Coding Operations at UC-Davis Health in California. She has ultimate oversight of 80 employees, a team that is busy querying, coding, and abstracting data for a huge organization that includes its flagship 646-bed multispecialty academic medical center.
Tami is a bright light in the field in all respects, and the accolades have been rolling in. This past May she was given the Recognition of Professional Achievement Award from ACDIS at its national conference in Orlando, and the year prior her organization won ACDIS’ first-ever award for Diversity in CDI award, as well as similar recognition for its efforts in diversity from Forbes Magazine.
It’s hard to believe she ended up in this position after initially studying to be an event planner at Sacramento State University, majoring in marketing and communications and ultimately earning an event planning certification. But the world works in mysterious ways, and a part time job as a file clerk at a small rural hospital ultimately led her to health information management.
UC Davis Health is the real beneficiary of that decision. According to a 2010 study, UC Davis Health generates more than $3.4 billion in annual economic output and more than 20,000 jobs. The organization is ranked in 9 specialties in the U.S. News and World Report Best Hospitals—data that of course is derived, in part, from Tami’s work.
We cover Tami’s stops over 30 years in healthcare, including 17 (wow) in CDI. Along the way we discuss its outpatient CDI program roll out and current progress, UC Davis’ decision to discontinue DRG reconciliation (and why you might want to follow its lead), and also its strong commitment to diversity, both in the CDI/coding departments and organization-wide.
Get inspired by an HIM professional who is doing cutting-edge work and building a CDI department that is committed to diversity of race, gender, ethnicity, and professional backgrounds (RN, HIM, MD, and more).
We cover a lot more too, including the reality of CDI technology and how smart it actually is (UC Davis is a big adopter in this space, and is currently piloting provider-facing tech), tips and suggestions for progressing from coding into leadership, the importance of CDI-coding collaboration, and the usual fun asides.
Despite her considerable responsibilities Tami hasn’t given up on her event planning dreams, and is actively looking to buy a wedding venue in California. I can neither confirm nor deny if the weddings will be CDI themed. Stay tuned.
Take a trip with me to the west coast for episode 3 of Off the Record. I hope you enjoy it.
“To be a good leader you have to get your hands dirty”: Meet Angie Comfort, LifePoint Health
To say LifePoint Health is a large healthcare system is like saying Nashville has a few good country music bands. Per its website, LifePoint’s healthcare delivery network spans 29 states and includes 62 community hospital campuses, 33 rehabilitation and behavioral health hospitals, and more than 170 additional sites of care across the healthcare continuum including acute rehabilitation units, outpatient centers, and post-acute care facilities.
With that size and diversity comes incredible complexity and challenges. These include multiple EHRs (Epic, Cerner, MEDHOST, Meditech) and upwards of 16 different versions of said EHRs, including 9-10 versions of Meditech alone.
Fortunately Angie Comfort is there to help run the show.
How does she manage it all? How did she go from coal miner’s daughter in the Appalachian Mountains of Virginia (no relation to Loretta Lynn) to Assistant Vice President of HIM Operations where she oversees a staff of 300? And find time to work on her Doctorate’s in Business Administration, in progress? You can’t call her Dr. Comfort—yet. That’s coming soon.
We talk about an incredible career arc that has taken her from reviewing ER documentation for missing signatures, to outpatient coder at Stuttgart Regional Medical Center, to Community Health System’s very first coder at the corporate office (where she ultimately trained 600 coders in ICD-10), to Senior Director of HIM Practice Excellence at AHIMA, and finally to her present role.
With many fun side detours along the way, as I’m wont to do.
Angie has seen it all but is not stuck in the past—80s nostalgia aside—and thinks remote coding and CDI work has been a blessing for the industry. She talks about what got her to make the leap to leadership, including the help of a mentor. Hers is a story of paying your dues in a remarkable climb to the top—and using her influence to give back, including in her personal life with The General Federation of Women’s Clubs.
What is Angie’s EHR of choice and, just as importantly, what is her favorite Def Leppard song and first ever concert?
Tune in to find out.
CDI, denials, UM, and case management, under one roof? No problem. Meet Susan Fantin
Susan Fantin, MSA, BSN, RN, CCDS, CDIP, is the Vice President of Integrated Care Management for McLaren Health in Grand Blanc, Michigan.
A one sentence description that is a woefully inadequate descriptor of what she does.
All of CDI, case management, utilization management, and denials run through Susan’s capable hands. Think, massive responsibilities. A staff of more than 300. Every new initiative, including a recent system-wide reorganization that aligned case management and CDI under one roof, despite the obstacle of multiple EHRs. Impressive stuff.
We don’t know how she finds the time to sleep. She admits she’s working on that.
We talk about McLaren’s program and metrics for success before turning to her career and an early hair-raising nursing experience, her rapid ascent up the ladder at St. Joseph Mercy Health System, a detour into consulting and what it taught her, then present day challenges and the importance of mentorship.