Catapulting case management and CDI coordination
A physician admits a patient with dementia, yet provides no further definitive diagnosis. The CDI specialist recognizes the scenario as similar to a case reviewed the week before, so she reaches out to the case management (CM) team to see whether they have additional insight. The CDI specialist believes the dementia is due to the elderly patient’s inability to self-medicate appropriately, so CDI and CM bring the case back to the physician, who agrees and documents the additional information in the medical record. That documentation, in turn, enables the case management staff to recommend alternative discharge plans, including greater supervision of the patient’s medication intake.
That’s just one example of how beneficial open lines of communication between the CDI and CM teams can be. And while most CDI programs report to HIM, the 2016 CDI Salary Survey shows nearly 15% of the more than 1,000 respondents report to CM. There’s a synergy there, to be sure, but those managing CM and CDI programs warn against too much overlap and emphasize the need for collaboration, communication, and caution.
The CDI program at Jackson Madison County General Hospital began in 2008 with five staff members and a manager who oversaw both CDI and CM efforts, says Debbie Ashworth, BNS, MSHA, CM director there. Ashworth felt the program had plateaued after about three years; she knew it needed changes but wasn’t sure what exactly needed to be done. As the ICD-10-CM/PCS implementation date neared, Ashworth won support for additional CDI staff members and leveraged their efforts on educating physicians about documentation needs, increasing her staff to nine and adding a dedicated manager over each team.
In the beginning, CDI efforts were “a work in progress,” Ashworth says. CDI staff thought management only cared about CM issues, and the CM felt management focused more on CDI concerns. CM staff thought CDI nurses focused only on record reviews for optimizing coding data, while CDI thought CM only looked at length of stay (LOS) and inpatient admission criteria. They only saw the slim line of what they thought the other team’s principal function to be and “couldn’t see how it worked
together,” Ashworth says.
“Getting people to understand their contributions to the bigger picture is one challenge I struggle with,” says Anna Winkowski, who worked in outpatient CM in Chicago when CHRISTUS St. Frances Cabrini Hospital in Alexandria, Louisiana, offered her a job two years ago as manager of its CM and CDI department.
Back at Jackson Madison County General Hospital, each team now has the support of additional staff and direct managers. The teams hold monthly departmental meetings that provide an overview of everyone’s efforts. They reinforce the need to bring documentation deficiencies forward to the appropriate individuals as needed. The CM team asks CDI to help with physician education on repeat documentation concerns. The CDI team contributes information that might help ensure the accuracy of the LOS, as well as reviewing records for present on admission, hospital-acquired conditions, and other areas of overlap.
“The days of ‘this is my job and I don’t care what you do’ are over,” says Ashworth. “In healthcare, everything depends on everyone else. Be it transport or dietary or coding or case management or CDI, every bitty piece that everyone does matters. Being able to hear what each other does and how it matters helps us all.”
Editor's note: For the full version of this story, see the December 2016 issue of CDI Journal.