acdis day2-13 track2-7 pres 0517-esquibel willmer-f · • enterprise for learning and personal...

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Natalie Esquibel, MS, BSN, RN, CCDSProgram Manager of Clinical Documentation Integrity Education

Carrie Willmer, BS, BSN, RN, CCDS, CDIPCDI Compliance & Data Manager

Sisters of Charity of Leavenworth (SCL) Health SystemDenver, CO

Cracking the Code for Clinical Documentation Excellence: Training New CDI Specialists Using the Criterion Referenced Instruction Method

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Learning Objectives

• At the completion of this educational activity, the learner will be able to:

– Apply general concepts of the learning method, Criterion Referenced Instruction

– Explain the value of using the instructional method to train new clinical documentation specialists

– Describe how the content is set up within the curriculum

– Illustrate how metrics are used to evaluate the new training program

– Discuss successes and challenges of the new training program

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2017 Copyright, HCPro, an H3.Group division of Simplify Compliance LLC. All rights reserved. These materials may not be copied without written permission.

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Polling Question #1

• How does your CDI program train new CDSs?

– We send them to a Boot Camp

– A consulting company comes to our site

– We use our own internally developed materials

– We use a combination of the above methods

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Background

• SCL Health’s CDI team

– Centralized team reporting to system VP HIM

– Leadership: CDI director, CDS manager, CDI manager data & compliance, CDI educator, audit/denial, and CDS/coder

– CDI teams at 7 care sites: Colorado, Montana, Kansas

• SCL Health strategic initiative

– Leverage skill, scale, learning

• Design/implement new clinical documentation initiative

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Collaboration

• Enterprise for Learning and Personal Development (EL&PD)

– The 2016 CDI training program redesign effort is strategically aligned to further SCL Health’s strategic priority: leverage skill, scale, and talent, and will be designed to:

• Ensure a consistent and high‐quality learning experience for CDSs

• Close knowledge gaps related to clinical documentation integrity standards and practices—to include strategies, priorities, processes, resources, tools, and behaviors to ensure best practices and alignment across the enterprise


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Criterion Referenced Instruction (CRI)

Need is identified Need is identified

Analyze need

Analyze need

Performance analysisGoal analysisTask analysis

Select solutionsSelect

solutions

May include:InformationFeedbackJob aidsTask redesignPerformance managementProcess Improvement

Design/develop non‐training solutions

Design/develop non‐training solutions

Is instruction part of the solution?

Is instruction part of the solution?

YES

NO

Monitor/ improveMonitor/ improve

Derive outcomesDerive

outcomesDesign/develop instruction

Design/develop instruction

Implement instructionImplement instruction

Course objectivesSkill hierarchiesTpop. descriptionprerequisites

Criterion testsRelevant practiceContent derivationDelivery system selectionModule drafting TryoutSequencing

Course proceduresGetting readyImplementing instruction

From “Making instruction work or skillbloomers: A step‐by‐step guide to designing and developing instruction” by Mager, R., 2012. Copyright 2012 by Mager Associates, Inc. Reprinted with permission.

Course improvement

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CRI: Top 3 Characteristics That Leverage Performance Results

• Three‐part objectives (condition, performance, & criteria)

– Clear direction

– Provides performance expectations from the start

– Set leaner up for success

• Content is derived from the job

– Real, not theoretical

• Practice and skill check

– Safe environment

– Learner will leave feeling competent and confident

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Project Plan

• Analyze, recommend, and implement revisions to the current CDS training program to increase its effectiveness and efficiency in the following areas:

– Adult learning applications

– Performance‐based training with practice and skill assessments

– Delivery and administration

– CDS performance during and after training


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Projected Benefits

• Improve CDS time to proficiency

– The goal of this project is to reduce the time to proficiency

• Increase CDS performance

– The goal of this project is to increase the level of CDS performance post‐training as compared to current, baseline levels

• Increase efficiencies and decrease costs

– The goal of this project is to reasonably optimize the use of available technology to increase efficiencies in training delivery and reduce the travel time and costs of the CDI educator

– An additional goal is to optimize the CDI educator’s time to support ongoing education and development of current CDSs

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Training Recommendations

• Enhancements to the existing CDI training curriculum:– Group learning activities around job tasks

– Increase controlled practice and simulation

– Pursue efficiencies in training delivery

• For each job task, develop:– Performance objectives

– Performance‐based practice activities

– Skill checks (assessments for each task)

– Participant guides (self‐paced lesson content)

– Preceptor guide (administration instructions for leads)

– Educator guide (administration instructions for educator)

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Cracking the Code for Clinical Documentation Excellence (CDE) Curriculum


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Course Map

ProgramOverview

Role ofthe CDS

Conducta Chart Review

Determine ICD‐10 Principal &

Secondary Diagnoses &DRG & Proc. Codes

FormulateQueries

FormulateQueries

FormulateQueries

Evaluate My Performance Using Metrics

ProcessMDC #24,25,26

Charts

ProcessMDC #1 Charts

Process MDC #1Charts

Chart ReviewPractical

Assessment


Assessment


Assessment

Followthe CDI Workflow





Process MDC #8,9,10,11 Charts

ProcessMDC #16,

17,18,19,20,21Charts

Reconcile Chart Coding

Educate & Advocate for DocumentationBest Practices with Providers



Module 1 Module 2 Module 4Module 3

Module 5‐9

5 CodingModules

Source: Course Map. (2016). Cracking the code for clinical documentation excellence. Sisters of Charity of Leavenworth Health System, Inc.

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Lesson 1: Program Overview

• Introduction to Cracking the Code for CDE curriculum

– Welcome videos

• Course length and timeline

• SCL Health CDS expectations

• SCL Health CDI mission, vision, & values

• Course map

• Course structure

• No skill check

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Lesson 2: Role of the CDS

• CDS job responsibilities and role

• CDI and SCL Health human resource policies and job description

• Introduction to performance metrics and goals

• CDI tools

• No skill check

• Testimonial video


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Lesson 3: Determine a Principal Diagnosis, Secondary Diagnoses, and DRG

• Review of the reimbursement system and process– IPPS– MS‐DRG– APR‐DRG– DRG Expert book

• Coding fundamentals

• Instruction, practice, and skill check on: – Selecting and coding the principal diagnosis– Identifying and coding secondary diagnoses– Selecting the principal & secondary diagnoses to determine the

working DRG

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Lesson 4: Conducting a Chart Review

• Instruction on where to start with a chart review

• Instruction on the tools and resources needed

• Walk‐through/demonstration of the steps to review a chart

• Review how to analyze the documentation, determine the principal and secondary diagnoses, and how to identify any needed additional information

• Practice and skill check on conducting chart reviews to identify critical information, potential diagnoses, and opportunities for queries

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Lesson 5: Formulate Queries

• Instruction about queries

• Where and how to use query templates

• Process to formulate a query

• Query follow‐up, including application use

• Practice and skill check on identifying query templates, query identification, components of queries, and formulating queries

• Includes a job aid containing important query facts and examples


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Lesson 6: CDI Workflow Process

• Review of the CDI workflow process and how to follow them as part of daily work

• This lesson puts all the components of the previous five lessons together as a single workflow

• No practice or skill check

• Provides a job aid to include daily workflow processes as a flowchart

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Lesson 7: Reconcile Charts

• What the reconciliation process is and how it is used

• Provides a job aid to determine how to reconcile a chart

• Practice and skill check is provided in each MDC lesson for chart reconciliation

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Lesson 8: MDC Lessons (18 Total)

• Introduce the Major Diagnostic Categories

• Lessons for the 18 commonly seen MDCs at SCL Health

• Each MDC lesson provides specific instruction, such as:– Common CCs/MCCs

– Opportunities for DRG movement

– Helpful hints and tips about what to look for

– Query templates

• Each lesson includes practice reviewing a chart and determining key CDI information

• The preceptor will also help identify live work charts for the CDS to complete as reinforcement/practice of each MDC

• The skill check for each MDC lesson is reflected in the practical assessment using actual, live work at the end of the program


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MDC Process

1. Preceptor identifies charts in CDS work queue and determines the corresponding MDC lesson that the learner should work on that day– Preceptor will assign the live cases first thing in the morning that correlate with the chief complaint and that MDC

2. Learner will access the appropriate MDC lesson and download that lesson’s materials– Participant guide

– Job aid

– Exercise booklet and answer sheet

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MDC Process

3. CDI educator will be notified of the chosen MDC and review the participant guide with the learner

4. Learner will work through the exercise booklet using the corresponding job aid and exercise answer sheet; the preceptor is available for assistance if needed

5. Preceptor will review the CDS’s exercise answer sheet for completeness and provide feedback if needed

6. Learner will begin to review the live cases selected that morning

7. Preceptor will review the live case work with the CDS, providing assistance with submitting queries and documenting in the CDIS tool

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Participant Guide: Example MDC 17

Source: Participant Guide MDC 17. (2016). Cracking the code for clinical documentation excellence. Sisters of Charity of Leavenworth Health System, Inc.


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Job Aid: Example MDC 17

Source: Job aid MDC 17. (2016). Cracking the code for clinical documentation excellence. Sisters of Charity of Leavenworth Health System, Inc.

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Exercise Booklet & Answer Key

• Exercise booklet is made up of patient case examples focused on specific disease processes– Qualifications: LOS, query opportunities, ICD‐10 coded

– PHI removed

– Answer key

• Exercise answer sheet requires the learner to identify the following: – Review findings

– Principal diagnosis, secondary diagnoses, and working DRG

– Query opportunities

• Impact

• Escalation policy

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Lesson 9: Educate and Advocate

• Key providers in your care site (individual completes a key contact list)

• Developing an elevator speech about CDI

• How to interact with providers around CDI documentation requests

• Includes a practice role‐play as CDS and provider


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Lesson 10: Evaluate My Performance Using Metrics

• The metrics that reflect the performance of each CDS

– Scorecard

• The metrics that reflect the performance of the CDS’s care site

– Dashboard

• No practice or skill check

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Metrics: Example of CDS Scorecard

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Practical Assessment

• Opportunity to submit live case reviews to educator that demonstrate best work for that MDC

• Expectations include:

– Starts at 9 weeks

– Work independently through live case reviews

• Queries are reviewed with preceptor

– Discussion of each submitted case with educator

– Opportunity to submit until expectations are met

– Complete by 3‐month evaluation


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Evaluation

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Assessing Progress of the Learner

• Qualitative feedback– Weekly progress summary

– Weekly case reviews

– Monthly query validation

• Quantitative feedback– Meeting expectations within orientation

• Completion of Lesson 8: MDCs

• Week 9 expectations

– Scorecards

– Practical assessment

– 3‐month evaluation

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Assessing Progress of New Curriculum

0

50

100

150

200

250

0 1 2 3 4 5 6 7 8 9 10 11 12

Month

CDS performance—initial reviews

Group A

Group B

Target


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Assessing Progress of New Training Program

0.0%

20.0%

40.0%

60.0%

80.0%

100.0%

120.0%

140.0%

160.0%

180.0%

0 1 2 3 4 5 6 7 8 9 10 11 12

Month

CDS performance—query rate

Group A

Group B

Group B

Target >30%

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Challenges of the New Training Program

• Resources

– Underappreciated time commitment for development

• 1‐year‐long project

– Staffing: A difficult balance

• Ongoing responsibilities and education needs

• Needs of external department and project deadlines

• Learning curves

– Collaboration

– Compromise

• Change is the only constant

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Successes of the New Training Program

• The training program is made available for everyone on the team to ensure transparency of education, centralized location, and standardization of content.

• Ensures specific expectations and consistent messaging are being held by learner, preceptor, and educator.

• Decreases travel time.

• “I was able to learn in a fairly structured and paced mode that provided essential components for my daily workflow. It is a lot of material with excellent resources to which I often refer.” (feedback from a new CDS)

• Educator findings—complex concepts identified earlier.


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Thank you. Questions?

[email protected]@sclhs.net

In order to receive your continuing education certificate(s) for this program, you must complete the online evaluation. The link can be found in the continuing education section at the front of the program guide.


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acdis day2-13 track2-7 pres 0517-esquibel willmer-f · • enterprise for learning and personal...

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