michelle callahan, rn, bsn, ccds, crcr regional manager, clinical documentation integrity kaiser...
TRANSCRIPT
Michelle Callahan, RN, BSN, CCDS, CRCR
Regional Manager, Clinical Documentation Integrity
Kaiser Permanente NCAL Revenue Cycle, Oakland, CA
Jillian Fore, RN, MPH, ACM
Clinical Documentation Integrity Senior Consultant; Former Interim Director, Clinical Documentation Integrity
Kaiser Permanente NCAL Revenue Cycle, Oakland, CA
CDI From Home? How to Implement and Maintain a Successful, Productive Telecommuting Arrangement
CDI From Home? How to Implement and Maintain a Successful, Productive Telecommuting Arrangement
The presentation will detail:• Policies • Procedures • Productivity expectations• How to manage relationships among the
team and with providers • Successful management of telecommuting
staff
Electronic Health Records
Economic Pressures
CDI work-at-home options
About Kaiser PermanenteNorthern California
• Founded in Oakland, CA, in 1945, Kaiser Permanente serves a diverse
population in Northern California
• Nationally, we currently serve 8.9 million members in nine states and the
District of Columbia
– Northern CA serves more than 3.3 million members in 21 hospitals and 233
medical office buildings
– We have 7,129 physicians and 74,985 employees, of whom roughly 65% are
represented by a labor union
• We have the largest civilian electronic health record in the world
• Kaiser Permanente’s approach to the CDI program supports two important
organizational goals:
– Our support for work-at-home programs is in keeping with our long history of
energy conservation and environmental stewardship
– KP is dedicated to being the best place to work, offering employees multiple
options for fulfilling their responsibilities
CDI: Growing a New Program
In the Beginning
Growing Pains
RethinkingInitial
Assumptions
• Regional program with regional accountabilities
• Place regional CDI staff in multiple local facilities
• Individual medical center characteristics
• Space challenges
• Staffing issues
• Interacting with local staff and physicians
• Day-to-day management
Ask ourselves:What was the TRUE benefit of having CDI staff located on-site?
Back to the Drawing Board
??
Who will do the job?
Where will the work be done?
Considertelecommuting as an option
Considerations:• Leadership approval• Technological requirements• Staff satisfaction• Go green!
Why should the work be done this way?
How will you support this model?
??
Telecommuting as a Win-Win
• Creating a recipe for success
– Intensive new hire training program
– Clear requirements around quality and productivity
– Practical tools and a safe work environment
– Detailed policies and procedures
– Regular connections and follow-up
• When possible, hire self-driven people with success working independently
Position “work from home” as an earned benefit, not a guaranteed benefit.
You Can Establish a Virtual CDI Function in Any Organization
Getting Started
Lay the Foundation
• Telecommuting policies and procedures
• Equipment
• Home office assessments
Establish the Framework
for High Performance
• Performance expectations and guidelines
• Signed telecommuting agreements
• Performance management/ improvement processes
Set Ongoing Performance
Expectations and Guidelines
• Ensure high performance before offering telecommuting as an option
• Support staff who require additional assistance
• Monitor performance trends
• Support staff performance with honest and timely feedback
Lay the Foundation
• Telecommuting policies/procedures
– Check with your human resources department to determine whether there are existing telecommuting policies/procedures
– Revise current HIM/coding telecommuting agreement/policy/procedure
• Equipment
– Determine which supplies/equipment your organization is willing to supply
– Identify a specific plan for IT issues
– Document accountability for damages to equipment supplied by employer
• Home office assessments
– Ergonomic evaluation
– Environmental safety assessment
– Adequate space/accommodations
Establish Framework for High Performance
• Clear department policies and desk-level procedures
– Recommended accompanying procedures• Absence notification
• Communication expectations
• Productivity and quality expectations
• Performance management/improvement process
• Telecommuting agreement
• Telecommuting procedure (including all requirements w/check-off list)
• Competency validation
• Provider query procedure/query compliance procedure
• Chart review completion
Set Ongoing Performance Expectations and Guidelines
• Productivity and quality
– Ensure high level of individual staff performance prior to allowing telecommuting
• Identifying performance opportunities
– Management monitoring of performance trends
– Ongoing discussion regarding comfort level and employee self-assessment of needs and areas of opportunity
• Supporting staff performance
– Give honest and timely feedback
• Training
– Initial CDI training
– Continuing education
• Work flow and workload distribution
– Begin with specific work flow
– Allow personalization as staff become more experienced
– Identify opportunities to assign work based on areas of program focus
• Relationships
– With providers and facility staff
– Build opportunities for engagement
– Develop incentives for physicians
• More relationships!
– With other team members
– Institute daily connections and opportunities for team building
Control the Things You Can Foster What You Can’t Control
Staying on CourseBuilding and Maintaining the Team
Staying on CourseManaging Across Distances
Management Adjustments
• Adjust management-to-staff ratio
• Clear, realistic performance expectations
• Make the extra effort to connect with individual staff members
Staff Adjustments• Goals include clear action plan
for performance• Take responsibility for education,
as needed• Remain connected to the home
site• Identify process improvement
opportunities
Performance and Data Sharing• Work hours• Identified performance metrics• Performance data
Retention Strategies• Career paths• Recognition programs• Incremental work-at-
home increases• Peer-to-peer kudos cards• Manager-designated
awards
Management Adjustments
• Staffing and responsibilities of management
– Will take more time and energy than traditional staffing; adjust management-to-staff ratio accordingly
– Establish and document clear, realistic performance expectations
– Make an extra effort to connect with each staff member regularly
Performance and Data Sharing
• Performance monitoring and communication
– Monthly review of work hours (through electronic systems)
– Weekly or monthly review of designated performance metrics
– Facility- or service-level performance data (response rate drilled down to provider level)
– Consider blind performance data sharing
Retention Strategies
• Consider promotional level within organizational/departmental structure
• Increased accountability and additional responsibilities/special projects
• Employee recognition program
• Incremental work-at-home increases
Staff Adjustments
• Increased staff accountability
– Clear action plan for performance under goals• Education
• Returning to home site
– Staff responsibility to identify process improvement ideas
Potential Pain Points
The Right People• Self-driven with high
levels of personal accountability
• Professional• The right experience• The right temperament• Skilled communicators
The Right Places• Proximity to home facility
The Right Sponsorship• From regional leaders• From local leaders
The Right Systems & Support• Downtime procedures• IT escalation plan
The Right Performance Management System• Performance feedback• Ongoing communication• Data sharing• Remote education and
mentoring• Implement staff ideas for
improvement
The Right People
• High level of personal accountability
• Professional
• Autonomous
• Chart review experience
• Experience and success with high-volume/high-stress work environments
• Ideally not straight from inpatient floor nursing
• Expertise at public speaking, education, presentations
• Previous experience within the facility
• Previous experience with electronic heath record and high level of comfort with basic computer programs
– Consider new employee testing in this area
The Right Sponsorship
• Gaining approval and acceptance
– Leadership• Thorough and thoughtful plans prior to presentation
• Utilize current organizational goals and initiatives to support this work model
• Consider a trial
• Regular performance feedback
Michelle Callahan, RN, BSN, CCDS, CRCRRegional Manager, Clinical Documentation IntegrityRevenue CycleKaiser Permanente, Northern California [email protected]
Jillian Fore, RN, MPH, ACMSenior Consultant, Clinical Documentation IntegrityFormer Interim Director, Clinical Documentation IntegrityRevenue CycleKaiser Permanente, Northern California [email protected]
In order to receive your continuing education certificate for this program, you must complete the online evaluation which can be found in the continuing education section at the front of the workbook.
Questions?