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Hybrid Clinical Documentation Improvement and Responsibilities

Published on 11/10/2016

Angie Curry is the corporate CDI manager at CoxHealth over 11 clinicians who review 1,400 cases per month for two hospitals in the five-hospital system in southwest Missouri. Curry will share insight about different staffing models, including a hybrid and remote CDI approach, during the Revenue Management Symposium at Cerner Health Conference. The session is entitled Hybrid Clinical Documentation Improvement with Service Line Responsibility.

In 2015, CoxHealth, recognized for its commitment to quality and patient safety, was the first to use Cerner's embedded clinical documentation improvement (CDI) solution. Since then, automating a CDI workflow in the same medical record as the physician has played a big part in efficiency gains and even finding additional revenue.

Angie Curry, corporate CDI manager at CoxHealth, tackled a unique staffing model in an effort to retain an in-demand certified team of clinical documentation specialist (CDS) nurses and maintain the productivity gains its highly engaged medical staff is accustomed to seeing across service lines.

“Our hybrid approach at CoxHealth gives CDI nurses the ability to work two days in the office and two days from home,” said Curry. “It’s a huge satisfier with the nurses, who are highly recruited by other national agencies. This work flexibility gives us an edge over other organizations.”

To aide in putting a face to the quality service CoxHealth is known for, CDI nurses were assigned to a specific unit of the hospital. One nurse reviews all cardiology patient documentation then attends all monthly cardiologist physician group meetings.

“We used our hybrid CDI approach for six months, and I had four months’ worth of data,” said Curry. “Our nurses now have the same amount of reviews as before, but the queries are more appropriate because they are able to concentrate better at home with less distractions. More accurate queries lead to more accurate reimbursement.”

Curry set stringent expectations upon CDI implementation to reach across broad populations, payers and care venues. “CoxHealth participates in four bundled payments for care improvement initiatives (BPCI) and in the last four months of data, two months—April and June—have shown 100 percent of traditional Medicare patient reviews,” said Curry. “I had a goal of 98 percent, and we blew that out of the water.”

Enhancing the provider-patient relationship is the ultimate end goal. “CDI nurses have an important role to make a difference. The medical accuracy of a patient record is worth more than the person even knows,” said Curry. “They deserve the clarity of their own personal medical record.”