Clinical documentation improvement (CDI) has become a strategic imperative at hospitals and health systems across the country as providers look to not only address case mix accuracy, but also “bullet proof” documentation against repayment demands, capture severity of illness, and respond proactively to the Value-Based Purchasing (VBP) mandate. One health system in South Florida, Baptist Health South Florida, demonstrates that a CDI implementation is not a “one-size-fits-all” scenario. Baptist Health South Florida is the region’s largest not-for-profit healthcare organization, with more than 13,000 employees working across six hospital campuses and multiple satellite locations.

Physicians Step into CDI Role

When Lorena Chicoye, MD, corporate medical director of managed care, Network Developmentand Medical Management, Baptist Health South Florida came to the Baptist Health system, she noticed that the documentation and utilization benchmarks needed improvement. Having past experience with J. A. Thomas & Associates (JATA), now Nuance, she recommended the introduction of a comprehensive CDI program.

“In 2009, JATA reviewed our DRGs and it was clear that we had many opportunities to improve our quality benchmarks, CMI, and appropriate reimbursement through better documentation. But it wasn’t until 2011, as ICD-10 loomed ever closer, that CDI became an imperative and JATA’s program was brought in-house,” says Dr. Chicoye.

As Director of CDI, Dr. Mauricio Palma began to hire clinical documentation specialists to ramp up the CDI program. “Applications began to stream in and the majority of them were from our international physicians,” says Dr. Palma. “While this is a different approach, we found that hiring international physicians as documentation specialists is a perfect fit for us.”

With 15 full-time documentation specialists (one critical care nurse and the rest international medical grads), Baptist Health South Florida’s CDI program is structured in a way that meets the cultural and institutional needs of this health system. “In our system, most of our CDI specialists have an M.D. badge, as well as a CDI badge. Physicians look at the M.D. badge, and it’s instant credibility,” notes Dr. Palma. While most systems face some degree of physician resistance to CDI, Baptist Health South Florida experienced a successful implementation since the M.D. licensed CDI specialists have not only strong medical knowledge, but also are used to working collaboratively with physicians and already ‘speak the same language.’

Baptist Health South Florida educates hospital physicians on the importance of accurate clinical documentation and how this accuracy not only helps the hospital, but also impacts their own professional profile, on web sites like Physician Compare. Baptist Health South Florida CDI specialists are on the floor and talk one-on-one with physicians as much as possible to discuss or clarify documentation concurrently.

Ramping Up CDI in Preparation for ICD-10

Baptist Health South Florida’s CDI program is strong and only gaining momentum as the ICD-10 transition nears. “Physician agreement across all of our hospitals is over 90 percent, which reflects the buy-in we have from physicians,” notes Dr. Palma. At Baptist Hospital of Miami, specifically, the baseline Medicare CMI prior to implementation was 1.56, the current Medicare FY 2013 CMI now stands at 1.74.

The CDI team works to improve accuracy on an ongoing basis. For example, the CDI team reviews charts that were flagged by Medicare RAC auditors for medical necessity. “We review those charts and assess if we touched the patient, and ultimately want to know if we could have done something additional to avoid the RAC audit,” says Dr. Palma.

Moving forward, Baptist Health South Florida is ramping up for ICD-10. First, the CDI team is using JATA web-based education modules and shortly, they will start dual-coding with JATA software. “This will help us hone in on what specialties and physicians are most impacted and why,” says Dr. Palma. Baptist Health South Florida stands as an example of how CDI can adapt and become part of a unique model for collaboration and workflow across the care continuum.

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Mel Tully

About Mel Tully

Melinda (Mel) Tully is the vice president of clinical services and education for Nuance Healthcare, overseeing the development and expansion of clinical documentation programs and clinical education best practices. Mel joined Nuance in 1998 and has more than 25 years of experience in multiple healthcare arenas as a provider, clinical manager in a large academic facility, and as an expert in clinical documentation improvement (CDI). Mel attended Emory University, where she earned her Master’s degree in Nursing. She has been certified through the Association of Clinical Documentation Specialists (ACDIS) as a clinical documentation specialist, as well as by the American Health Information and Management Association (AHIMA) as a documentation improvement practitioner.