CDI: Little Bites Over a Long Period of Time
One of the keys to successful weight loss is taking smaller bites over a long period of time. The same holds true for improving clinical documentation in preparation for ICD-10.
Everyone knows that on Tuesday, Oct. 1, 2013, will start coding in ICD-10, at least for Medicare. The directive to implement I-10 is fueling clinical documentation improvement (CDI).
CDI involves a variety of clinicians and hospital staff, but the biggest area of change is physician documentation. Do not wait and make this mistake of trying to implement CDI for ICD-10 using the big bang approach. Physicians do not typically do well with massive one time change. They do much better with small incremental change -- bite size.
Many of the physicians I have worked with over the years fall into the "just tell me what to say" category. That is, they are amenable to change, but they want it fed to them slowly, easily and directly. The best practice is small incremental change fed to them in short (10 - 20 minutes) timeframes. Clearly, making the changes that give the biggest bang for the buck should be first priority. So, put those changes into effect as soon as possible and make them second nature to your physicians. You can use "lunch and learns," pocket cards and other small reminders in the CDI process. Remember, this needs to come from physicians to physicians -- as peer-to-peer training has proven itself far superior to any other methodology.
This process should be interactive. Audit now, implement CDI, audit again and then tweak training -- as CDI should be a continuous process and not your final destination. A last reminder is if you are using CDI to deal with I-9 issues, you can achieve economies of scale by implementing I-10 changes at the same time. For more information on making your CDI program ICD-10 ready, visit my ICD-10 blog.