documentation Archives - NonClinical Physicians

Pursue One of These Part Time Nonclinical Hospital Jobs

John Jurica — Tue, 18 Mar 2025 12:49:49 +0000

The Path of Least Resistance – 396

In this week's episode, John describes the most accessible nonclinical hospital jobs and how to pursue them.

These hospital-based roles—physician advisor for utilization management and physician advisor for clinical documentation integrity—present relatively low barriers to entry while offering flexible schedules and meaningful work that leverages a physician's clinical expertise in new ways.

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Breaking Into Hospital-Based Physician Advisor Roles

John explains how physicians can position themselves for utilization management positions, where they'll help determine appropriate patient care status and educate colleagues on insurance guidelines. This role involves reviewing cases to ensure proper resource utilization while maintaining quality standards.

He recommends specific resources, including books like “Hospital Guide to Contemporary Utilization Review,” and organizations such as the American College of Physician Advisors. He also suggests gaining practical experience by joining hospital committees focused on case management or denials.

Building Expertise in Clinical Documentation Integrity

The clinical documentation integrity advisor role focuses on ensuring accurate medical documentation to support proper coding, appropriate reimbursement, and quality metrics.

John outlines practical steps physicians can take to prepare for this career path, including connecting with coding specialists, studying CPT guidelines, and engaging with professional organizations like the Association of Clinical Documentation Integrity Specialists. He emphasizes how this position can significantly impact hospital operations while allowing physicians to use their clinical knowledge in a less stressful environment.

Summary

Both physician advisor positions provide excellent opportunities for physicians to transition gradually from clinical roles while maintaining involvement in patient care at a systems level. These positions can begin as part-time commitments of just a few hours per week and potentially grow into full-time roles, making them ideal for physicians seeking work-life balance or testing nonclinical waters.

Additional resources and networking opportunities can be found through organizations like ACPA, ACDIS, AHIMA, and annual events like the SEAK Nonclinical Careers Conference.

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Transcription PNC Podcast Episode 396

Pursue One of These Part Time Nonclinical Hospital Jobs

John: I want to provide a brief overview of two part-time hospital physician advisor jobs that you might want to consider if you've decided to expand your options and begin your transition away from direct primary care for whatever reason. I’m addressing these two because they overlap quite a bit. They're both based in the hospital setting, generally started part-time, and can later become full-time jobs. There aren't a lot of barriers to starting such a position, and if you're already working in the hospital environment, it's really not all that difficult to do.

So, these are the two positions I'm talking about today: the physician advisor for utilization management and the physician advisor for clinical documentation integrity. Just so we know, using this term "physician advisor," sometimes these are called medical directors. Now, if you're doing utilization management for a large insurance company or other healthcare payer, they're typically going to use "medical director" for that position as the title. In the hospital setting, it's typically called a physician advisor. It's a part-time job that could start out as little as one or two hours a day, but they might also use that medical director moniker as well.

If you're already working in the hospital in a variety of inpatient settings, you could easily start doing one of these jobs if your organization has a need for it. So, when I talk about this kind of topic and about transitioning, I do like to generally talk about some other things to prepare us to make this kind of transition.

So, the first thing I want to do is mention some of these items and talk about how to get into the right mindset. What happens typically if you've been working clinically full-time and now you're thinking of making this change? It can be difficult because of some limiting beliefs or even some myths that we have internalized that I want to talk about right now. I'm not going to address every one of these; I actually have addressed this in other presentations. As a reminder, let's just go through two or three of these.

So, the first thing is that this is going to be a difficult process because all I know is medicine and I don't have the necessary skills to begin a new career. Here’s what I have to say about that issue: especially for these jobs, having completed medical school and residency, maybe a fellowship, you really already have a lot of demonstrated valuable skills and abilities. Okay? So whether it's focus and concentration, lifelong learning commitment, organizational skills, teamwork, analyzing data, and formulating a plan, you have a lot of background in the necessary sciences, including biochemistry, physiology, anatomy, epidemiology, etc. You're good at writing, lecturing, and speaking, teaching, and mentoring. You've done leadership oftentimes in your roles. You're great at decision-making, and you have a lot of other qualities that make you an awesome employee in general. So those exist, and these two jobs don't really have a lot of requirements for additional skills. So they lend themselves to being learned on the job. You will learn some new skills for this new career, but they'll be learned on the job. And since you're already a lifelong learner, it's going to be quite straightforward for you to do that.

The second belief sometimes is that you're wasting your medical career if you pursue a nonclinical job. The thing is, once you become a clinician, you actually have reached a plateau, and there are dozens and dozens of other jobs that you can only do after becoming an experienced clinician. It's like saying that you're wasting your training as an attorney if you decide to pursue politics or to become a judge, or you're wasting your training as a nurse if you decide to become a nursing home administrator. An administrative job is a business position, but yet you have that background as a clinician, which is very helpful for many important, fulfilling careers. Having a medical degree and board certification is a prerequisite to even being considered for that new career. So it's not wasted training. Chances are you've already applied your training in that venue, and now you want to move on to something bigger and better. In some cases, oftentimes it even pays more and has more responsibility, particularly when you're taking a leadership role.

Number three that I want to talk about is: you know, my family, my friends, colleagues, and other people I know will be disappointed if I leave clinical medicine for a variety of reasons. You think that they might not really understand it, and maybe they'll say something that makes you think that. But the reality is, particularly if you're burned out or unfulfilled with this job, it's not really satisfying you doing this clinical work. You know, everybody in your life that loves you just wants you to be happy, fulfilled, and working in a career that brings you joy. That's really the ultimate goal. Many of us think that taking care of patients is the way to do that, but for whatever reason, sometimes it's just not true. So I don't think the people that are important in your life are going to sit you down and try to convince you not to remain in a job that's tedious, unfulfilling, or producing anxiety or is unhealthy.

I know the financial aspects will be a concern at times, but really, ultimately, that shouldn't be the thing that stops you because there are a lot of positions that will equal your current financial reimbursement or compensation, and yet with less stress and more joy in doing that very job. I think that shouldn't hold you back either, unless you can find there's something simple to change in what you're doing clinically to make it more palatable that I think you should continue to move forward.

Now, there are also some caveats that I want to mention to you. Some of these are pretty obvious, and don't be offended if it seems like I'm being too obvious, but let's see here: first, no matter what job you're doing, continue to do it with excellence. Okay? So just because you're burned out or you're feeling like you're going to have to change jobs or something like that, don't sort of quit while on the job. Don't become lazy or try not to become overwhelmed and just indifferent. Your current employer and colleagues will be asked to comment on your dedication, integrity, ability to work with others, accountability, etc. If you've already started to pull away and not keep up that high level of performance that you probably are used to doing, it can harm you because it may take you a while to get that first job. Particularly, even if you're going to stay with your current employer, hospital, or health system, then that might be something that puts the hold on it, particularly if you somehow have been becoming more vocal about how unhappy you are. So try to keep everything at that level of excellence and just move forward with trying to make the change.

The second caveat is you must try to gain some experience in your new career even before applying for the new job if you can. Notwithstanding what I said earlier that these jobs are open to you already, but every little bit of information and understanding of the role you're going to step into will be helpful. And so if that means volunteering somehow, you can do that. Two areas we're talking about are utilization management and clinical documentation integrity. They usually interface with the medical staff and clinics face-to-face when you're dealing with the topic and also in committees and subcommittees that deal with the results and try to come up with plans for improving things. You can usually volunteer for one of those committees and understand the lingo better. You can meet some of the people that are currently involved in that. Sometimes you can get a little bit of experience in a nonprofit board of some type, some steering committee. So think about that.

That's the second caveat. The third is that it's always great to use a mentor, find a mentor, engage a mentor, and interact with them. Now, when I tell you about mentors, I'm always talking about something that's pretty low-key, not a lot of time. I've had mentors in my life who didn't even know they were mentors—just someone I would meet with briefly or run through, you know, briefly for five or ten minutes, ask a question, get the answer, and then use that information to help me figure out my next steps. So it's helpful to have multiple mentors and just use them judiciously to help point you in the right direction. Obviously, this mentor should usually be someone who's doing the job that you're thinking about moving into.

And so, you know, that's just the third bit of advice. The fourth is that there's probably some book or course that can help you in the process. You know, on these topics, for these two exist, and I'll talk about resources where you can find those in a minute. Fifth, there are usually places, getting, you know, kind of building on the fourth one, there are usually specialty societies or associations, professional organizations that have more resources that I'm also going to mention later.

So that's given. And then the sixth thing is that sometimes when you're doing a nonclinical career, it's helpful to have some kind of a blog or a podcast or something. I mean, as an example, if you're becoming a medical writer, then, you know, if you can create a platform where you're writing regularly and you're sharing some of that for free, in addition to posting things that maybe you've sold that you've done as a medical writer, that could be awesome. In this situation for doing these two, I would say the main thing is to get a good LinkedIn profile. You probably could find your first job directly on LinkedIn without even engaging a headhunter or something like that. You know, particularly after you've already done the job at your current organization, if that's how you choose to move forward. But having a really completed LinkedIn profile, which is something I've talked about in the past, can really help people reach out to you and actually recruit you directly off of your LinkedIn profile as long as you put in there some of the experience that you've already gotten that applies to the job that you're looking for.

So, let’s start then with the first position, and that’s as physician advisor for utilization management. So, to summarize, in the hospital setting, again, you can do this kind of job for an insurance company, but in the hospital setting, it's a little different. It's quite direct with the providers; the physicians and NPs and PAs are taking care of patients in the hospital. So basically, the physicians who are leading the patient care will need help in determining the appropriate care status—outpatient versus inpatient, for example—and work with other team members to decide if continued stay is warranted. Warranted means meeting guidelines, specific guidelines that say that they should either go or stay. They need an intermediary like you, the physician advisor, to help educate on that and to actually answer questions directly on this patient that we're considering right now.

So, you can do teaching too, where you help clinicians understand CMS and other payer rules. And that's around the appropriateness of testing and invasive procedures. Like, you know, if somebody comes in for heart failure and you've got them 90% better, is it appropriate to do a colonoscopy? Well, that can be hard to justify. That's a pretty obvious example, but you don't want to be doing those things because you really want to try to keep that admission as short as possible while using the minimum resources so that the hospital actually has a bottom line.

There are full-time and part-time positions doing just what I've described. Most of those job descriptions will say that you need to be residency trained, board certified, with five or more years of clinical experience. Sometimes they have a preference for primary care, but not always. And they may even say that they want a current hospital staff member.

Now, I'm going to read you a typical job listing for this. They don't all look exactly like this, and this is a very shortened version of it, but just so we're clear, let me describe that: Candidates have a strong clinical background with excellent communication skills and leadership abilities. The role of the physician advisor of case management services requires the review of other physicians' cases, their plan of care, and resource utilization. Case study can be necessary for various reasons, including patient outliers, i.e., extended stays, utilization review issues, reimbursement issues, or quality concerns. The physician advisor will work with hospital administration on all campuses and clinical committees as requested to develop processes and guidelines to improve quality of care and value, or the outcomes divided by the cost.

So, that is a short version of a typical job description.

So, let's talk about some real practical things you can do other than being a good medical provider right now at your current institution. First thing, the first step is to see if you can get your hands on a copy of the "Hospital Guide to Contemporary Utilization Review" by Stephanie Daniels and Ronald Hirsch. This thing is probably at least five, maybe even as long as ten years ago, originally published. I think there are multiple editions. But this is a good guide. So, this is what I mentioned earlier. There may be a book that can be very helpful. I think it's relatively expensive. I looked it up recently, and it was like $170 for a new copy, but you might be able to find a used copy or you might go to your own hospital and say, "Hey, do you have a copy of this thing?" Because the utilization management department might have it. And it can be helpful to read through it; it gives some of the background behind doing utilization management and affecting things like length of stay and how to move people through the system. And also, you know, what needs to be documented.

If possible, here are some other steps you can take. Join your own hospital utilization or case management committee if one exists. Get involved with denials management, maybe even in appeals. You may not be able to appeal another physician's case, but if you have a case that becomes denied and you know, normally you hand that responsibility over to the UM department, you could try and at least be involved in the appeal in your case, particularly, you know, if you're talking about an online or telephone appeal, live appeal, and you can learn about what's important in the terminology.

Again, I'll reach back to what I said earlier about a mentor. So, look for a mentor that's currently working in utilization management, possibly the current medical director or physician advisor for your case management. Establish that relationship and just talk with them a little bit over time. Again, don't make them feel like you're trying to own your success. You want to just chat with them, get their advice on how they got into this and are they aware of any really good resources that they found to be helpful?

Here are some of the resources I think that are no-brainers that you can get into right away: You might look at the resources in the American College of Physician Advisors. You can find them at acpadvisors.org. It's the American College of Physician Advisors. You can just Google that if you want. And they have all kinds of research sources written. They've got lectures and conferences that they do every year. I think sometimes they might even have some kind of certification. When I last looked, I mean, there were at least six or seven tabs on their website for resources for their members. You can get involved directly, and there's probably publications that you can get from them as well. And I don't think the membership fees are all that high.

When I've talked to other people about this, they always bring up the Seek Annual Non-Clinical Careers Conference because usually they have at least one speaker talking about this one, utilization management for sure. Sometimes they also have somebody talking about the second topic for today, which is the CDI or clinical documentation improvement. If you want to get really into it a little bit and understand how people use guidelines, what the guidelines look like.

Oh, by the way, to find the Seek Annual Non-Clinical Careers Conference, it's usually in October, and you can find it at nonclinicalcareers.com/conference. That's a link that I created from my website. So if you go to nonclinicalcareers.com/conference, it should bring you to the Seek Annual Non-Clinical Careers Conference. It's spelled S-E-A-K. It doesn't stand for anything in particular, but it is in the Chicago area every October, and they've been doing that for about 15 or 16 years.

You can get a copy of the Milliman Clinical Guidelines. That's one set of guidelines that UM nurses and others who are doing reviews of charts for purposes of, you know, utilization management and continued stay and so forth. That's what they use. They use Milliman Clinical Guidelines. There's InterQual guidelines as well, I believe, but the Milliman seems to be more commonly used, and you can find that at mcg.com.

And then there's an organization called the American Academy of Professional Coders. Now, when I talk to UM people and when I was doing this job as a physician advisor, I don't think I ever saw that organization or heard of that organization. But if you go to aapc.com for American Academy of Professional Coders, there are resources there that you can access, and it gives you again some of the basic nitty-gritty about becoming a physician advisor for utilization management, benefits management, and so forth.

All right. So now I want to move to the next one, which is this physician advisor for clinical documentation improvement. Well, now we call it clinical documentation integrity. And basically, if we want a short description of this, it is as follows: Physicians in this position will need to learn about appropriate coding and documentation guidelines, either in the hospital or outpatient setting, and help teach other physicians about coding and interact with them on specific cases to make appropriate changes to coding if necessary. Full-time or part-time positions are available.

Now, this one, you know, there's a big motivation to do well on this because the coding is what leads to the reimbursement. It also leads to the quality of care as observed by other people because a big part of coding is to capture pre-existing conditions, complications, and so forth. And if you find things that are present on admission and document those appropriately, then they won't be counted as a complication later on. So if somebody is admitted with some problem, let's say pneumonia, and then they develop diabetes or hyperglycemia and then they get a coding for diabetes during that stay. Now, we all know that it's probably pre-existing, but if it's not put in as a present on admission, then it's going to be counted as a complication. And that's a bad thing that can affect your reimbursement at the hospital.

They usually are going to be looking for someone who's residency trained, board certified, with five or more years of clinical experience. The typical job listing will sound something like this: As the CDI physician advisor, the PA will act as a liaison between the CDI professional, HIM (which is Health Information Management), and the hospital's medical staff to facilitate accurate and complete documentation for coding and abstracting of clinical data, capturing severity, acuity, and risk of mortality in addition to DRG assignment.

So, that's what you're going to see, and you're not going to see requirements for a lot of formal training. What they might look for is more experience. Now, another comment I want to make, kind of a caveat, at any time you're looking for a job and you're looking at job descriptions is that keep in mind that a job description is the new employer's attempt to get absolutely 100% of things they could get in the best possible circumstances. So, they almost never get a person that meets all those so-called requirements. And so you have to try and tease out whether the requirement they're listing is absolutely mandatory. Like, for example, they might say they want someone with five years of experience and at least two years doing a CDI. Well, what if you have four years of experience and you're only doing one year of CDI? These things are all flexible, and you have to learn how to tell the difference between something that's absolutely required as opposed to something that would be nice to have because most of this will be learned on the job.

Okay, so here are some advice for steps to take. Number one, you might get a copy of the CPT Professional 2025, which is the CPT manual that's put out by the AMA every year. Now, it's expensive, and you know what? Things don't change that much. So if you can get an old copy of the one from 2024 or 2023 or 2022, a lot of the rules will be in there; it'll be exactly the same. It's just the fine details change from year to year in terms of the definitions of the DRGs and the weighting and things like that. So just try and get a copy of that, and you can probably borrow the old one from your current CDI group and go from there.

If possible, these are some actions you can take now to position yourself: If there's a CDI team, see if you can join as a volunteer or go to some of their meetings. Spend time with the coding specialists in the Health Information Department. When you talk about coding and documentation, not only do you have yourself as a clinician doing the documentation part of that, but you have the nurse documentation specialists. And maybe some paramedical staff, you know, that aren't nurses or physicians. And then you have the billing departments, whether it's in a clinic or at the hospital, what you would call the Health Information Department. They have experts in coding and documentation. They're the ones that do the final coding on the charts.

They're usually not a nurse, but they usually work so closely with a nurse and the physician advisor to get things right. Sometimes they're in a big hurry and they don't want to take the time to do that. So you have to help set up systems where you can quickly respond when they have a question. Because again, the more accurate it is, the better off the hospital is and better paid the hospital is.

Okay, so you're going to try and just start mingling with those people. You're going to identify a mentor that's currently doing this kind of work, clinical documentation integrity, and maybe the medical director if there's a medical director in the hospital doing this, or there might be somebody who's over that in a large medical group. It's totally different coding in the outpatient and inpatient side, so you might want to end up specializing in one or the other, but most of the time, what I'm talking about are the physicians who are working for the hospital to do this job.

And then you're going to also complete your LinkedIn profile, just like I mentioned for the last position, and try and focus and list your experience and documentation and coding in the hospital setting. No question comes up on LinkedIn all the time is, "I don't want to scare away somebody, or I don't want to tip my hat, my hand, so to speak, that I'm thinking of leaving and looking for this job." So sometimes you can do a LinkedIn profile that's somewhat generic. That's focusing on your professional activities, and you know, you might put in there all the things you've done clinically, and then maybe a paragraph that talks about what you've done from the standpoint of documentation and coding and understanding how it works because all clinicians need to do this anyway. But if you focus on it a little bit more, then a recruiter is going to be more prone to notice and actually reach out to you on LinkedIn and say, "Do you want to talk about maybe looking for a job?" And it could be even a headhunter who maybe doesn't even have a job for you right now, but when they notice someone with that kind of profile, then they're going to reach out and position themselves to be ready to tap you when the time comes.

Some of the other resources which would be very helpful would be the American College of Physician Advisors, which can be found at acpadvisors.org. I think this is the same one that I said earlier. It's good for both utilization management and for clinical documentation improvement. So that's a repeat. The Seek Annual Non-Clinical Careers Conference is another repeat. Every October, you have a two-day event with a pre-conference and post-conference, so there's a lot of activities going on. You can look that up.

There is something new here: the Association of Clinical Documentation Integrity Specialists. It's a hard one to remember; it's kind of a tongue-twister. The Association of Clinical Documentation Integrity Specialists, known as ACDIS, can be found at acdis.org. Lots and lots of resources there. You can join even before thinking about doing this in a way, see if there's information in it that sounds interesting to you. And then when you do think about moving forward, then start accessing some of those. I think that one has training and even certificates, things like that.

The other big one is the American Health Information Management Association. Now, this is multi—actually, both of these are multi-professional, I guess. There are nurses, there are physicians, there are health information management workers, there are all kinds of people in both of these: ACDIS.org and the American Health Information Management Association, which is called AHIMA, A-H-I-M-A. A lot of people refer to it as AHIMA, and it's at ahima.org.

And then I've seen one mentioned several times in the past called the National Association of Physician Advisors. When I last tried to access it, it would not let me link up because of a fear of some kind of lack of security on the website. You know, some of these old websites are not really good at preventing, you know, issues with people trying to steal information and so forth. So if you can find the National Association of Physician Advisors, that might be useful. Otherwise, the other four places I talked about would be helpful for you.

But, so that's basically what I had to say about these two nonclinical positions. Again, they start part-time, they can eventually go full-time. There's a lot of jobs out there. There's lots of resources, and you can maybe find a job where you're doing 50% clinical, 50% one of these, or go 100%. There's a lot of flexibility. And if you're in a big metropolitan area, there's probably many jobs around that would be at other institutions within driving distance.

And so that's why I talk about these quite frequently. I've always had a lot of—not my most of my nonclinical jobs were in the hospital setting. These also can lead to getting a BPM or a CMO job because if you think about it, the Chief Medical Officer at a hospital is responsible for typical things that go that include these: utilization management and length of stay, quality improvement, clinical documentation integrity, which goes directly into quality improvement, and then informatics a lot of times. And so if you're involved with any of those four, it's a good starting point. And ultimately, if you end up looking for a job as a CMO, which usually pays more than a primary care clinical position with about 20% less commitment of time each week, that's an awesome job. Payments for CMOs are quite high. You're going to have to learn about all four of those plus a lot of other things.

And my usual advice for that is go to the AAPL, which is the American Association for Physician Leadership. And you can get a lot of those, which it wouldn't hurt to start that now while you're doing these other jobs or thinking about doing these other jobs. And they do have some specific courses, actually, at the AAPL, which are kind of introductions to the areas we're talking about today.

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The post Pursue One of These Part Time Nonclinical Hospital Jobs appeared first on NonClinical Physicians.

Become a CDI Expert – A PNC Classic from 2019

John Jurica — Tue, 12 Nov 2024 13:21:44 +0000

Interview with Dr. Christian Zouain – 378

In this podcast episode, we revisit our enlightening conversation with CDI Expert Dr. Christian Zouain. He shares his journey from foreign medical graduate to a Clinical Documentation Improvement (CDI) specialist.

Dr. Zouain reveals how his transition from pursuing a traditional residency path led him to discover CDI. There he found his calling in ensuring accurate medical documentation. This critical aspect of the medical record impacts patient care quality and hospital revenues, which creates excellent opportunities for CDI consultants and medical directors.

Our Sponsor

We're proud to have the University of Tennessee Physician Executive MBA Program, offered by the Haslam College of Business, as the sponsor of this podcast.

The UT PEMBA is the longest-running, and most highly respected physician-only MBA in the country. It has over 700 graduates. And, the program only takes one year to complete.

For Podcast Listeners

John hosts a short Weekly Q&A Session on any topic related to physician careers and leadership. Each discussion is posted for you to review and apply. Sometimes all it takes is one insight to take you to the next level of your career. Check out the Weekly Q&A and join us for only $5.00 a month.
If you want access to dozens of lessons dedicated to nonclinical and unconventional clinical careers, you should join the Nonclinical Career Academy MemberClub. For a small monthly fee, you can access the Weekly Q&A Sessions AND as many lessons and courses as you wish. Click the link to check it out, and use the Coupon Code “FIRSTMONTHFIVE” to get your first month for only $5.00.
The 2024 Nonclinical Summit is over. But you can access all the fantastic lectures from our nationally recognized speakers, including Dr. Dike Drummond, Dr. Nneka Unachukwu, Dr. Gretchen Green, and Dr. Mike Woo-Ming. Go to Nonclinical Summit and enter Coupon Code “30-OFF” for a $30 discount.

The Daily Life of a CDI Specialist

Working as a CDI specialist involves reviewing patient records, collaborating with physicians, and ensuring accurate documentation for both quality care and appropriate reimbursement.

Dr. Zouain describes the evolution from traditional paper-based systems to modern electronic health records, emphasizing how technology has transformed the way CDI specialists interact with healthcare providers. The role offers regular working hours (typically 8-4 or 9-5) and provides opportunities for both on-site and remote work.

Growing Opportunities in the CDI Field

The CDI field continues to expand, offering various career paths from hospital-based positions to remote consulting roles. Dr. Zouain emphasizes the importance of starting with hands-on hospital experience before transitioning to remote work.

He recommends three helpful steps to consider when pursuing this career:

joining professional organizations like ACDIS and AHIMA,
pursuing certifications such as the CCDS (Certified Clinical Documentation Specialist) and CDIP (Certified Documentation Integrity Professional), and,
networking within the CDI community.

Summary

Whether you're a foreign medical graduate, practicing physician, or healthcare professional looking for a change, CDI provides a promising career alternative that leverages clinical knowledge in a new way.

Want to learn more about CDI? Connect with Dr. Zouain on LinkedIn or check out ACDIS's apprenticeship program. Your journey into healthcare documentation excellence awaits.

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Today's PNC Podcast Transcript

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Transcription PNC Podcast Episode 378

Become a CDI Expert

- A PNC Classic from 2019 with Dr. Christian Zouain

John: Hello, Dr. Christian Zouain, welcome to the PNC podcast. I'm happy that you're here with us today.

Dr. Christian Zouain: Oh, Dr. Jurica, thanks for having me. I'm a frequent listener, I really appreciate you having me today as a guest.

John: Awesome, one of my three listeners. I'm glad to hear. Hi, mom. No. Kidding. So, no, I really wanted to get you on here. I did listen to a recent podcast where you were a guest and it was really interesting. I personally have this interest in CDI, which we'll explain what that is in a minute, but I thought you'd be a good one because you've had some recent experience in different venues, and I thought, okay, let's get Christian on the podcast.

Dr. Christian Zouain: Great, thanks. Yeah, sure.

John: good, it'll be fun. All right. I'll have recorded a short intro. It gives a little background about you, but why don't you tell us just a little bit, if you want to give us the brief history and a little bit about what you're doing right now?

Dr. Christian Zouain: Yeah, sure. I am a foreign medical graduate, originally from the Dominican Republic. I moved to the United States in 2011 to pursue residency initially, and while I studied for the boards, I worked as a medical assistant, later as a medical scribe, later landed a job in case management, utilization review at a hospital, as a means to get closer to the hospital setting and make connections, meet the doctors and obtain a residency position.

This is when I started doing research and looking into other non-clinical options, which I've never, had never done before. To me, the only path was obviously coming from the Dominican Republic was going into clinical or that's it. I knew a few people that were doing research, but I started exploring the other options. I remember I attended the SEAK non-clinical careers conference in Chicago in 2015, which is the one you've mentioned in your podcast a couple of times already.

John: Let me break in here and clarify that the SEAK non-clinical careers conference is spelled S-E-A-K, and it's not an acronym for anything. There's a reason why it's spelled that way, but it really doesn't relate to the content of the conference. It is still running annually in the Chicago area as far as I know. They just had their most recent annual big non-clinical physicians conference this past October, a few weeks ago, and I believe they will continue to do this annually. It's held not too far from O'Hare airport. They say it's in Chicago.

It's really technically in a hotel at Rosemont, Illinois. Next year will be the 20th event. Most physicians find it really useful because it presents about 20 live lectures over two days, plus access to 40 mentors, more or less during those two days. And they also have, I think, one or two pre-conferences. there's a lot going on. And I thought I would just mention that, and let's get back to our conversation.

Dr. Christian Zouain: And it really helped me realize that I was not alone in my decision to pursue a non-clinical path. then I enrolled in a clinical documentation improvement and ICD-10 coding course at New York University through the advice of a friend. This was actually new because ICD-10 was coming up. It was 2015. It was a big change, October 1st. they were saying that CDI was a growing career that actually needed a lot of healthcare professionals to jump in.

And while taking this course, I learned a lot about the impact that a complete and accurate documentation had in all areas of healthcare. I became really interested in that, and I eventually just decided to jump all in into CDI as a career path. At that point, I also became more involved with the use of social media, LinkedIn. And through there, I was able to land my first position in CDI. right now, yeah.

John: That's great. Let me stop there because I want to check a couple of things with you because some of what you said resonates with me. My recollection when I was working in the hospital setting was, I was involved with UM and CDI both. And at least my recollection was anything having to do with utilization management and the cost of care and even quality, much of it depends on the documentation. it's a natural partner in that whole process of trying to at least improve how things look on paper in terms of the quality. Would you agree with that? Was that part of this thing that led you to the CDI?

Dr. Christian Zouain: Yeah, definitely. Everything, all aspects of that, I would say would fall into place after you would get that true clinical picture of that particular case with the documentation. It's not just about... Initially, I remember I was thinking, okay, it's about reimbursement. And that caught my attention. But then later I started to find that a lot of things besides the reimbursement had a huge say with documentation.

John: I remember when we had projects and we were working on some quality project or some UM project or whatever, we always had the director for, well, it was health information services or whatever it was, but basically it was the coding experts who were at every darn meeting.

Dr. Christian Zouain: Yeah, and that's a huge part of it. In my previous job as a CDI, I was the only CDI, and I was involved particularly with all the administration. I had to report directly to the CFO. And it was a new venture for me because I came from my first experience, which was a department of 12 CDI specialists. We were just there reviewing charts and closing our records, dealing with the coders. But now I would have to go to all these meetings with the administration. I had to interact with the doctors, with case management, with quality management. I would see how it all blended together. I had to be there. I had to be in those meetings. And it's actually also a good opportunity to let them know up front what things need to be done. When they discuss cases, I can just jump in and let them know, this is how we can better document this particular situation for next time, just we don't have to go through the query process. And that way you also work to educate the physicians.

John: Absolutely. The other factor that's heavily dependent on documentation and coding, and we're not talking a lot about it here today, maybe a little bit we're touching on it, but it's the perceived quality of your hospital. The risk-adjusted mortality, complications, and length of stay depend on the accuracy of coding and understanding of inclusion and exclusion criteria and risk adjustment related to preexisting conditions versus those that develop during a hospital stay.

So for all those top 100 hospitals and all those five-star hospitals and forth, they heavily depend on very complete and accurate documentation and coding to demonstrate the quality of care because of those factors I just mentioned. All right. Let's get back to our interview. we're going to go back and go through the detail of how you actually made that transition.

You started to tell us about that, but I want to put a plug in for myself right now, only because I did a podcast early on in one of my, I guess I'd call him a friend, although we don't keep in touch, but we were working together at the hospital I worked at, and that was Cesar Limjoco, who's sort of this icon in a sense of CDI. I think you've probably heard of him, and he's got this massive following on LinkedIn and everything.

Dr. Christian Zouain: Yeah, I do. I do follow him. I haven't been able to, probably this year at this conference, I think he usually presents every year. Probably I'll go ahead and meet up with him. I mean, I know him. I've seen his articles. I follow him on LinkedIn, and he has really good information.

John: Yeah. And the thing that it was, in doing that interview, I mean, I really liked it because he gave like his whole perspective, but the thing is he is unique in the sense that he's been doing this consulting for long, and now there's other companies that are doing it, and really the starting point for someone like you or I back years ago was not what he's doing because he's been doing this for long. So I've been wanting to get a hold of somebody like yourself who has been a more recent entry into this, and again, that's just another reason why I'm happy to have you here on the podcast today, but I will say that was episode number five for anyone that wants to listen to it.

Dr. Christian Zouain: Yeah, I do remember. That was actually, I think, that was the first episode I heard from your podcast when I heard his interview. Yeah, because I was, I really wanted to know more about his journey as well.

John: Well, now we're going to supplement with your journey because you're following in the footsteps.

Dr. Christian Zouain: Thank you.

John: you had been exposed to UM, you became interested in CDI, you actually took the ICD-10 course, but then what are the steps did you take to try and make that leap into basically was essentially a brand new career for you?

Dr. Christian Zouain: Well, I was doing case management and utilization review, and what really caught my attention again was the contribution that Accurate Documentation brought to the process of healthcare. And I mean, I just decided that at that point, clinical medicine wasn't for me. I think that I just saw value and importance of helping the hospitals, helping the physicians in this current profession. that's why I decided eventually to take it on as a career path. I don't know if I'm correctly answering your question. Just let me know.

John: Let me ask you this, and I'll ask you some leading questions. were the hospital, where you're doing the UM, did they have a formal CDI program and did you end up working for them or did you end up going somewhere else?

Dr. Christian Zouain: Oh, no, I ended up going somewhere else. I believe they did later. I would find out later. They have some sort of CDI program that was starting. But I, again, I started doing research. I started being more involved with LinkedIn. So I started following all these hospitals. I was back in New York. And I would follow their HR department and this particular opportunity came up where they said that they were looking for professionals in the healthcare arena to go into CDI.

It was actually a dinner conference. if you had some sort of exposure or knew a little bit about CDI in some formal way, you could attend that meeting. I, at the time I was doing, I was doing the course at NYU. that was my ticket to go, to get into that dinner conference. And that's where I met my future boss. And eventually I was hired as a CDS.

John: now this was part of their recruiting process for people.

Dr. Christian Zouain: Yes.

John: Okay. Where were they promoting that? Where did you see that?

Dr. Christian Zouain: On LinkedIn.

John: On LinkedIn, was it a company that you were following or did they reach out to you?

Dr. Christian Zouain: It was a company that I was following, a health system. And yeah, they posted the human resources recruiter, posted the ad on LinkedIn. And I contacted them, send them all the information. At first they were hesitant because the course at NYU was new. they didn't know, but they wanted to. But I sent them the curriculum and everything and they said, "Okay, you know a bit about CDI. You've been studying for a while on that. you're good to come in." And I remember I was expecting for it to be a big conference or at least a lot of people to join in because I got new at the moment. That's all I would hear about how the CDI profession was growing. I was thinking I don't have the experience.

I was told by a friend initially that you might have to take a pay cut from your case management position because you don't have experiences in CDI. But I was willing to do that because I knew there was a better path for me in CDI. I actually went and it turned out to be the opposite. I didn't end up taking the pay cut. It was actually more. Well, I didn't have the experience, but at that point, there weren't a lot of professionals that had experience.

So I remember I showed up to the dinner meeting conference and we were like five applicants only. we had, there was the health system, each director for CDI of each hospital, which were around five. There were only five people that showed up that were interested. Two of them I remember were also foreign medical graduates, but didn't live close by. And one of them was a nurse who worked on the floor still. I was the only one who, okay, I was already taking the class of CDI and I had good interactions with the other directors.

The little I knew at that time, I was able to discuss during the dinner because they had a presentation, but then we had a moment where we would sit down at the table and meet the other directors. each one of them, I was able to interact with at some point. And one of them actually caught interest in me and decided to interview me and I was in.

John: No, that sounds excellent. That is such a good example of networking, getting in front of somebody who is in a position to make a decision about recruiting and forth. Let me jump in again on this point. LinkedIn is extremely useful. And I would say a necessity if you're looking for a non-clinical job. There is a lot of recruiting and hiring done directly through LinkedIn for many of these non-clinical jobs and some clinical. Many recruiters use it as their number one way to find and contact eligible candidates.

So it behooves you to optimize your LinkedIn profile and understand how to use it. If you're not comfortable setting up your LinkedIn profile and how to use LinkedIn effectively, I recommend you purchase the course called LinkedIn for Physicians by Dr. Heather Fork. Now, this has been out for, I think, at least three years. And she does updates on it every often. It's quite comprehensive.

And you can go find her website at doctorscrossing.com or you can go to my link and check it out at nonclinicalphysicians.com/linkedincourse. That's all one word. nonclinicalphysicians.com/inkedincourse. And I do receive a small payment. If you purchase using my link, the cost is the same either way. But this is an affiliate link. Okay. Now, let's return to the conversation. Now, at that point, were you already a member of any kind of professional society or organization? I mean, is it the ACDIS or there's other organizations? How does that fit into this whole scenario?

Dr. Christian Zouain: No, not yet. At that point, I remember I was still deciding. I was still studying for my boards and et cetera. I wasn't fully in. I haven't decided yet. I was still thinking about CDI as an approach to continue to work with the doctors and acquire experience and make connections.

But then it was that my director at that point, when she was a nurse, but she'd been doing CDI for 15 years. And I remember her telling me, "If you know CDI, if you learn to do CDI well, if you know the basics and acquire experience over time, this experience will take you a long way. You can do a lot of things. You can jump into different areas of healthcare, not necessarily clinical." I think that was the last step for me when I decided, you know what? I think I'm sticking with CDI instead of going into clinical.

So when I made that decision, I started reading more. I started getting more involved with the associations with ACDIS. After two years, I was able to, I got my ACDIS certification and also obtained the one from AHIMA, the CDIP. The one for ACDIS is the CCDS, which you're allowed to obtain two years after, with two years of experience working in the field. at that point, yeah. they have a lot of resources. So I really jumped in. I purchased. They have books, they have guides. that was a good turning point right there because even if when I took the class, I wasn't really sure until you get your hands on in the actual work, you start realizing what it's really about. when you combine that with the resources that are available out there, it makes it much easier. it makes much more sense.

John: let me just clarify for the listeners. the ACDIS is one big organization of people that are involved in CDI are with. Now AHIMA is A-H-I-M-A, right? Is the acronym?

Dr. Christian Zouain: That's correct.

John: Yes. That's more about health information.

Dr. Christian Zouain: Yes, that covers a lot more. That covers HIM, medical records, coding. ACDIS is focused on, exclusively on clinical documentation.

John: Allow me to clarify here a little bit. There are two major organizations that Christian discusses here. The first one is the ACDIS, Association of Clinical Documentation Specialists. You'll hear later in the interview about their apprentice program. But what they're really known for is the CCDS certification, that Certified Clinical Documentation Specialist. And you can find that at acdis.org. So that's the first one. And then the other organization is AHIMA. That's A-H-I-M-A, AHIMA, American Health Information Management Association. And it has at least eight different certification programs. Usually, I think the CDIP is the one most applicable to physicians, which stands for Clinical Documentation Integrity Professional. And that's a CDIP certification, can be found there at ahima.org, A-H-I-M-A.org.

Okay. Now, let's get back to the interview. And I think this is my last interruption. Now here's a question I have because you brought up ICD-10. Which is kind of, that's on the, pretty much the diagnosis codes basically, right?

Dr. Christian Zouain: Correct.

John: How important is that? I mean, that's important in inpatient and outpatient. We're talking mostly inpatient right now in terms of where you were, is that right?

Dr. Christian Zouain: Yes, yes. ICD-10 works, you have on the inpatient side, you have ICD-10, and for clinical codes and for procedures, you have ICD-10 PCS. In the outpatient, for clinical codes, you have ICD-10 and for procedural codes, you have CPT. that's something different right there. there's a lot of, yeah.

John: Now, in my recollection, sort of the coding, the documentation, the risk adjustment was more or less based on the MS-DRGs, but the ICD-10 feeds into the MS-DRGs. Is that how it works?

Dr. Christian Zouain: Yes. It's a bit of a complicated subject, but you have the right path right there. You have ICD-10, which then bundles up the list of diagnosis and then you obtain an MS-DRG, which is then what you use to then bill and what reflects the severity of the patient's condition while he was treated. Or outpatient.

John: there's many different directions we could go, but let's focus on your career at this point. what were you doing in that first job? If I remember, that was a hospital-based job and you're basically helping them better demonstrate the documentation and you can maybe tell us how that day looked like for you and what were the benefits for the hospital as well when you're discussing that? Maybe you can address that.

Dr. Christian Zouain: Sure. my first experience is CDI. we would basically come in CDI, you work Monday through Friday, it's office hours, but it also depends on the hospital and the hospital needs. You might be working with a specific department. It could be surgery. You might want to come in a little bit earlier because surgery is rounding at 7:00 a.m., 6:00 a.m., but our hours were around 8:00 to 4:00, 9:00 to 5:00.

So we would come in, we would have a list of records that we would need to review, particularly at, let's say, at the two-day, three-day mark after the patients were admitted. Not just right away because we wanted to give time to the physicians they could document, we could have enough documentation. It wasn't just like, okay, we just have an HMP, let's go with that. No, we wanted to give the admitting physician and the consultants to take a look at what was going on with the patient and then review.

So we would have a set number of cases that we would do in the morning, my colleagues and I. And in this particular hospital, it was still hybrid. it wasn't completely in... the medical records weren't completely in the electronic medical system. the progress notes were still in paper. we would have to go to the floors and it was a good opportunity as well because there we would see the doctors from time to time they were around or their residents or the physician assistants if we needed to ask them right away.

But we would, this is how the process goes, we review the cases. We would leave a query if we needed clarification on a case. We will leave a paper query inside written document, inside the record. they would see and remember it was a green fluorescent color. they wouldn't miss it. And once they opened that, they would look at the query and they would respond on the next progress note accordingly. And that we will leave there. We would come back the next day and follow up if the cases were not to see if the cases were answered or not. If they didn't, then we would escalate if it had been a couple of days. But particularly most of the time they would ask or we would see them around in the hospital. we would ask them just like I told you earlier, right there and there. And they were either document, agree or disagree. Then we would bring it back, close the cases. And once the case was already sent to billing in this particular hospital, we were involved with coding and we knew at the end what the final DRG was. we were able to make sure to see if we had impact or not on that particular case. we would start with what's called a working DRG, which is the initial DRG that reflected that patient when we first reviewed that case.

Once we obtained the further clarification, the diagnosis with more specificity, then we would change to DRG. we would have a system that would compare both and would tell us the difference that we had achieved on that particular case. I know that that's one of the metrics that we were able to capture with our program and see how good we were doing. We would also get feedback from the coding department. They would receive their denials.

So we would know if a particular case that we had impact had been taken back and it was denied because it didn't meet criteria. we knew what action to take further next time if we needed to change the criteria we were asking the doctors and what to do forth.

John: Yeah, and I want to jump in here and try and for you listeners that are maybe not used to hearing about CDI, I mean, if you work in a hospital, you're pretty much aware of it because you're going to be having these conversations. But the thing is, I mean, it can make such a big difference in both the payment that might because it's DRG based and if you're in a low DRG versus a high DRG, but the quality, that was my big thing when I was chief medical officer is that your risk adjustment's going to look lousy if your documentation's not good and someone who really has renal failure as opposed to, let's say, mild renal injury or something or you name it.

I mean, it becomes important to capture this information and to have basically these consultants like yourself, Christian, walking around helping the physicians. Now, they don't necessarily always want the help. Some do. I guess that's my question for you. Were they already used to having CDI people around and did your relationship with the physicians, was it pretty good there?

Dr. Christian Zouain: Yeah, this particular hospital, it was a big hospital. It was a 900-bed hospital and I know the program had been there for a couple of years already, but being that they were still in some part in paper, it would make it a bit, let's say, annoying for them because now a lot of programs, they use either email or you can send the queries through the actual medical record. in this case, you would have to leave everything, leave something in the medical record.

You don't know if they probably missed it or they didn't really want to answer the query. And in this particular hospital, it was interesting. Some of them were okay because coming also from a clinician's background, being a doctor myself, I know what they go through, what they're going through. So they have tons of other people calling them all the time. They have nurses, they have discharges that they have to do, they have case management, they have people from that administration calling them. with us, if we needed to contact them, we had to page them.

John: Right.

Dr. Christian Zouain: I knew that they were for me when I first started I said, oh my God, but a page that's for emergencies. And sometimes when I would call when I would page them with my number. I would pick up the phone I said I would say, "Good afternoon, CDI clinical documentation. This is Christian." Let's say, is this an emergency? This is not an emergency. I mean, you're paging me. So from that point, it was a bit difficult. Some of the doctors they would just run away. Sometimes we had to be a bit inappropriate because we would see them maybe in the cafeteria or just walking into the hospital. We tried to be as polite as we could they just let them know, "Doc, you have a query in one of your records would you mind taking a look when you have the chance or where can I find you later?"

That's what we don't have to do it right here and there in the cafeteria. Maybe they're taking a break. But yeah, those particular hospitals if it's a big facility and I would say with the inconvenience that this system is not fully automated it could be a bit of a hassle. Later when I was in my second job as CDI where I was the only one, everything was electronic and it was a smaller hospital, but I didn't have a problem there with going meeting with the physicians because it was mostly internal medicine doctors and they were all pretty good. So it depends a lot on the exposure that they have and if you're working with different specialties that could also be something to take in consideration because going from a multi-specialty hospital to internal medicine, basic medicine institution it's a big difference. You're able to handle it better.

John: Let me ask you, Christian. based on those first two experiences. I mean, how were you feeling? Were you pretty happy with the way things were going? Were you pleased that you had made that transition? I just want to understand how you were feeling and whether you feel like it also was a fit like with your personality and what advice you would give to others in that regard?

Dr. Christian Zouain: Yeah. It was tough. At that first one, it was tough because I wanted to let the doctors know that I wasn't there to really bother them again. The majority if we could handle it with the residents or with the PAs up front we would do it. But if it was, say, a surgery attending someone that's really, really busy, sometimes I would think twice on it. Maybe should I go? Should I do it?

I had my ups and downs on that particular job. But I knew that it was different because I've in other places because I would talk to other colleagues. I knew that it could change, that it was just the part that it was starting ICD-10 and in the whole process of documentation on the day until doctors would actually get readjusted. And until they would find update upgrade the system. it would make it easier for them. Because the way it was, it wasn't particularly really convenient for them right now, until later once I started my second job it was particularly way much easier. Now I had control electronically, the doctors could just come in and see my notification there and answer right away. They wouldn't have to be bothered with a call or a page unless they didn't really answer I did have to call them. Yeah, just to answer your question it was, initially I had my ups and downs. But I knew it was going to get better because it was just a particular case of where I was at the time.

John: Okay. Let me ask you this, because this can be a big impact on the way someone in your position is working and feeling. Did you feel like both institutions they had the support of leadership? I mean, here's what I experience is that sometimes the CEO or the COO doesn't want to have that conversation with the medical staff to say hey guys and gals, this is important, and we want to do a good job for you, we want to pair a nurse as well. We want to get paid and the only way we can do it is if you document and we support what we're doing here. We ask you to support it. I mean, did you feel like you had that kind of support at the institutions generally?

Dr. Christian Zouain: Yes, yes, but especially at my second job, because now I was, like I said, I was more involved with the hospital's administration. I was there at every meeting. The doctors already knew me. I remember when I first came in, they actually, they introduced me to the whole staff at one of their monthly meetings, to all of the attending docs. And I felt like I was really important. They really paid attention. And that's a good point you're making when you have the support of your CFO, your CEO when they back you up and they see that importance, they see that it's really necessary.

And especially when you're working in conjunction with the other disciplines again when I worked with case management and quality altogether. Sometimes the case management department would call me, the nurses would call me and will tell me, "I just saw that this particular GRG for this patient it's only giving us three days. Can you take a look at the case?" And sometimes I would say, "Oh." Especially turns out that this case, I had a query for one of the doctors until he answers if he answers, I mean, in the way that I'm expecting, it might change.

So I would tell them, "It might change, it might not. I just have to clarify. Well, I'm thinking of something but I just have to clarify the information with the attending." they would help me, once they had that conversation with the doctor in the floor, they would tell them, "Listen, Christian told me that you had some pending documentation that you need to further clarify. can you please go ahead go down to the floor where he's at and work on that to see if we can move this patient around, if we can keep him or what's going on." at that point, I had good interaction with everyone. we were all working together with a common goal.

John: Excellent. that's good. Yeah, I think that when you're working on a team and you have the support of administration, it's great. maybe that's even something to look at when someone's looking for that second or third job, maybe the first one. Now, I don't want to get bogged down here. you've been involved in a big institution with lots of staff. You've been involved where you're like the solo person, the solo at least the physician CDI person. then you made another change, right? you're doing something different now within CDI. why don't you explain that to us?

Dr. Christian Zouain: yeah, right now I'm working for a company. The company works for, I work remotely. Exclusively remote. I work from home. I know it's a big change. And I decided to make that change because I wanted to experience something different than just being in the hospital. I know there's a lot of these companies out there that they help in some sort of way. They either take over a whole CDI department for a hospital just like they did in the first hospital I used to work, or they help at the back end with physician education, denials management, and CDI. I was looking for that because I saw a trend and that's why I wanted to experience that. And also, I wanted to get to work in an environment with a lot of professionals from different backgrounds. CDI is a field that you're constantly learning new things and you don't know everything. That's why you have to stay updated, continue to read, go to conferences.

I like to be in an environment when I have all these professionals interacting with one another where you can get help in a particular thing to see what can you do in this particular situation? Do you have experience on this? that's also what caught my attention. that's what I'm doing right now.

John: now with that, how does that compare in your mind? Do you feel like this remote CDI activities, do you think that's going to be something that grows? Is it difficult to do when you don't actually have let's say a face-to-face relationship with somebody? What's your opinion on that?

Dr. Christian Zouain: Well, in this particular situation, I feel like the doctors have already, physicians in the hospitals that we work for, they've had some previous experience with CDI in the past couple of years. Every time if I'd contact them through email most of the time. But if they do have any questions or anything, they can just contact me. They can call me. But I haven't seen the need in this particular case to have that face-to-face because I think as time has gone by, they're used to the whole process. they know what CDI is looking for. I rarely get here and there a doctor that's asking me, "Do I have to do this same thing for every case that I have?" And I say, "No." Obviously. But that's one in 100. I mean, I think they're getting used to it and the whole process. I mean, it's still the process that we follow still has their CDI on site, which they can go to. But I mean, they can basically reach out to us via phone or email.

John: Okay. Now, would you say that if you were giving advice to someone who's thinking of moving out of clinical into CDI would it be, is there a better way to go would they try to find one of these companies that are completely remote? Or would it be better to start on the ground with colleagues that you can consult with? What do you think about that?

Dr. Christian Zouain: Yeah. I think it would be better to start in the actual hospital and get familiarized with the whole CDI process as much as you can. See, if you're a practicing physician at the hospital you can visit their CDI department, get to meet everyone and express your interest in CDI. If you can shadow them or they can sit down with you while they review your cases it's even better because these discussions between the CDS and the physician, the treating physician are a great learning experience for both of them and it will save a lot of time in the front and in the future just they don't have to query that much that the doctor knows up front what they need on a particular case.

John: Okay. That makes sense. That's what I assume but no, much is being done remote nowadays. Most people, let's say physicians even practicing telehealth or telemedicine, of course, started with you know live face-to-face patients, but I wonder if there'll come a time when they'll skip that step. But I did want to circle back to something and you went through your process and the fact that when you finished med school and then moved here to the States, but I do want to get your opinion on this because you were able to make this transition.

You did not end up doing a residency and becoming board certified and all that, which is fantastic because I have a lot of listeners who are for whatever reason finished med school whether it's in the US or elsewhere. Didn't do a residency and they're really saying okay, what are my options and there's several things out there. This is the first time that I've talked to anybody that's done that in the CDI realm.

So I just want you to comment on that and maybe what would be the difference if any between someone who maybe did have some clinical experience residency training and they were working for a while versus someone in a similar situation to you. How would the approach be different if it would be in your opinion?

Dr. Christian Zouain: I think that just like I mentioned, if you're already working at a hospital if you have the clinical experience could be easier because you've been already been exposed to CDI. You've had to work with them. The difference would be I would say if you're non-clinical if you're working somewhere else, and if you're interested in CDI you could enroll in a basic coding course of ICD-10. Again, get familiarized with the concepts and the guidelines, get involved with ACDIS. They actually right now they have an apprenticeship program that teaches the principles of CDI.

Which is also a good start if you don't have the experience and it will be valuable to employers later on. ACDIS has local chapters in every state you can look them up on their website. They have meetings every month, some of them maybe more frequent. And just like we said earlier networking is very important they can, both parties, I would say, the ones that have clinical experience and the ones that don't, they can become part of the meetings and go and attend, join ACDIS and the coding classes.

John: Now, you mentioned an apprenticeship. How does one find those or who are those through?

Dr. Christian Zouain: That's in the ACDIS website. I think you can just Google ACDIS apprenticeship program.

John: Okay. I'll definitely put links in the show notes. I'll track down all the URLs for these and listeners can do that, but yeah, another tool, another tactic I guess to really get experience.

Dr. Christian Zouain: Right. Definitely. Yeah, that will help a lot.

John: Any other bits of advice for someone thinking to go into this career that we haven't touched on already?

Dr. Christian Zouain: I would say, don't be discouraged if, this happened to me, if at the beginning you just don't understand right away how all of this works, how the coding side of healthcare works just like we were talking earlier about DRGs and ICD-10 and ESMs and all that. I know for a lot of us, we were not trained in this particular field in school and yet when we start working on it, we feel like we should be able to figure it out right away. But it really takes time to adjust your thought process into the CDI and the coding mindset.

I remember when I started I used to work with a group of nurses that were also CDS's and one of them told me once you have to lower your clinical brain a little bit. You turn down your clinical brain a little bit because as physicians we're taught to look at a case and diagnose, make a diagnosis, make a decision for management. Here we are looking for the wording and how it relates to codes it's different. We might see exactly what the treating physician is trying to portray but we have to be mindful of the coding guidelines and how it's supposed to be written. So that's different and it can take a while to make that transition. for those interested, if you start, and you start feeling like you quite don't get it, believe me, with enough practice and time and studying you'll get there.

John: Well, you're serving almost like a translator in two different languages in a way because the coding language is not meant to be or didn't, I mean it just it's like a legalese in a sense as opposed to what we learn as clinicians, this is what we mean when we say heart failure. But it may not be exactly the same when you're talking in coding language. yeah, you're translating being [inaudible 00:47:40].

Dr. Christian Zouain: Definitely.

John: Well, I think we're getting near the end here. what would be a way to maybe we could reach out to you if somebody just wanted to touch base and maybe follow what you're doing should they go to your LinkedIn page or what do you think?

Dr. Christian Zouain: Sure. Sure. Yeah. LinkedIn, you can send me a message. I have my email there and also my phone number which surprisingly I don't think people realize that because they usually send me messages. But yeah, I mean, if anyone has any further questions...

John: Yeah, I think that's great.

Dr. Christian Zouain: I'm glad to help.

John: And just to have that LinkedIn, it gives them, it's like a little bit of a barrier there. You got to make a little effort you don't get swamped with questions, but I'm not going to put your phone number out on the show notes but it's pretty easy to get through on LinkedIn. And sometimes if there's an issue, sometimes if you're like a third degree connection, you can't always, it won't let you necessarily ask to connect people can go to my LinkedIn page because some of my listeners probably already linked to me and then I could password along or whatever.

Dr. Christian Zouain: Yeah, sure. Definitely.

John: That would work. All right. Well, Christian, anything else you can think of we need to talk about before I let you go?

Dr. Christian Zouain: No, that's it. I think we have covered a lot today. Thanks for having me. Yeah.

John: No, I really appreciate it. And I think those that have even the slightest thought of going into CDI, here's a comment I was going to make earlier, but I guess I'll throw it into my little cynicism is that we have these cottage industries, which are now big industries that have all grown up because CMS has put processes and barriers in the way in a sense whether it's our views for capturing what we do in the clinic or UM there's just tons of rules and now CDI and for what it's worth I think we need physicians like you, Christian, in there serving as experts to translate all those crazy rules for us physicians. So, thanks.

Dr. Christian Zouain: Yeah. Yeah, definitely. There's a huge opportunity for right now just like you're saying, with all these companies developing and they're in great need of good clinicians to work for them and eventually take those things forward.

John: It didn't sound like there's a lot of call involved. that's a good thing.

Dr. Christian Zouain: I'm sorry?

John: It didn't sound like there's a lot of on-call duties involved as many of our non-clinical careers.

Dr. Christian Zouain: Yeah.

John: If you take a slight hit on the income, boy, you're going to make it up in terms of time with your family and free time and giving up the pagers. that's another positive to keep in mind.

Dr. Christian Zouain: Yeah, definitely. Definitely. Absolutely.

John: All right. Well, thanks again for joining us today, and hopefully, I'll get a chance to catch up with you again in the future, Christian.

Dr. Christian Zouain: Okay. Thank you, Dr. Jurica. It's my pleasure.

John: Okay. You're welcome. Bye-bye.

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The post Become a CDI Expert – A PNC Classic from 2019 appeared first on NonClinical Physicians.

Follow This Plan to Establish a Solid Hospital CDI Career

John Jurica — Tue, 12 Dec 2023 13:45:35 +0000

Interview with Dr. Christian Zouain – 330

In today's episode, John revisits the hospital CDI career with Dr. Christian Zouain. He was first interviewed in March of 2019.

We explore the fascinating world of Clinical Documentation Integrity (CDI) through the lens of Dr. Zouain, a seasoned professional in the field. Whether you are a seasoned CDI professional or someone considering a career shift, Dr. Zouain's experiences serve as a valuable resource. His journey reflects the changing face of CDI, and the diverse career pathways available within this field.

Our Sponsor

We're proud to have the University of Tennessee Physician Executive MBA Program, offered by the Haslam College of Business, as the sponsor of this podcast.

The UT PEMBA is the longest-running, and most highly respected physician-only MBA in the country. It has over 700 graduates. And, the program only takes one year to complete.

By joining the UT Physician Executive MBA, you will develop the business and management skills you need to find a career that you love. To find out more, contact Dr. Kate Atchley’s office at (865) 974-6526 or go to nonclinicalphysicians.com/physicianmba.

Dr. Christian Zouain's Journey into Clinical Documentation Integrity (CDI)

Dr. Christian Zouain reflects on his transition from medical school in the Dominican Republic to his involvement in CDI in the United States. He shares insights into the significance of CDI in healthcare, his initial encounters with physicians, and the evolving role of clinical documentation.

Significance of CDI in Healthcare

Clinical Documentation Improvement (CDI) significantly enhances healthcare quality by ensuring accurate and detailed medical documentation. It thereby improves patient safety, reduces errors, and promotes effective communication among healthcare providers enhancing care coordination.

Evolving Role of Clinical Documentation

In Christian's encounters with physicians, he discovered the evolving role of clinical documentation. What started as expertise needed to optimize payments, later became a critical understanding of how to demonstrate the quality of care. With annual updates published by CMS, the CDI expert must continually update their knowledge base.

From Clinical Documentation Improvement to Denials and Appeals

Dr. Zouain sheds light on the transformation of CDI from Clinical Documentation Improvement to Clinical Documentation Integrity. He explains the crucial role CDI professionals play in ensuring accurate and complete clinical records. Additionally, he explains how his knowledge of CDI enabled his professional growth in the area of denials and appeals.

Summary

Dr. Christian Zouain can be contacted through his LinkedIn profile. For information about job openings and updates, Acuity Healthcare's official website is a valuable resource. Dr. Zouain also recommends following Acuity on LinkedIn for the latest job postings. If you pursue a job, please be sure to mention Dr. Zouain to the recruiter.

If you have additional questions about this career or pursuing your first position, he encourages you to reach out directly to him.

NOTE: Look below for a transcript of today's episode.

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Today's PNC Podcast Transcript

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Transcription PNC Podcast Episode 330

Follow This Plan to Establish a Solid Hospital CDI Career

- Interview with Dr. Christian Zouain

John: I wanted to bring back today's guest for several reasons. First of all, his story is very fascinating. Now, he was here in a previous episode in March of 2019. You can learn more about that at that episode, and I'll put a link to that. But he has a really fascinating story about how he became a hospital CDI expert.

I wanted him to come back because I personally think that a CDI specialist is really critical to hospitals functioning. I don't know how any hospital cannot do what they do and get paid appropriately and so forth without using a CDI specialist in some way. And I think it's a position that's often underappreciated and some of you should really consider that. So, welcome back to the show, Dr. Christian Zouain.

Dr. Christian Zouain: Thank you for having me again. It's great to be here.

John: I just remember our session back, those whatever, four or five years ago. I always loved CDI when I was working in the hospital environment, number one. And number two, it was so interesting to hear how you had gotten involved with CDI. And we'll define what CDI is in a minute. Why don't you, for our listeners, just give us the thumbnail sketch about your background and how you first got into the CDI business.

Dr. Christian Zouain: Yeah. The resumed version would be, I graduated from medical school back in the Dominican Republic in 2010. Initially, my plans as every other doctor, especially foreign doctors, who has a vision to come into the US is taking the USMLE. I practiced for a few years while I studied for the boards, and then I moved to New York, and I started getting into roles in the healthcare system. While I studied that way, I could also meet some people, network and all that to get my way through the residency process.

While I did that, I started finding out about these opportunities that were available. And it wasn't after I would say two or three years in that I found out about coding, clinical documentation improvement, the value it brought to healthcare, the importance is has for our health systems, and the well of our whole community.

I said, "You know what? There's something here. This is something that I can see myself doing. This is something that has value and that it will eventually continue to grow." And it's been already eight years. I've been doing this seven, eight years. So it's been great. It's been just as my original mentors had originally told me, listen, if you get into this, if you get the basics, there's so much you can do. There's so many pathways you can take. There's so many ways you can help within the industry to make things better, help the doctors, help the facilities, and eventually help the patients, which is the main reasons why we came into medicine, is to help our patients. That's one of the other good things that we are helping our patients in a good way by doing this work.

John: Yeah, it seems like a lot of these things that we do, whether it's utilization management or informatics or quality or CDI. Ultimately, the bottom line is to get the patient's care taken care of, pay for it, approve it, allow them to stay in the hospital or not stay in the hospital. There's lots of these things that we have to do to make sure they get the care that they need.

Tell us the technical, what does CDI mean now. When I was back in the hospital whatever, nine, 10 years ago is always called clinical documentation improvement. But I think you've kind of evolved that to a different definition now.

Dr. Christian Zouain: Yeah. It has evolved. They changed the last part, which now it's considered, they want to call it clinical documentation integrity, which we just want to make sure that we get the actual most complete accurate picture of that clinical scenario that happened in the hospital for that patient, translated into the record so the hospital, the physicians, and the entire health system gets reimbursed the proper amount of what went on that particular visit.

That's what the basics of CDI is. We're just trying to be of help, be that middleman between the physician and the coding expert, which is something that we don't really learn when we're in school. We tend to learn about this where when you're in residency or you start working in the hospital. Obviously like 10 years ago, I remember when I started something that physicians, they found a bit irritating. Someone's coming up to you, asking you all these, I would say dumb questions.

I even remember taking that as one of my approaches, when going to talk to one of the physicians saying, "Hey, doc. This is a really stupid question that I'm going to ask you, but I need to know this." That way I would be able to get that closeness and that reaction from that physician and I would get the information I needed.

But yeah, it has evolved. Gratefully, a lot of physicians have understood the importance, that this is not something that we're trying to question them or something that we're just trying to mess around. Sometimes I explain to someone that it's not the industry, like it's a game because it's something that it's a process that the insurance has, coding has, and then the hospital has its own process.

We're trying to manage on a day by day basis how to get everyone along. It's like getting all these rules together, getting everyone to understand each other. It's not like something that's going to be clear cut eventually that it's going to be fixed. No, it's something that it's still taking time. It's a process. And rules change every day.

John: I've heard in the past a metaphor where somebody was trying to describe this to me, and they talked about Michael Jordan and basketball or whatever. It could be anybody. But the thing is, games have rules. And you got to know where you can go in terms within the rules and do it right. But even in basketball, should you fouled out, should you not? That's a strategic decision. And you have to know the rules when you're playing a game or you're never going to win at the games. This is another one of those examples.

Now, one of the things that they used to tell me back in the day when we first heard about CDI and the importance of documenting and getting everything down to the last issue in terms of someone's preexisting conditions or president of admission. I don't even know if they call that anymore. But because most of the quality measurement of hospitals is based on billing data, then again, this is another reason why CDI is so important because there's a risk adjustment. And so, tell us about that. Is that still true?

Dr. Christian Zouain: Yeah, absolutely. Every day, again, it still holds true. That was the main reason why the billing process was shifted towards from pay for service, pay for performance. We're paying for the quality of service, the patient experience. How well was that patient treated, not based on the amount of procedures that the patient had. That's why we have the different billing systems, the MS DRG, the APR DRG. We have those in place. And that's the main focus of those. It's shifting that process of payment towards that, because eventually the quality, it's what's going to drive that payment factor.

We just want to make sure that the patient's reflected correctly, that we don't bill for things that happened in the hospital present on admission, of course, that's still something that holds true today. If you came in with something, everything has to be specified as being, okay, did the patient come in with this? Because if the patient had a fall and had a fracture eventually in the hospital, that code by itself can actually shift towards something that increases the bill. And you want to say, okay, if just by shifting that POA code present on admission indicator, shifting it from "yes" to "no" can make a huge difference on the payment.

Something I didn't mention to you earlier, which is now I'm not doing the actual clinical documentation improvement part. I'm working more in the denials and appeals part. I did a lateral shift, and I've been able to see a lot of these things that I would query initially, like coming back. That's one of the main reasons why I wanted to do that, to make that change. Because I wanted to see eventually, okay, is the insurance company really accepting what I'm having these doctors, that document in these records? How are they internalizing it? How are they fighting it back?

I do remember the other day, there was something that I didn't know, it was something about a procedure that the patient had a complication, and they said the doctor clearly said that this was a complication, and it wasn't coded as a complication, and it made a huge difference on the payment. And I said, you know what? They're right. I don't usually agree with what they said, but this is one of those instances where I say, you know what? I didn't know this, but it's interesting how these small factors come into play, the present on admission, quality indicators, anything that happens in the hospital, that make a difference in that payment, how it changes.

John: Yeah. That's why when I think back about my days in the hospital, we probably had at least every two or three years another consulting firm come in. And I don't know that there were these big companies, maybe Acuity was around and some others, but usually just people come in to help us bolster, improve our CDI program. It just amazed me that there were hospitals that still didn't have really even a dedicated nurse or physician even focusing on that. So, it kind of blew my mind. Although I have a question I have for you. Does it seem like the physicians coming out of training, residency and fellowship, do they have a better understanding of this now than they did five or 10 years ago?

Dr. Christian Zouain: Yes, I believe so. Yeah. I definitely think so, especially because just like you said, with let's say the rise of having these consulting companies, like Acuity, the one I work for is something of so much importance because when you have it on site, it is important. You have that person that the doctor can relate to. They know which doctor to go to.

But sometimes even if you're part of a big health system, because I worked in different hospitals, large health systems, small hospitals, and it's hard when you don't have that I would say that support, because you don't know it all. All these rules are very complex. You have the clinical part, but you also are continuing to learn the coding part. So you're trying to do your best.

Now, the doctors, when they see this, it's like, okay, sometimes you might make a mistake or they might think you're a little bit obnoxious. They don't want to really sit down with you and answer to all these nonsense questions. But with these companies now you have these group of professionals that they're all in tune. Even if you're not sure, for example, the model of acuity is you have a physician, which is a medical director position with an expert coder going into the case firsthand reviewing the entire case. So, you have an expert in clinical and an expert in coding reviewing that case.

Next part is they capture the opportunity, they send it over to someone like me, that was my position initially when I started in Acuity, which is the query writer. I would write the query based on the information they provided.

Now, when you have a more effective system, I would say it works better. I think physicians are able to accept it more with more ease. When they have a solid professional asking them questions and explaining to them in the right way, why are they asking the questions? This is the reason why we're doing this. We can show you in the code book. Or you also have administration behind supporting the consulting company.

And they're not just saying we're doing this for the money. No. These are companies like Acuity, and I don't know other consulting companies, but we go on site and we provide education to the physicians on how our process works. And we also give them education on them based on whatever issues we find recurring in their facility, why we are asking these questions, and how it translate into the coding and it translate into the payment and the quality metrics. That's been a huge part in answering your question. I know it's been a little bit lengthy, but yeah, I think that the physicians in these years have adapted more to the role because of the search of these consulting positions definitely.

John: Well, that's a good segue to talk about not so much CDI itself as an entity, as a domain to learn about, but what are the jobs in the CDI? Because I think you've held a number, and I don't remember exactly what you were doing before within CDI, but I know there are remote positions now a lot more probably since the pandemic, but then you have to go on site sometimes. Sometimes you're employed by a hospital system directly. Sometimes you're employed by a company that does the outsourcing. So, what's kind of the range of jobs out there that listeners might say, "Oh, this does sound interesting, this one's got the flexibility I might need?" Maybe give us an overview of that.

Dr. Christian Zouain: Yeah. It all starts with the coding. When I started, again, you have the clinical part and then you need to learn about the coding. And with that, basically, you can go into CDI. Again, I did a lateral move into appeals and denials, but as far as I know, it's coding, CDI, you can do inpatient, you can do outpatient within the realm of CDI. Then you have the different ramifications, which is you can focus more on a specific aspect. You can go more into education. You can be a director in a hospital. You can become a physician advisor. Going by what we have in Acuity, from what I know, just like I said, we have the medical director positions. But then we have educators, we have the people that go on site. We have query closers, we have query writers, we have appeal writers. The coding world is very, very, very, diverse. Just in the inpatient setting, there's a lot of ways you can go.

I remember about three or four years ago, the outpatient, CDI, was coming up and I said, "You know what? I think this is going to be like the future of this because I know a lot of procedures are being done like outpatient, eventually inpatient is going to be." And that was about for a year, two years. That was something that was really booming. But eventually, it has grown, but I've stayed in the inpatient setting. As far as I know, in Acuity we do mostly inpatient. And again, I went into doing appeals now, which I like even more because I get to see, I feel like I am using that knowledge again, and justifying why that service has to be covered or that diagnosis is valid using my knowledge and my expertise in coding in clinical and CDI.

John: Let me ask you this. Talking about specifically your role now in the denials and the appeals and so forth, are they looking at making an alteration in the principle diagnosis? Are they looking at whether the MS-DRG comes in three levels for most diagnoses? Is it that? What are the kind of things that actually get appealed in which you have to provide clarity when you can?

Dr. Christian Zouain: Yeah. In Acuity so far we only do clinical validation and MS-DRG appeals and denials. We receive changes in principal diagnosis, whether it is clinically valid or not. We receive request to change coding based on coding rules. Coding rules, which are sometimes more complex. Like this diagnosis were based on this guideline, it's supposed to be the correct principle diagnosis instead of this one.

And present on admission indicators, but mostly it's clinical validation. Clinical validation denounce is what we get the most. Sepsis. They use a lot of the argument now that sepsis three to one that has to be used, but the facility hasn't placed the rule, the guideline that still used the sepsis two. So we have to argue that okay, although sepsis three was put into place, they don't use that. So, we have to defend it on that end. Or the patient didn't really have an increase in creatinine of more than 0.3 to be considered AKI, but the doctor wrote it consistently throughout the record. Those things are the ones we fight every day mostly. It's mostly that validation of diagnosis that they feel like the diagnosis are not clinically valid.

John: Now, when you say appeals and denials and fighting these things, I have a friend that works at a local hospital. And on the UM side, he's getting on a conference call with an administrative law judge and other people on their side and Medicare side and their people on the hospital side. Is it like that? How do you do these appeals? Who are you appealing to?

Dr. Christian Zouain: No. We received the letters directly from the auditor or the insurance company. We receive letters and the letters have their own rationale. We provide the information, we make a document and we just send it back to the hospital.

John: So, it's a written appeal.

Dr. Christian Zouain: Right. It's a written appeal. We send back to the facility. The facility is in charge. I put my signature on it with Acuity's name, and then they send it over to the corresponding auditor. But then after, we might have several levels, but after it's exhausted how we call it, that's up to the hospital to decide if they want to escalate on their own part. If they want to have a peer-to-peer with their doctor and discuss that at that point. The hospital takes care of that. We are only part of I would say three levels of written appeals. We only do it in writing.

John: Got it. Got it. Yeah. This gets all very confusing because we can throw out a term and say there's always different jobs available, but Acuity does things one way, and there's probably 10 other firms that do other things and the hospital is doing its thing. But just to give us a glimpse in the time you've been doing this, both as in the denials and even before, are these the kind of jobs that are pretty much done remotely? Does it require checking into the office and showing up in person? Is it something you can do on your own time? Is it 9:00 to 05:00? Just give us some of the constraints on these kind of positions in terms of the time and the travel and so forth.

Dr. Christian Zouain: Yeah. When we first did the first interview a few years ago, I had just started with Acuity. And at that time, I do remember that I knew when I found them, I was like, "Wow, this is amazing." Because it was actually the first company I knew that it was 100% remote, and they were hiring foreign medical graduates. Other companies would require you to have an RN license, or some sort of license to work, which I found a bit strange because I was like, really? I'm doing work from home and it's documentation. I'm not really writing a script or anything like that.

But I do believe, especially when COVID hit, when the pandemic hit, a lot of other industries they had to go into fully remote or part-time remote. Then they just basically realized that it was doable.

This work can be done 100% remote. My company Acuity, it's been 100% remote. When I started, the only thing that I had to be present for was the training, which I had to go to the main office in New York to meet with, we had to get all the access and do everything. But during the pandemic that switched. So, the training is now being done just the same way, like any other presentation that's done in the company. It's done via Zoom or Teams. It's done remotely. It's 100% remote.

Now, I do know there are probably other facilities when you have your onsite DDI program, they probably still have it. I know some of them are maybe half and half. You would go several days to the hospital so they can see you and the other days you can work from home because you have access to the electronic health record through your computer at home.

But yeah, eventually I think mostly the ones that are still in the hospital, they are still require some sort of presence. And that's good because I think that's one of the benefits of doing the onsite. I had that I would say that privilege of doing that initially when I started, which it was 100% on site, and the hospital I used to work for was hybrid. They still had part of the records in paper charts.

So, it wasn't something that we could even argue like, "Hey, listen, can we do one day from home?" No, that was out of the question because they were still on paper and we had to go to the floor. But that helps you a lot to build that, to break out of that shell, I would say, to get close to the physicians, have a conversation, get to understand what's really going on with the patient, get their view. And also they learn from you in terms of, "Hey, listen, this is why I'm asking you because this documentation translates into this." Now with being 100% remote, you can't do that. After I started working with Acuity, my contact, when I was writing queries, I would talk to a doctor maybe once every two months. And it was because they would call me, they would see my name on the query, but they weren't really supposed to. They were someone else in a different department who would take care of that. Whereas when I was in the hospital, it was constantly, for every single query I sent, I had to talk to the physicians.

John: Yeah. Interesting. It has evolved quite a bit. I was talking to someone who does UM. He is relatively new, but it was kind of the same thing. He's in a system and they didn't really have a pretty robust UM program. He was assigned and he took a job as a medical director, and there were multiple sites, but he was doing half of it remote because he couldn't drive hundred miles in a day to hit every hospital. He'd do some of it remote, and then sometimes he had to show up and meet the physicians, and he really thought that helped. But I could see him migrating at some point to a 100% remote job with a big company because the lifestyle is so much better.

And so, would you say in general that most physicians are going to be very happy with working in CDI at one of these companies in terms of the lifestyle, the pay and vacation and opportunities for advancement?

Dr. Christian Zouain: Yeah, absolutely. Absolutely. The shift that I've seen and the opportunities just like I've seen in my own work environment, even though I don't interact as much. The company right now from the last town hall, they said we had about 600 employees nationwide. They did implement some sort of activity that we would do. Everyone that lives in the same state or close by, like in the same city, they would get together. I was able to meet a few of the doctors that work for the company as well and other coders. One of them was head of IT education portion of Acuity.

The others, they were directors of coding. There's a lot of opportunities still out there. I think much more that than what I know of, but definitely, again, just like I said, knowing the craft can get you towards getting a lot of opportunities in the field. And I've seen that. I would continue to encourage everyone that likes it and finds the value in it. It's really a good career. And all the companies, just like the one I work for, they're doing a great job and they're growing, expanding, and they're doing a lot of great things.

John: Excellent. That's good to hear. We want to have as many opportunities for our physicians as possible as they decide to transition to something maybe out of clinical that they're doing now or something like that.

We are going to run out of time. We're probably getting close to the end here. Real quickly, if someone is currently in practice, maybe they're doing some inpatient so they have exposure to that part of it, what would you advise them is how to start to look at making that transition? They just start looking up jobs, or is there something they can do in the meantime to set them up to succeed if they decide to apply for a job like this with one of the companies that does the remote CDI activities?

Dr. Christian Zouain: Yeah, I would say it would be the same advice I gave on the first part podcast. Again, you basically have the clinical knowledge part. Just get into knowing more about the coding aspect, how it works. Maybe do a coding course geared toward maybe a certification like a CCS. That's one I would say. For example, there's several coding certifications, but the CCS, it's like the more expert one. But for us physicians, to be honest, it's something that it's not that hard to acquire because we already handle all the terms, all the clinical terms. We just have to know all the coding rules and games, again, like we mentioned earlier.

After that, again, I know that Acuity has that particularly that the medical director position, the doctors they hire, they do have some coding, clinical background, but they don't need to be really like coding experts per se because they're looking more toward the clinical part and having a basic understanding of the coding part. And along with the coding director and with the company itself, you're going to be able to start learning everything and grasping. Because again, every company does everything on their own way.

There's not a specific way. Just like every hospital, CDI program does things a certain way. I know this because since I've worked for different facilities, one might think, "Oh, well, maybe when I go to this next job or this next facility, they might think I don't know how to do it because we did it differently."No, everyone in the industry is very aware that every facility has their own ways of doing things, but the core of everything is knowing the basics of medical coding and how it works. Other than that, it's just a matter of time and experience. Even till this day, I don't know everything, I don't think I'll ever know everything because again, there's a lot out there and everything changes from time to time, but it's a constant process.

There are certain things that are the main focus. There's always opportunities for sepsis, for acute kidney injury. There's diagnoses that are pretty common, for example. There's commonalities on every industry. But that would be my advice. Getting to coding and reach out to other colleagues that are doing the same thing, either in your hospital or through LinkedIn.

Right now, I do remember someone that reached out to me. I think it was who listened to your podcast about a year ago. I do remember she told me. I'm glad she listened to the episode. And a year later she messaged me again, and she told me, I just wanted to let you know that I was just hired in your company. And I didn't know. She actually went on her way. I think she got a coding certification, and she met someone else from the company through LinkedIn. And I think they established a friendship. And she was able to get hired for her first job in CDI 100% remote, which was something that if you would've asked me, probably like five years ago, I would've said no. You have to start maybe on a hospital, that they give you an opportunity on onsite. But now, it's possible. There's a lot of opportunity out there. There's a lot of facilities. You can reach to a lot of people.

John: Plus the power of networking.

Dr. Christian Zouain: Yeah.

John: It's like meeting people, getting advice, getting mentors and talking about their company. Who do I apply to? Is there someone I can talk to? There's so many little tricks you can do too along the way.

First I want to say that you're on LinkedIn, obviously, as you mentioned. Just look Christian Zouain up, or if you want to use the URL, I think it's linkedin.com/in/christianzouain. It's hard to miss you really. There aren't that many other Christian Zouains around. I don't think. I do see though on your LinkedIn frequently you'll post that your company has openings. I could put you on the spot now and say, are there openings there? And if someone has a question about an opening, they can just go ahead and apply, but I suppose it'd be okay to contact you and ask you a little bit more about it.

Dr. Christian Zouain: Yeah, definitely, if anyone is interested. As soon as I see any posts from HR or anything, I would do a repost just so anyone can see. If anyone has any questions, again, just like you mentioned earlier, I want to emphasize just like we did. I know we did on the first podcast interview, like networking that is very important, not just for this industry, for anything that anyone would want to do or pursue. The power of networking, it's very powerful. I would say reach out. Don't be afraid to reach out to anyone for advice. If you don't get a response from someone just move to the next one. There's a bunch of people. Look for someone that works in the company you want to work for and try to establish a connection with them. But if you see me reposting or you can go to Acuity's website, acuityhealthcare.com, or follow them on LinkedIn, they usually post the open positions there. If you have any questions on that, you can reach out to me. Just to throw it in there, we have a referral program. If you want to mention my name, just to put it out there, you can also do so.

But yeah, I'm available for any questions that you might have, any orientation that I can provide. By doing this, what I'm trying to do is be the person that I wish I could have found when I first started, because there was not a lot of people out there. Yesterday I spoke to, there was someone that came to my house. He's a nurse. He works as a nurse in the hospital, but then he's a doctor back in Brazil. And he was telling me. He came in, he did the process of getting his RN license and all of that. I was telling him what I did, and he was impressed because he said, "You know what? I've been doing this. I've been working here 15 years and I've never heard of what you do." And I said, "Really?" And he was like, yeah.

We talked for a while and I said write down my phone number. I send him the presentation I've had that I did back to do the Medical Association to that group of doctors. Because still, sometimes I'm impressed by the fact that these opportunities are really not out there so people can see them. Even if they're in the hospital, if they don't find the right person, some people maybe they keep more to themselves and all that, but whenever I find a colleague and they tell me they're a foreign doctor or a doctor that is trying to do residency, I tell them what I do, because you never know. And also I'm always open to give advice or even not just give advice, also learn, because I can learn from the other person as well.

John: I know there's at least a thousand physicians and other clinicians who eventually will listen to this episode. And so, I'm going to tell you that if you have any linkage whatsoever with a hospital or with documentation, coding, patient care, and if you're actually practicing, of course, you're exposed every day, then this is an opportunity. There's a huge need. It's a good lifestyle, and you're applying your medical background. And so, what could be better?

And the other thing is I don't apologize about maybe having someone mention that you referred them to your employer, because guess what people? I'm talking to my listeners now. All my guests come on for free. They take their time, they share because they're professionals or physicians, most of them, and they want other physicians to prosper and succeed and be happy in their careers, not be miserable doing corporate style healthcare seeing 50 patients a day and working all weekend. The least you can do is if you contact Acuity that you mentioned Dr. Zouain's name just as a little bit of a bonus for taking the time to share his information with us. So I do appreciate that, Christian.

Dr. Christian Zouain: No, thank you. Thank you for allowing me to be on your platform.

John: Basically Christian is agreeing to be your informal mentor. And by the way, if you need a mentor in the future, I always remind my listeners too. A mentor is not someone you're going to sit down for three hours with and take up all their time. A mentor is someone you just go to, you send them a note, or you have a brief conversation, ask them a question, and boom, you just take their advice and move on. And then maybe reconnect again three or six months later. We're not talking about intense coaching here. We're talking about just networking and communicating and getting a little bit of free advice.

Dr. Christian Zouain: Absolutely.

John: All right, Christian. I guess it's time to go. I really appreciate you being here today. It's been fun. I've enjoyed catching up and learning from you, again, more about CDI since I was involved with it over 10 years ago. I'm sure we can reconnect again down the road. Again, thanks for being here today.

Dr. Christian Zouain: Definitely. Thanks a lot, Dr. Jurica.

John: All right. With that, I will say goodbye.

Dr. Christian Zouain: All right. Take care. Bye.

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Why CDI Medical Director Is a Great Nonclinical Job – 224

John Jurica — Tue, 30 Nov 2021 11:03:08 +0000

And How to Pursue It

Today we discuss CDI Medical Director. It's a popular hospital-based job that can be a stepping stone to the C-suite.

CDI was originally the acronym for clinical documentation improvement. More commonly today, it refers to clinical documentation integrity.

I have interviewed two CDI specialists in the past. One worked primarily as an independent CDI consultant. The second worked as a physician advisor for a large consulting firm.

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The UT PEMBA is the longest-running, and most highly respected physician-only MBA in the country. It has over 700 graduates. And, the program only takes one year to complete.

What is CDI?

Clinical Documentation Integrity is critical to a hospital's success. It is the lynchpin for demonstrating the quality and safety of care. It is also integral to receiving appropriate payment and avoiding performance penalties from Medicare.

A good CDI program will improve internal and external quality reporting. External reports dependent on CDI include HealthGrades, HospitalCompare, Watson Top 100, and LeapFrog Rankings.

CDI Medical Director

Most physician experts start out as hospital Physician Advisor for CDI. If the organization is large enough, CDI Medical Director is the next step up. Revenue cycle consulting firms also employ physicians in these roles to work on-site or remotely.

In the hospital setting, the CDI Medical Director position can lead to a senior level position as Department Director, Vice President, or Chief Medical Officer.

Preparing for the CDI Position

To prepare, interested physicians can take the following steps:

find a mentor in the field,
volunteer for committee work at your hospital,
work as part-time CDI physician advisor,
join the American Health Information Management Association (AHIMA) and/or the Association of Clinical Documentation Integrity Specialists (ACDIS), and,
advance to medical director or director.

Summary

A hospital CDI job is excellent in its own right. But it is also a good way to position yourself for other jobs. These include revenue cycle physician advisor at a healthcare consulting company or a more lucrative leadership position in hospital management. The lifestyle and pay are good. Both home-based and on-site work are available. And opportunities for advancement are excellent.

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Transcription PNC Podcast Episode 224

Why CDI Medical Director Is a Great Nonclinical Job

John: I'm going to talk to you today about a popular hospital-based job that can also serve as a good segue to the C-suite. It's the position of CDI medical director. CDI is the acronym for Clinical Documentation Improvement or more commonly today, Clinical Documentation Integrity.

I've previously interviewed two CDI specialists. One worked primarily as an independent CDI consultant, and the other worked as a physician advisor at a large consulting firm. But today I want to provide my take on hospital-based CDI professionals. And I will explain why working in CDI is so attractive, what the employed hospital-based CDI expert does and how that position can be leveraged for career advancement.

Let's start by defining what it is. CDI, as I said, it's Clinical Documentation Integrity, and the way I'm using it today mostly applies to the hospital setting. Now there obviously is clinical documentation in the outpatient setting, and that does fall under the CDI situation, but I'm talking about hospital-based CDI medical directors, physician advice, and so forth today. And I'll talk a little bit about how they overlap with the other situation.

A person that works in CDI has to understand how documentation in the medical record, in the EMR relates to payment and communicating what happened during the hospital stay, for example, with other entities, particularly with insurance companies including CMS - Center for Medicare & Medicaid Innovation.In fact, this whole industry grew out of the development of DRGs primarily also ICD-10 or ICD-9, which we had before. Because again, we're trying to use clinical data to do billing, to monitor quality, to just keep track of what happened in the hospital setting. And we normally don't go directly into the medical record every time we need some information that will tell us how much to pay or what we're charging, if we're on the hospital side, as opposed to the insurance side.

The reason for calling it clinical documentation integrity, and again, I was not involved in this, but there was a feeling that it was focused more on getting paid more. But really the bottom line, if you talk to CDI professionals, is that they want the medical record to reflect exactly what the patient's condition was, the services that were offered, what happened while they were in the hospital. And so, that is reflected in the quality measures and in the way that institution is being paid. Because obviously if it's a more complex situation, it usually has a longer length of stay, usually uses more resources. And so, they want the payment to correlate with those factors.

As I said, this all grew out of the development originally of DRGs, which was really in the early 80s. Actually, I think it was released while I was still in medical school. Prior to that, hospitals were being paid on basically what they build or on customary charges. But since around 1986, hospitals have been paid on DRGs - Diagnosis Related Groups, and the principal diagnosis and other things that happened while they're in the hospital, including surgeries, complications, and so forth.

It became a little more sophisticated a few years ago when they developed ways to identify presents on admission, which is basically an easy or simple way of saying that if someone came into the hospital with a preexisting condition, it had a different effect on the payment and was not considered a complication.

Now there are over 700 specific DRGs for hospital care. Most physicians only use a small number of those depending on their specialty. And the DRGs, for the most part, are broken down to three levels for each individual DRG. Let's say triplet. It's for the least complicated, the moderately complicated, and the highly complicated cases. I'm not going to get into the DRG system, but suffice it to say, what I'm trying to explain is that this whole idea of having experts in CDI grew out of the fact that over the last 30 years or so, coding and documentation have become more and more complex.

It is very similar to the office space, coding, and documentation, which many of you are more aware of because you realize that when you document in your record, either under the old or the new system for outpatients, you have to document the right things and then you have to choose the right diagnosis based on what is supported in the record. Well, it's the same thing on the hospital side, but we're talking about a lot of money and other effects, including a more direct effect on the reporting of quality. Although that also applies in the outpatient setting. And again, everything I'll say today about CDI in the hospital is pretty much applied to the outpatient setting as well. It's just that those areas don't have the need for consultants as much or for physician advisors and medical directors. Although you will see that in the outpatient side as well. But let's face it, the hospital and health system environment accounts for about a quarter of all healthcare costs in the country in any given year. And a lot of hospitals spend a lot of money trying to optimize their coding and documentation and maintain their integrity.

Now, the other reason why it's so important is that it has now been used extensively to help also to reflect the quality. Because we have these systems that measure quality or track quality and report quality in the hospital setting. And they don't go into the medical record in search of what was done. It's too complex. We don't have the systems in place yet for that, although they are developing. If you look at Hospital Compare, if you look at Health Grades, if you look at Watson Top 100, it used to be Truvin.

Anyway, when you look at those, they are using medical record data to identify the risk of the patient when they come in the hospital, what happens during the hospital and deciding whether the outcomes are as expected.

The CDI specialist, whether it's a nursing specialist or a paraprofessional or a physician medical director or physician advisor, have become very, very important. There are just simple things that I can give you as an example, but for many of these quality metrics, if your patient dies, of course, that is a mortality and it goes into your numbers generally.

However, when I was working back in the hospital, it wasn't uncommon for us to find that there were patients who were really comfort-care-only, basically a palliative care or hospice type of patient, although they may not have been on the formal hospice service. And if they died during their stay, if you didn't code appropriately and make sure that you used that suffix at the end of your coding to indicate that they were comfort care only, it would really hurt your numbers.

If you excluded all the people, which is how these measures are usually designed, as you exclude those that are comfort care only, then your mortality rates look much better. Similarly, for other factors that go into complication rates and length of stay, even which most people really consider a type of quality measure. And when you look at the Watson Top 100, for example, a lot of these factors are important. It's the outcomes for specific diagnoses, the overall mortality rate, the overall complication rate from surgery and from medical care, the length of stay, readmissions are now included, and other factors, many of which relate to the clinical documentation.

And I was looking at LeapFrog. This is probably the other big quality tool or system that people look at. It's obviously an external entity that tracks the quality based on its own metrics. And some of those are also affected by the clinical documentation.

Because we have this big system of tracking these things and reporting these things, remember, some of this reporting is internal. I was doing reports to my board every quarter, and we had tools that we instituted inside. We didn't have to share those with anyone, but we needed a way to monitor risk-adjusted outcomes.

And so, we used these tools, which evolved over time and are much more sophisticated now. And I reported that to my board and we had to have those and we had to understand how those systems work and what they were looking at in terms of monitoring and reporting quality. That's what we did. But it's become even more important now with Health Grades and Hospital Compare and others. There's Nursing Home Compare and Hospice Compare and others that the public is going to look at your outcomes. They're going to make decisions about where they want to have their care. And so, it becomes more important than ever. That all rolls down to the bottom line of the hospital. So, it's extremely important.

Now, what jobs are there? Most of these jobs fall into two or three categories. There's definitely a physician advisor for CDI, just as there is a physician advisor for utilization management or case management. There's usually potentially a physician advisor for quality improvement in some hospitals. There are often physician advisors, which might also be called informaticist physicians or medical informaticists do the same kind of thing, only on the information side, mostly for the EMR.

Physician advisors can be part-time or full-time. And so, it's a job that is kind of an entry-level position, helping hospitals. Now there are third-party consulting firms that also provide offsite support in the form of physician advisors since the EMR is now usually available online. It's always online internally, but it can be accessed from outside the hospital. And therefore, we now have many companies that hire many physicians doing remote PA work for CDI.

But I'm talking again in the hospital. In the hospital, you've got the physician advisors, and then you also have the medical director. Now, a medical director. I'll talk about their roles, but that's the next level up. And then sometimes you'll get into an actual director's role because often a large hospital will have a clinical documentation integrity department. It might be part of health information services. It might be under finance. It might be under medical affairs, which was the area that I had.

I always had CDI under me. I was never a PA for CDI directly, but I did a lot of clinical documentation improvement work in my role as VP for medical affairs and then as chief medical officer. Again, a physician can end up running this area where there would be the medical director and the actual department director. And then, eventually, this can help you move into other leadership positions. I'll talk more about why that is in a minute.

But the thing is, remember, the areas that this impacts include revenue cycle, of course, how their hospital is being paid, and Medicare compliance. There are a lot of issues that have to be addressed and met, and the documentation is key to that because that's really what CMS looks at. Occasionally you end up having to explain yourself personally, or to an administrative law judge let's say for utilization management or something like that. And maybe CDI would be involved, but usually, it's just based on what's documented in the record and supported by the record.

Let's look at the individual roles and what a CDI expert does. We're talking about a physician at this point, although I would say for those non-physicians listening, there are certainly many jobs. In fact, the majority of jobs in CDI in hospitals are nursing jobs, because nurses are the clinical documentation specialists. Obviously, they would be more of the front line in terms of reviewing the records. Lots of communication with the health information systems people so-called the medical records to make sure things are clear. But then the nurses will oftentimes interact with physicians and will engage the physician advisor or the medical director when they need some help. And some of the experts in CDI across the country are physicians because it's such an important part of what we do.

The day-to-day for a physician advisor is to advise physicians and nurses through queries and direct conversations and tell them whether they need to improve their record or ask them about something to clarify an issue, to see if it does need to be changed or updated. It's not that physicians don't know how to document. Most of us get that training. In fact, I'll say that since most of the frontline hospital work is done by the emergency medicine physicians and the hospitalists, those two groups really generally know how to document pretty well.

And during their residencies, these topics will be discussed. What is a DRG? What are the levels of a DRG? What goes into the final diagnosis? What are the complications? What's present on admission? What are the exclusion and inclusion criteria in certain circumstances? If you're a nephrologist, you're going to know the renal diagnosis codes and DRGs extremely well. If you're a cardiologist, you're going to know all of the cardiac diagnosis codes and different codes for different types of heart failure and different levels of heart failure on the DRG system. And so, most of you'll have exposure to this through your residency. But what we're talking about is getting even more sophisticated.

And one minor change in a code suffix or what we call a modifier can make all the difference, whether something is paid or not paid and how it's paid. And so, the physician advisors will be asking physicians sometimes directly or in a written query. It looks like the patient is on this kind of medication, yet you didn't mention that diagnosis and that can be a "present-on-admission." So, could you document that? Or why are you not documenting that?

That's one way that the nurse and physician advisors look through the record to see if there are medications being used that are not fully justified in the medical record, not from a medico-legal standpoint, although that's important, but to say, "Oh, this patient has a condition that you're not reflecting, but we're kind of get the hint of that because of the medication that they're taking".

They might be doing reviews of charts after discharge, but before billing. And they're going to be making recommendations, but they're kind of the front line. And so, the physicians are working with the nurses and they're all working with the attending staff or the consultants on a case, just to try to clarify things. They also do some education and one-on-one training and maybe even presentations to larger groups as part of an educational process.

Now, usually when you move into a medical director role, that's a little bit more management, more leadership, let's say. You might be doing more common presentations to the board of a hospital or to a group of physicians to try and get them up to speed on changes. Every year there are dozens of changes to the DRG system. And the way things are communicated, new codes are added. Old codes are dropped, as our principal diagnoses, as our DRGs.

The medical director, of course, would probably be supervising the physician advisors and training them if they need training. And then they may be more likely to interact with the quality improvement committee. They may sit down to some of those committee meetings or certain projects, utilization management committee meetings. They might be working directly with health information systems to solve problems about why things aren't being documented and how the health information system can be used to maybe do the queries better or to automate some of those functions. And even with the informatics department, again, because the informaticists are teaching the physicians how to document in the EMR generally, and they're helping to create little tools and maybe order sets, things like that, which if they're designed properly, could actually help with the documentation.

Definitely more management, more leadership. I'll give you an example. Let's say that you decide you're at a hospital that you want to really shoot for the Watson Top 100 designation. That's a multi-departmental issue because it includes finance, documentation and coding, quality, utilization management. If you have any other sub-teams on avoiding readmissions or things like that, then you're going to have this large group that's multidisciplinary, that's going to work together to strive towards and measure progress towards being a top 100 hospital. And you can engage Top 100 to teach you how to do that. But it definitely involves all of those different departments. Well, as a medical director, you might run that team, that project team, that oversight team that's keeping everybody on track and monitoring the overall scores internally that mirror the scores that end up being published externally. And so, again, that's something the medical director might do, or a director, as I mentioned earlier, who's director of the department, or even a vice president level.

Basically, you're working with larger groups of people and you're managing more projects and more committees than you would as a physician advisor, which can be very minimal time and minimal expertise needed.

How does one get the training and experience to do this? Well, simple. The things we've talked about before. Number one, find a mentor. If you can have a mentor who's a medical director for CDI, they're going to be a great resource. They're going to point you in some of the directions I'm going to point you to today, but they're also going to answer direct questions about how to do this job and how to work towards maybe going from part-time to full-time to more of an advanced position. Mentors are always important.

The other thing is to get involved at committee and departmental levels at the hospital, most of which is volunteer, but usually, if you're on staff at a hospital, you need to spend some time working on different committees and departments. Maybe it's QI, maybe it's documentation, maybe it's utilization committee, it might be the Credentials, Committee, but you're going to have to do that anyway. If you can focus your efforts on those that relate directly to health information systems and clinical documentation, then you're going to start to get some education, start to learn what that's all about. You'll start hearing a lot of the keywords and you'll hear about really specific issues related to meeting health grades, five-stars versus three-stars versus one star, or how documentation can help with LeapFrog and that kind of thing.

And then the next obvious step is to just sign on as a part-time physician advisor. Depending on the size of your hospital, there might be one or two positions or there might be dozens. Some of the hospitals are going to use offsite physicians through a company like Optum360 where they have offsite physicians, and sometimes, they place physicians onsite.

Sometimes that is another job option later in this process is to work for a company like that. But in any event, even if you have offsite services supporting you, you'll usually probably have maybe one or two part-time people that can interact directly or give lectures and presentations. That's obviously one step.

If you find that you like what you're doing in that process, then you want to maybe get more education. I looked at the AAPL website and they don't seem to have anything directly that applies to clinical documentation improvement. They have a lot about quality, obviously, which interfaces with that. But number one, there's the American Health Information Management Association - AHIMA. You'll hear that talked about a lot. That's usually what we used to call the medical records department or health information services, which is a more global moniker, so to speak.

And that organization does have physicians and does have education and information about CDI. Although it's probably overshadowed somewhat in that arena by the Association of Clinical Documentation Integrity Specialists known as ACDIS, they have a lot of information and a lot of support for nurses, physicians, and others to learn about what CDI is, new trends. And actually, when I was on the website recently, I saw they have a lot of education. They have certifications that will demonstrate and that you do have a base amount of knowledge about DRGs and applying CDI principles. I think the certification only basically requires being in the job for two years and then taking the exam. But it's a fairly comprehensive exam and it gets into pretty great detail.

Now I will say they also have a podcast. I listened to an episode or two of that, which was quite interesting and really gets into the nitty gritty of different types of documentation improvement scenarios. It'd be very useful if you're a PA or trying to be a PA for CDI at your hospital, and even blogs, a lot of written articles, and that sort of thing. The ACDIS is a must-join organization if you're serious about getting into clinical documentation improvement. AHIMA might provide some assistance as well.

Now, as far as getting your first job, I've already alluded to that. Of course, you would carve out time, if the position is available, to become a part-time physician advisor. You could do it in the mornings. The way people document, depending on their rounding patterns and so forth, it's now kind of something that could be useful to do all during the day in little spurts of time, from what I know. Do some chart reviews and interact with the nurses, the nurse clinical documentation specialist at lunchtime, or maybe shortly before closing, because you want to catch people before the patient gets discharged, if at all possible, for at least the concurrent reviews. There are actually post-discharge reviews, of course, as well. And maybe you could focus on those.

But you want to spend an hour or two a day just like in the old situation where you would do that kind of thing as well. And there are some physician advisors who do both of those because it does involve looking at the record anyway.

And then, over time, if it's something you like, then you increase your hours. And basically, you're carving out from the clinical. If you're in a big capitalist group, for example, a lot of times the group itself would like to have someone involved with that because your performance as a group will depend on things like the risk-adjusted length of stay, risk-adjusted complications, and mortality rate. And so, it's to the group's advantage to have an expert in those areas that can help the rest of the group with it.

And then you just gradually increase your hours as the need occurs. If you're at a hospital that has, let's say, three, four or five part-time people, well, maybe you go half-time or almost full-time while cutting down on the part-time people. And to the hospital, the budget's the same but you're increasing your hours and you're getting away from the drudgery of the call and the long hours and so forth that comes with clinical medicine and the highs and the lows and the urgency that occurs. Whereas CDI is a more constant type of job where it's a move and you get time off.

Anyway, you do that and then eventually just build yourself up to be the medical director at that institution. Or after you've been doing PA work for a while, and if you feel like you're willing to make a change, you could move to one of these offsite consulting firms that provide services. So, then you can be working remotely reviewing records and talking to physicians and nurses remotely, or you could move up to that director level at another institution. And then again, similarly, you can do a lateral move to maybe get a CMO job, or stay at your own institution if a position opens or in your system if you're part of a multi-hospital system. I think if you get involved heavily in health information, informatics, quality, and utilization management, while you're working in the CDI realm because again, there's a lot of overlap and coordination, then that really will position you well for a position as a chief medical officer.

Just to mention the salaries briefly. Probably if you're swapping your time out as a PA one or two hours a day, it's going to be the equivalent of $150,000 to $180,000 per year. In other words, if you were full-time. I don't know what that amounts to, I think that would be maybe $70 to $100 per hour. But basically, what you want to do is say, "Look, I'm going to cut back by a quarter-time in my clinical, and I'm going to replace it with this". The dollars will probably be pretty close to what you would get clinically.

Then if you move up to medical director, the typical medical director will earn usually between $180,000 to $230,000 per year in an equivalent full-time position. You can move to be a PA or a medical director at a revenue cycle company like I mentioned earlier that offers these services and the pay I think is about the same. And they'll either place you in someplace or they'll just do the remote.

And once you get to the position of a VP or chief medical officer, you're basically going to be making $300,000 or more. Depending on seniority and the size of your system, you could make well over that with bonuses and seniority. That's why it's such a good job. It's a good entree. It's a good part-time job that can morph into a full-time job, which can morph into more management and more leadership. The salaries on the hospital side are pretty darn good.

I think that's basically what I wanted to cover today. Hopefully, I've given you a good idea of what clinical documentation integrity is, what a physician advisor for CDI and a medical director for CDI would be doing, how that can segue into a position as a VP or a chief medical officer. And if it's something that you might be interested in, I advise you to look at those resources I mentioned today. Check it out and let me know how it goes.

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The post Why CDI Medical Director Is a Great Nonclinical Job – 224 appeared first on NonClinical Physicians.